Magnitude of the problem
Postpartum haemorrhage or PPH is frequently described as the discharge of more than 500 ml or 1,000 ml of blood within the first 24 hours after the childbirth. There may be symptoms related to low blood volume for the situation to subsist. Symptoms and signs may originally include feeling faint upon standing, an increased heart rate, or an increased oxygen consumption rate. When more blood is discharged from the body, the mother may feel cold, blood pressure may decrease, and she may become unconscious or restless (Rath, 2011). The following part of the paragraphs will discuss about the postpartum haemorrhage or PPH and its current positions and the causes and also how these techniques can be develop for a better future in safe pregnancy. The symptoms of PPH can take place up to six weeks after the child is born. Accordingly, postpartum hemorrhage or the postpartum bleeding is of two types. They are primary postpartum bleeding and the secondary postpartum bleeding. One of the common causes is the contraction of the uterus after the childbirth. Not all of the causes includes placenta after the delivery, poor blood clotting or the tear of the uterus (Leduc et al., 2009).
PPH occurs for those who have a low amount of red blood cell count, with having more than one baby, women having obesity or the older women more than 40 years of age. Additionally, it can usually occur after the caesarean sections, and with those who requires use of forceps or vacuum, and those who are dealing with an episiotomy. According to the World Health Organization (2012) postpartum hemorrhage is the main cause of maternal morbidity and mortality across the globe and it is reason for almost one-quarter (25%) of the cases of maternal deaths. Across the globe it is responsible for total of 127,000 deaths per year. The latest figure of WHO states that 10.5% of all the child births were complex with postpartum hemorrhage, and approximately 13,795,000 women deals with PPH with 13,200 maternal deaths in the years. Globally PPH is one of the primary reasons of maternal mortality across the globe with a reported occurrence of 2–11% (Kumar, 2016). The correct figures may fluctuate according to data source and the evaluation methods with occurrence of 10.6% when detected by objective assessment of blood discharge and 7.2% when considered by the appropriate techniques. Although the total prevalence of PPH is small in the developed countries when compared to the developed nations, but many researchers have shown an increase in the rates of PPH in the regions that are developed as well. In addition it was researched that the rate of postpartum hemorrhage increased from 1.5% in 1999 to 4.1% in 2009, and rate of atonic PPH increased from 1% in 1999 to 3.4% in 2009 (Knight et al., 2009). There are mainly three areas in which the results from PPH can be improved and they are treatment, rescue and prevention (Lalonde, 2012). Prevention deals with the antenatal strategies, and the effective management of the labour third stage, and the necessary treatment for the retained placenta. PPH treatment includes the medical and surgical interventions, and moreover the rescue therapies for PPH include the blood transfusion and the administration of intravenous fluids, supportive care like compression garments and coagulation correction (Kennedy & McMurtry, 2017).
Causes of PPH
Causes of the PPH- The primary causes of postpartum hemorrhage or PPH are trauma, placental abnormalities or retained placenta, coagulopathy and the uterine atony. Together they are commonly termed as “Four T’s”.
Damage in a birth canal includes cervix, uterus, vagina and the perineum. The blood loss is substantial because all the organs in the body become more vascular in the time pregnancy. Thrombin or the bleeding disorder happens when there is a blood clotting failure. Tissue retention from the fetus or the placenta or any kind of placental change may lead to blood discharge. Placental tissue retention may add to the uterine atony. One of the most common causes of PPH is uterine atony. Uterine atony is the powerlessness of the uterus to contract and may prompt constant bleeding (Marasinghe & Condous, 2009).
Current state in PPH care
Assessment which is based on the blood-loss volumes- PPH defined as a loss of more than 500ml of blood in the child birth. However, the proper measurement of blood loss during postnatal stage defines that such amount of blood loss is common in women occurring in more than 50% case of the child delivery. Exact idea of volume of the blood loss is significant in the accurate management of postpartum hemorrhage. However, researchers found that using calibrated drapes to measure the exact quantity of blood loss did not trim down the total amount of blood loss of the patient or progress the outcomes (Sheldon et al., 2014). This has prompted a reappraisal of the significance of blood loss volume evaluation. The evaluation of the volume of blood loss has been given excessively accentuation: professionals don’t base their choice to treat exclusively on repeated formal blood misfortune estimates, yet more on a clinical choice based on various components which includes rate of blood flow, background risk, professional identity and the accessibility of treatment, and also the volume of blood discharged from the body (Kramer et al., 2013). Further research is required to comprehend this procedure but a choice to treat in view of the physiological reaction to blood misfortune, for example, shock index (pulse/systolic blood pressure) or side effects might be more significant. A basic electronic screener will quickly analyze the shock and could be demonstrated as a more viable diagnostic apparatus than the assessment of blood volume. Recent researches have looked to inspect the segments of dynamic administration in more detail. In general, they propose that it is the oxytocic is in charge of the helpful impact to the pregnant women welfare, there is no maternal advantages of early cord clamping, yet presenting adequate neonatal harm. This is also reflected by the most recent WHO rules.
