Managing Complications in Pregnancy and Childbirth: - IAWG

VAGINAL BLEEDING AFTER CHILDBIRTH S-25Vaginal bleeding in excess of 500 mL after childbirth is defined aspostpartum haemorrhage (PPH). There are, however, some problemswith this definition:• Estimates of blood loss are notoriously low, often half the actualloss. Blood is mixed with amniotic fluid and sometimes with urine. Itis dispersed on sponges, towels and linens, in buckets and on thefloor.• The importance of a given volume of blood loss varies with thewoman’s haemoglobin level. A woman with a normal haemoglobinlevel will tolerate blood loss that would be fatal for an anaemicwoman.Even healthy, non-anaemic women can have catastrophic bloodloss.• Bleeding may occur at a slow rate over several hours and thecondition may not be recognized until the woman suddenly entersshock.Risk assessment in the antenatal period does not effectively predictthose women who will have PPH. Active management of the third stageshould be practiced on all women in labour since it reduces theincidence of PPH due to uterine atony (page C-73). All postpartumwomen must be closely monitored to determine those that have PPH.PROBLEMS• Increased vaginal bleeding within the first 24 hours after childbirth(immediate PPH).• Increased vaginal bleeding following the first 24 hours afterchildbirth (delayed PPH).Continuous slow bleeding or sudden bleeding is an emergency;intervene early and aggressively.