A mother’s joy, a hidden risk: Tackling postpartum hemorrhage for safer births

Excitement, disbelief, joy- a woman feels a roller coaster of emotions, when she gets to know that she is pregnant and bringing a new life to the world- her joy. This happiness is intertwined with anticipation of the day when she finally holds her baby in her arms, the tiny fingers wrapping around hers, the first cries filling the room. However, this journey of motherhood also comes with challenges and unexpected complications. Among these complications, postpartum hemorrhage (PPH) stands out as a rising concern causing maternal mortality and morbidity worldwide. According to reports, incidence of PPH, in India, after vaginal delivery is 2%–4%, contributing to 19.9% of the maternal mortality rate.

For a mother, the fear isn’t just for herself but for her newborn. Who will hold my baby if I can’t? Who will love them the way I can? Therefore, it is of utmost importance to recognition of severe postpartum hemorrhage early for timely intervention and optimal outcomes. Healthcare providers must be vigilant in monitoring postpartum patients for signs of excessive bleeding, such as persistent heavy bleeding, hypotension, tachycardia, and signs of shock. Routine postpartum assessments, including uterine palpation, per vaginal examination and measurement of blood loss, are essential for detecting abnormal bleeding patterns early.
Risk factors for postpartum hemorrhage such as uterine atony, retained placental tissue, coagulation disorders, and multiple pregnancies, should be carefully evaluated during antenatal care and childbirth. Women with known risk factors require closer monitoring postpartum to facilitate early recognition of potential complications.


The treatment and management of postpartum hemorrhage are focused on resuscitation of the patient while identifying and treating the specific cause.
In cases of uterine atony, the main cause of severe postpartum hemorrhage, Medical management with uterotonic and pharmacologic agents is typically the first step if uterine atony is identified. If the uterus is contracted, genital tract should be inspected for any trauma. If detected, appropriate intervention should be taken to repair the tear. Blood coagulation abnormalities should be evaluated simultaneously. While oxytocin is given routinely by most institutions at the time of delivery, additional uterotonic medications may be given with bimanual massage in an initial response to hemorrhage. Uterine massage, bimanual compression, and the use of uterine balloon tamponade devices can help achieve hemostasis and reduce bleeding. Surgical options, including uterine artery embolization and hysterectomy, may be considered in refractory cases or when conservative measures fail.

Educating women and families is crucial about the signs and symptoms of excessive bleeding after childbirth is crucial in the early recognition of severe postpartum hemorrhage. Severe postpartum hemorrhage remains a challenging obstetric emergency that requires swift and coordinated action. Early recognition of the signs, immediate interventions, and a multidisciplinary approach involving obstetricians, midwives, anaesthetists, and blood bank services are key to ensuring the best outcomes for mothers facing this complication.
While prompt and effective management of severe PPH is vital, preventing it altogether is the ideal scenario. Antenatal care plays a crucial role in identifying risk factors for PPH, such as placental abnormalities, multiple pregnancies, or a history of PPH. During labor and delivery, active management of the third stage of labor, which includes administering uterotonic drugs, controlled cord traction, and uterine massage, has been shown to reduce the risk of PPH significantly.

By staying vigilant, prepared, and proactive, healthcare providers can continue to improve maternal health and reduce the impact of PPH on new mothers and their families.
(By: Dr Asha Verma - Sr. Professor & Medical Superintendent , Mahila Chikitsalay, SMS Medical College Jaipur)