Antenatal
Postpartum Haemorrhage (PPH)
October 17, 2026
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1. Introduction
Postpartum haemorrhage (PPH) is excessive bleeding after childbirth. It is a serious obstetric emergency that can lead to shock and death if not treated quickly. It can occur after vaginal birth or Caesarean section.
2. Causes of Postpartum Haemorrhage
The main causes are known as the 4 Ts:
Tone: The uterus fails to contract properly after delivery. This is the most common cause.
Trauma: Tears or injuries to the cervix, vagina, or uterus.
Tissue: Placental tissue remains inside the uterus.
Thrombin: Problems with blood clotting.
3. Signs and Symptoms
Common signs include:
Heavy or continuous vaginal bleeding
Passing large blood clots
Fast heartbeat
Low blood pressure
Pale, cold, or clammy skin
Dizziness or weakness
Fainting or confusion
Important: Heavy bleeding after childbirth is an emergency. Do not wait for all these symptoms to appear before seeking help.
4. Risk Factors
Factors that may increase the risk include:
Previous postpartum haemorrhage
Prolonged or very rapid labour
Multiple pregnancy, such as twins
A large baby
Retained placenta
Caesarean birth
Anaemia during pregnancy
Blood-clotting disorders
However, postpartum haemorrhage can occur even when no risk factors are present.
5. Management
Treatment must begin quickly and depends on the cause and severity of bleeding.
Massage the uterus if it is poorly contracted.
Give prescribed medicines, such as oxytocin, to help the uterus contract.
Give intravenous fluids to support circulation.
Administer tranexamic acid when indicated.
Remove retained placental tissue when necessary.
Repair tears or injuries.
Give a blood transfusion if required.
Perform procedures or surgery if bleeding continues.
The healthcare team monitors the mother's vital signs and blood loss closely throughout treatment.
6. Nursing Management
The nurse or midwife should:
Call for urgent assistance.
Assess the amount of bleeding and check vital signs.
Monitor uterine firmness and contraction.
Establish intravenous access as directed.
Administer prescribed medicines promptly.
Monitor urine output and the mother's response to treatment.
Reassure the mother and explain the care being provided.
7. Prevention
Postpartum haemorrhage risk can be reduced through:
Good antenatal care
Identifying and treating anaemia
Skilled care during labour and delivery
Giving recommended preventive medicines after birth
Regular observation of the mother after delivery
Early recognition and treatment of excessive bleeding
8. Tips
Report heavy bleeding immediately after delivery.
Attend all antenatal appointments.
Take prescribed iron supplements if recommended.
Do not ignore dizziness, faintness, or sudden weakness after childbirth.
Never attempt to manage severe bleeding at home.
9. FAQs
1. Can postpartum haemorrhage occur after a normal vaginal delivery?
Yes. It can happen after both vaginal delivery and Caesarean section.
2. Is bleeding after childbirth normal?
Some bleeding, called lochia, is normal and gradually decreases. Heavy bleeding, sudden gushes of blood, or bleeding accompanied by weakness or dizziness requires urgent assessment.
3. Can postpartum haemorrhage be treated?
Yes. Prompt treatment can control bleeding and save the mother's life.
4. When should medical help be sought?
Seek emergency care for heavy or increasing bleeding, fainting, severe dizziness, a racing heartbeat, or difficulty breathing after childbirth.
Conclusion
Postpartum haemorrhage is a life-threatening complication that requires rapid recognition and treatment. Skilled maternity care, prevention, and close monitoring after delivery help protect the mother's life.
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