Current state in PPH care
Future aspect or the further research- In spite of enormous investment in maternal wellbeing across the world, PPH exists as a noteworthy reason for increase maternal mortality. The fast beginning and movement of PPH implies that amazing administrations are needed to prevent the PPH related morbidity and mortality. The arrangement of uterotonics to all ladies is crucial, and the accessibility of misoprostol would help to reach ladies who don’t have any approach to wellbeing administrations (Hofmeyr & Gülmezoglu, 2008). Ongoing investigations recommend that the primary advantage of prophylaxis is the significant reduction in the postpartum anaemia rate, with the impact on maternal death remaining less certain (Uncu et al., 2015). In the event that significant enhancements in mortality related to PPH are to be accomplished, there should be an expanded arrangement of superior quality of emergency obstetric care administrations (Svanström et al., 2008). This incorporates the arrangement of careful administrations to prevent PPH (manual evacuation of placenta and cesarean segment), PPH restorative medicines (oxytocin and potentially tranexamic acid), physical treatments (uterine pressure, medical procedure and the balloon tamponade), and packages for rescue (blood transfusion and blood items) (Grotegut et al., 2011). More research is currently required to decide the most financially savvy method for giving these administrations.
It can be concluded hereby that postpartum haemorrhage or PPH remains a noteworthy reason for maternal death around the world, and is assessed to cause the death of women in every ten minutes. The above researches display the most recent clinical advice, which includes new proof on misoprostol, oxytocin and controlled cord traction (Hofmeyr et al., 2009). The controversy around the diagnosis of PPH, the confinements of novel ways to give obstetric emergency treatment and the limitations of universal prophylaxis are additionally displayed. It closes with a call to grow high quality front line obstetric administrations that can affect quickly with unforeseen hemorrhages and additionally limiting blood misfortune at vital times: placenta praevia, cesarean for long-term labour and major abruption.
References
Grotegut, C. A., Paglia, M. J., Johnson, L. N., Thames, B., & James, A. H. (2011). Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. American journal of obstetrics and gynecology, 204(1), 56-e1.
Hofmeyr, G. J., & Gülmezoglu, A. M. (2008). Misoprostol for the prevention and treatment of postpartum haemorrhage. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(6), 1025-1041.
Hofmeyr, G. J., Gülmezoglu, A. M., Novikova, N., Linder, V., Ferreira, S., & Piaggio, G. (2009). Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bulletin of the World Health Organization, 87, 666-677.
Kennedy, B. B., & McMurtry, S. B. (2017). Collaborative Strategies for Management of Obstetric Hemorrhage. Critical care nursing clinics of North America, 29(3), 315-330.
Knight, M., Callaghan, W. M., Berg, C., Alexander, S., Bouvier-Colle, M. H., Ford, J. B., … & Oats, J. (2009). Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC pregnancy and childbirth, 9(1), 55.
Kramer, M. S., Berg, C., Abenhaim, H., Dahhou, M., Rouleau, J., Mehrabadi, A., & Joseph, K. S. (2013). Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. American journal of obstetrics and gynecology, 209(5), 449-e1.
Kumar, N. (2016). Postpartum hemorrhage; a major killer of woman: review of current scenario. Obstet Gynecol Int J, 4(4), 00116.
Lalonde, A. (2012). Prevention and treatment of postpartum hemorrhage in low?resource settings. International Journal of Gynecology & Obstetrics, 117(2), 108-118.
Leduc, D., Senikas, V., Lalonde, A. B., Ballerman, C., Biringer, A., Delaney, M., … & Shepherd, D. (2009). Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. Journal of obstetrics and gynaecology Canada, 31(10), 980-993.
Marasinghe, J. P., & Condous, G. (2009). Uterine compression sutures for post?partum bleeding with atony; modification of the B?Lynch suture. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49(1), 67-70.
Rath, W. H. (2011). Postpartum hemorrhage–update on problems of definitions and diagnosis. Acta obstetricia et gynecologica Scandinavica, 90(5), 421-428.
Sheldon, W., Blum, J., Vogel, J. P., Souza, J. P., Gülmezoglu, A. M., & Winikoff, B. (2014). Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG: An International Journal of Obstetrics & Gynaecology, 121, 5-13.
Svanström, M. C., Biber, B., Hanes, M., Johansson, G., Näslund, U., & Bålfors, E. M. (2008). Signs of myocardial ischaemia after injection of oxytocin: a randomized double-blind comparison of oxytocin and methylergometrine during Caesarean section. British journal of anaesthesia, 100(5), 683-689.
Uncu, Y., Karahasan, M., Uyaniklar, Ö., & Uncu, G. (2015). Prophylactic misoprostol for the prevention of postpartum hemorrhage: a randomized controlled trial. Eur Rev Med Pharmacol Sci, 19(1), 15-22.
World Health Organization. (2012). WHO recommendations for the prevention and treatment of postpartum haemorrhage. World Health Organization.
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