In the series of our posts regarding webinars organized by the CrackingMRCOG on several significant topics, the next one is postpartum haemorrhage (PPH). PPH is one of the leading cause of maternal mortality. It can be defined as excessive blood loss per vaginum (>500 mL in case of normal vaginal delivery or >1,000 mL following a caesarean section) from the time period extending within 24 hours of delivery and lasting until the end of the puerperium. PPH is further classified into two distinct types as minor and major on the basis of blood loss. PPH is described as minor when there is blood loss between 500 mL to 1,000 mL or as major when there is blood loss of more than 1,000 mL. Major PPH can be further divided as moderate where the blood loss is between 1,000 mL to 2,000 mL or severe where blood loss is more than 2,000 mL.
The WHO has classified PPH into two categories:
1) Primary PPH: It can be defined as blood loss, estimated to be greater than 500 mL, occurring from the genital tract, within 24 hours of delivery
2) Secondary PPH: It can be defined as abnormal bleeding from the genital tract, occurring 24 hours after delivery until 6 weeks postpartum.
The mnemonic ‘4 Ts’ helps in describing the four important causes of PPH that includes tone, trauma, tissue and thrombin. Every maternity unit should have a multidisciplinary protocol for the management of PPH. Regular drills and team rehearsals must be conducted to train the healthcare professionals in the management of PPH. Appropriate management approaches should be adopted for PPH. Both active management and the prophylactic uterotonics usage in the third stage of labour help in reducing the PPH risk.
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