What Are The Causes Of Postpartum Haemorrhage Among Nigerian Mothers?
According to W.H.O., Postpartum haemorrhage or PPH is the leading cause of maternal mortality in low-income countries like Nigeria. And it is the major cause of about a quarter of all the maternal deaths in the world.
Scientists estimate the volume of blood in a human body to be approximately 7 percent of body weight. So, whatever your size is, 7 percent of that value tells you how much blood you have. The average adult has between 9 and 12 pints of blood in their body. That's between 4258.59ml and 5678.12ml, depending on your size. Postpartum haemorrhage is the loss of up to 500ml of blood within 24 hours after you have a baby vaginally. It's a very serious condition, responsible for a quarter of maternal deaths globally, according to WHO. And that's why we'll be examining the causes of postpartum haemorrhage in this article.
Most deaths resulting from PPH occur during the first 24 hours after birth. Most of these deaths are avoidable by timely treatment, but also by understanding these causes of postpartum haemorrhage. In 2015, WHO estimated that in Nigeria, about 58,000 women died from childbirth complications. Let's compare that to the 1,200 maternal deaths that occurred in the 46 most developed countries, all in 2015.
Sadly, the Nigerian woman has a 1 in 22-lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion; whereas in the most developed countries, the lifetime risk is 1 in 4900. Why is postpartum haemorrhage so deadly, and what causes it?
What Are The Causes Of Postpartum Haemorrhage?
Once your baby comes out, the uterus normally contracts and pushes out the placenta. After the placenta is out, these contractions continue. They help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage. Doctors refer to it as uterine atony.
If small pieces of the placenta stay attached, bleeding is also likely.
These other factors may lead to postpartum haemorrhage:
- A tear in the cervix or tissues of the vagina
- Tear in a blood vessel in the uterus
- Bleeding into a hidden tissue area or space in the pelvis. This mass of blood is a hematoma. It is usually in the vulva or vagina.
- Blood clotting disorders
- Placenta problems
These are the most common symptoms of postpartum hemorrhage:
- Uncontrolled bleeding
- Decreased blood pressure
- Increased heart rate
- A decrease in the red blood cell count
- Swelling and pain in the vagina and nearby area if bleeding is from a hematoma
The symptoms of postpartum hemorrhage may look like other health conditions. Always see your healthcare provider for a diagnosis.
Your healthcare provider will review your health history and do a physical exam. Lab tests often help with the diagnosis. Other tests may include:
- Your doctor makes an estimate of how much blood you have lost
- He'll also check your pulse and blood pressure
- And he will check your blood cell count
- Then he will look out for clotting factors in the blood
Causes Of Postpartum Haemorrhage: Who is at risk?
Some women are at greater risk for postpartum hemorrhage than others. Here are some conditions that may increase your risk of this deadly pregnancy complication:
- Placental abruption. This is when your placenta detaches too early from your uterus.
- Placenta previa. With placenta previa, your placenta covers or is near the opening of your cervix.
- Overdistended uterus. This is when your uterus is larger than normal because you have a large baby or too much amniotic fluid.
- Multiple-baby pregnancy. You've had twins, triplets or more.
- High blood pressure disorders of pregnancy
- Having many previous births
- Prolonged labor
- Using forceps or a vacuum-assisted delivery
How is postpartum haemorrhage treated?
Replacing lost blood and fluids is important when treating postpartum hemorrhage. Your doctors may quickly give IV (intravenous) fluids, blood, and blood products to prevent shock. Oxygen may also help. Their aim is to find and stop the cause of the bleeding as soon as possible. For this, possible treatment may include:
- Massaging the uterus to stimulate uterine contractions
- Removing pieces of the placenta that remain in the uterus
- Examining the uterus and other pelvic tissues, the vagina, and the vulva to look for areas that may need repair
- A Bakri balloon or a Foley catheter to put pressure on the bleeding inside the uterus. Your doctor may pack the uterus with sponges and sterile materials. And he may do this if a Bakri balloon or Foley catheter is not available.
- Laparotomy. This is surgery to open the abdomen to find the cause of bleeding.
- Tying off or sealing bleeding blood vessels. This is done using uterine compression sutures, special gel, glue, or coils. The surgery is done during a laparotomy.
- Hysterectomy. This is surgery to remove the uterus. In most cases, this is the last resort.
Postpartum hemorrhage can be quite serious, even fatal. But when your provider quickly finds and treats the cause of bleeding, you often will be able to recover fully.
Also read: Postpartum Acne And How To Get Rid Of It