A life-threatening postpartum haemorrhage (PPH) involves losing at least 500 ml of blood from the uterus or vagina. The most critical period to develop a PPH is during the third and fourth stages of labour.
About 90% of deaths due to PPH take place within four hours of delivery. During the ﬁrst four to six hours, you should make sure that the uterus remain swell contracted and that there is no heavy loss of blood. However, awoman can develop a haemorrhage at any time during the puerperium, generally in the ﬁrst week after delivery, but even up to six weeks postpartum.
This type of bleeding is referred to as secondary (late) postpartum haemorrhage. The presence of anaemia or a heart condition can be life-threatening for the mother even if the loss of blood is less than 500 ml. A woman who is malnourished is also usually less able to cope with blood loss than a woman who is well nourished.
Causes of late postpartum haemorrhage
The bleeding is usually as a result of poor contraction of the uterus after the birth, which fails to close off the torn blood capillaries where the placenta has pulled away. If the uterus is unable to reduce in size as it should do normally, it may be because of infection, or retention of a piece of the placenta, which later tears loose from the wall of the uterus and causes a haemorrhage.
Endometrial wall infection: When the site of placental implantation (the placental bed) is not yet healed, infection in the uterus can cause the blood capillaries in the placental bed to start bleeding again.
Poorly contracted uterus: The uterus may not contract well because of infection, retained placental fragments, or an unknown reason. As a result, bleeding can start again.
Retained placenta: Remnants of placental tissue or fetal membranes retained in the uterus are common causes of late PPH.
Sloughing of the placentalbed: There is apossibilitythatthe healed placentalbed peelsaway( sloughs)and opens theblood capillaries again.
Molar pregnancy: Although it is uncommon for a woman to develop a molar pregnancy after delivery, its occurrence can have life-threatening complications; the rapidly growing mass of grape-like tissues in the uterus can cause profuse haemorrhaging.