Postpartum haemorrhage (PPH) is defined as blood loss of > 500mls and may be primary or secondary

Primary PPH

• occurs within 24 hours
• affects around 5-7% of deliveries

Causes

The causes of postpartum haemorrhage (PPH) may be remembered as the 4 'T's.

• Tone (90%)
  • The most common cause of PPH is uterine atony, which is the failure of the uterus to contract after delivery.
  • Assess by palpating the uterus and seeing if its firm or not, massage and see if this (and the bleeding) changes.
• Trauma
  • PPH may come from a birth canal injury or tear. This risk is increased in instrumented deliveries.
• Tissue
  • Retained placental or foetal tissue can lead to continued bleeding
  • Assess womens placenta, see if its all there
• Thrombin
  • Coagulopathies can lead to continued bleeding due to a failure of clotting.
  • Send of coagulation screen, also look at the blood to see if its clotting/thin

Risk factors for primary PPH include:

• previous PPH
• prolonged labour
• pre-eclampsia
• increased maternal age
• Multiple pregnancies (>5)
• polyhydramnios