Postpartum haemorrhage (PPH)

Definition

§         A blood loss at birth of up to 500 mL is considered to be normal

§         A primary postpartum haemorrhage is a blood loss of 600 mL or more in the first 24 hours

§         A widely accepted definition of postpartum haemorrhage (PPH) in many institutions is a blood loss of 600 mL for a normal birth and 750 mL for a caesarean birth

§         The classification of PPH in relation to the amount of blood loss is problematic, largely due to a well-documented underestimation of blood loss

§         A clinically relevant alternative is a substantial fall in the haematocrit e.g. 10 % (normal range 0.32 to 0.47 L/L), or the requirement for a blood transfusion (Mousa and Alfirevic 2003)

Aetiology

§         In 2006, PPH affected 7.1 % (1,316) of birthing women in South Australia (Chan et al. 2007).  PPH may be associated with:           

o        Abnormalities of uterine contraction (Tone) 70 %

o        Retained products of conception or invasive placenta (Tissue) 10 %

o        Genital tract trauma (Trauma) 20 %

o        Abnormalities of coagulation (Thrombin) < 1 %

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