Post-Partum Haemorrhage (PPH) is excessive bleeding following the birth of your baby. There are 2 types of PPH; primary and secondary.

Primary PPH is blood loss of over 500ml within 24 hours of delivery. It is the most common type of PPH, below are some of the most common causes:

  • Uterine Atony – for those of you who don’t know this is simply the loss of muscle tone in the uterus; normally the uterus contracts which compresses the vessels and reduces the blood flow; if you have a uterine atony the lack of contraction can cause acute bleeds. It is estimated that 75-80% of PPH is a result of uterine atony.
  • Retained Placenta – This can be all or part of the placenta.
  • Lacerations of the Vagina or Vulva
  • Hematoma – This is the collection of blood outside the blood vessels and can be caused by an internal bleed

Secondary PPH is defined as abnormal bleeding from 24 hours up to 6 weeks after giving birth.
The two most common causes of secondary PPH are:

  • Infection- endometritis. Occurs in 1-3% after spontaneous vaginal delivery. It is the most common cause of postnatal morbidity between day 2 and day 10. At this point I should point out that if you have an infection following delivery it does not mean that you have Secondary PPH or will necessarily develop it as you can see from the percentage of cases it is quite rare.
  • Retained products of conception (RPOC) – This is usually in cases where the placenta is incomplete or if the pregnancy has been terminated and there has been some foetal tissue left behind, again this is very rare and is usually detected before it causes any problems.

Both Primary and Secondary PPH are diagnosed following an examination of the genital tract, blood tests and in some cases a MSU (a urine sample). The good news is that both types of PPH are treatable having suffered from Primary PPH myself I know that if the facts are not explained to you it can seem very scary and this is perfectly normal if you experience either Primary or Secondary PPH and the medical professionals involved in your care don’t explain what is going just ask they will oblige and explain what is happening. I can verify this as when midwife realised I had a primary PPH it seemed like doctors and other medical staff seemed to appear from nowhere and it seemed like everyone had adopted panic stations and were talking amongst themselves, without telling me what was going on, I simply said “stop. Now, tell me what is happening.” The midwife apologised and explained what was going on and what they were going to about it.

It is important to point out that if you don’t understand you shouldn’t be afraid to ask because further down the line it may be relevant and it can save alot of time if you are able to supply them with the information rather them having to trawl through your entire medical file to gain the information. As I discovered with my second pregnancy because I had asked what was going on when I had complications with the first pregnancy I was able to answer the questions asked to gain treatment for a complication with this pregnancy faster as they didn’t have to trawl through over 20 years worth of notes.