Jaipur, June 2, 2018 – Postpartum hemorrhage is the leading cause of maternal mortality globally; accounting for almost 18% of all maternal deaths says Dr. Aditi Bansal, M.B.B.S., M.S. (OBS &GYNAE), Shree Ansh Advance Fetal medicine Center Jaipur. She says that any woman giving birth can experience postpartum hemorrhage that can pose as a threat to her life.
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Postpartum hemorrhage happens when more than 500 ml of blood is lost after childbirth. She says that even though the preventative strategies and risk factors are clearly documented, not all cases are avoidable or expected. Uterine atony is the main reason why postpartum hemorrhage happens. Dr. Aditi states that uterine massage combined with ergot alkaloids, prostaglandins, and oxytocin can be used to manage the condition. However, even with appropriate management, around 3% of natural deliveries results in severe postpartum hemorrhage.
Complications from this medical condition include fatigue, anemia, and orthostatic hypotension. These complications make maternal care of the infant even more difficult. On the other hand, anemia increases the risk of postpartum depression. She says that she has dealt with several postpartum hemorrhage cases and most of them required a blood transfusion. However, there are associated risk factors when it comes to blood transfusion. In most adverse cases, hemorrhagic shock can also lead to anterior pituitary ischemia with a failure of lactation, dilutional coagulopathy, occult myocardial ischemia, and even death. The complications may also include delayed postpartum hemorrhage and bleeding after 24 hours as a result of retained placental fragments.
She continued, the risk factors for postpartum hemorrhage include a history of postpartum hemorrhage, fetal macrosomia, and episiotomy, multiple deliveries, and prolonged third stage of labor. But pregnant women can experience postpartum hemorrhage without any of these risk factors.
Strategies developed at Shree Ansh for minimizing the effects of postpartum hemorrhage include determining and correcting anemia before delivery, eliminating routine episiotomy, and being aware of mother’s beliefs about blood transfusion.
She says that the best way to prevent postpartum hemorrhage is active management during the third stage of labor. Her hospital guidelines encouraging active management has helped in reducing the occurrence of massive hemorrhage. Active management involves controlled cord traction, early cord clamping, cutting, and administering a uterotonic drug.
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She says that significant amount of blood loss requires standard medical resuscitation measures that include quick action and an interdisciplinary team approach.