1. Postpartum Hemorrhage (PPH)
Definition:
PPH is excessive bleeding after childbirth defined as:
- >500 mL blood loss in vaginal delivery.
- >1000 mL blood loss in C-section.
- Severe PPH: Blood loss >1500 mL or requiring transfusion.
2. Types of PPH
|
Type |
Time of Occurrence |
Causes |
|
Primary (Early) PPH |
Within 24 hours of delivery |
Uterine Atony, Trauma, Retained Placenta,
Coagulopathy |
|
Secondary (Late) PPH |
24 hours – 6 weeks
postpartum |
Retained Products of Conception (RPOC), Infection,
Subinvolution |
3. Causes of PPH (4 T’s)
|
Cause |
Description |
Examples |
|
Tone (Atony) – Most Common |
Failure of uterus to contract |
Uterine atony, Overdistended uterus (Polyhydramnios,
Multiparity) |
|
Tissue (Retained Placenta) |
Placental fragments remain in uterus |
Retained products, Placenta accreta |
|
Trauma (Birth Canal Injury) |
Tears or lacerations |
Episiotomy, Cervical/Vaginal tears, Uterine rupture |
|
Thrombin (Coagulopathy) |
Clotting dysfunction |
DIC, HELLP syndrome, Abruption |
4. Clinical Features of PPH
- Excessive vaginal bleeding.
- Soft, boggy uterus (Atony).
- Signs of shock (Pallor, Tachycardia, Hypotension).
5. Management of PPH
First-Line (Initial Measures):
- Call for Help & Assess Blood Loss.
- Uterine Massage (Stimulates contraction).
- Oxytocin 10 IU IM (First-line uterotonic).
Second-Line (If Bleeding Persists):
- Additional Uterotonics:
- Ergometrine (Avoid in Hypertension).
- Misoprostol 800 mcg (Rectally).
- Tranexamic Acid (TXA) 1g IV (Antifibrinolytic).
Third-Line (Surgical Measures):
- Balloon Tamponade (Bakri Balloon).
- B-Lynch Suture (Uterine Compression).
- Hysterectomy (Last resort in uncontrolled bleeding).
6. Puerperium (Postpartum Period)
Definition:
The 6-week period after childbirth where maternal organs return to pre-pregnancy state.
7. Phases of Puerperium
|
Phase |
Duration |
Key Changes |
|
Immediate Puerperium |
First 24 hours |
Uterus contracts, Risk of PPH |
|
Early Puerperium |
First week |
Lochia discharge, Hormonal changes |
|
Late Puerperium |
6 weeks postpartum |
Return of ovulation, Uterine involution |
8. Uterine Involution
Uterus shrinks from 1 kg to 60–80 g by 6 weeks.
Fundal Height Changes:
- Immediately postpartum: At umbilicus.
- Day 7: Between umbilicus & pubic symphysis.
- 6 weeks: Non-palpable.
9. Lochia (Postpartum Vaginal Discharge)
|
Type |
Duration |
Characteristics |
|
Lochia Rubra |
1–4 days |
Red, Blood & Decidual tissue |
|
Lochia Serosa |
4–10 days |
Pink/Brown, Serous fluid & Leukocytes |
|
Lochia Alba |
10–14 days (Can last up to 6 weeks) |
White/Yellow, Mucus & Epithelial cells |
Foul-smelling lochia → Endometritis (Postpartum Infection).
10. Hormonal & Systemic Changes
Endocrine:
- Estrogen & Progesterone drop → Mood changes, Hair loss.
- Prolactin remains high → Suppresses ovulation in lactating women.
Menstruation & Ovulation Return:
- Non-breastfeeding women: Ovulation returns by 6 weeks.
- Breastfeeding women: Delayed due to high prolactin levels.
11. Common Puerperal Complications
Postpartum Hemorrhage (PPH) → Most serious
complication.
Puerperal Sepsis (Endometritis):
- Signs: Fever, Uterine tenderness, Foul-smelling lochia.
- Treatment: IV Antibiotics (Clindamycin + Gentamicin).
Postpartum Depression:
- Lasts >2 weeks, Affects daily activities.
- Management: Psychological support, SSRIs if severe.
Deep Vein Thrombosis (DVT):
- Prevent with Early Ambulation, LMWH in High-Risk Cases.
12. Summary Table: PPH & Puerperium
|
Feature |
PPH |
Puerperium |
|
Definition |
>500 mL blood loss (Vaginal) |
6-week postpartum recovery |
|
Causes |
Atony, Retained placenta, Trauma |
Normal uterine involution |
|
Lochia |
Excessive bleeding, Clots |
Lochia rubra → serosa → alba |
|
Complications |
Hypovolemic shock |
Infection, Depression, DVT |
|
Management |
Oxytocin, Uterine massage, Surgery if needed |
Monitoring, Breastfeeding, Contraception advice |
13. Key Takeaways
- PPH is the leading cause of maternal mortality, requiring rapid management.
- Oxytocin & Uterine Massage are first-line treatments for PPH.
- Uterine involution & lochia progression are normal postpartum changes.
- Breastfeeding delays ovulation but is not a reliable contraceptive.
- Monitor for infections, depression, and thrombosis in puerperium.
Postpartum hemorrhage (PPH) is excessive bleeding after childbirth, defined as:
- >500 mL blood loss in vaginal delivery
- >1000 mL blood loss in C-section
- Primary PPH: Occurs within 24 hours of delivery
- Secondary PPH: Occurs after 24 hours up to 6 weeks postpartum
PPH is a medical emergency requiring immediate obstetric care. Homeopathy can be used as a supportive therapy alongside conventional treatment.
1. Sabina Officinalis
- Profuse, gushing bright red bleeding with dark clots.
- Severe pain in the uterus, radiating to the thighs.
- Worsened by the slightest motion, better at rest.
- History of repeated miscarriages or early postpartum bleeding.
- Feeling of heaviness in the uterus, as if everything will fall out.
2. Secale Cornutum
- Persistent, dark, thin, and watery bleeding.
- Burning sensation in the uterus.
- Extreme weakness and cold sweat, even with severe bleeding.
- Aggravation from warmth, better with cold applications.
- Common in women with a history of prolonged labor.
3. Trillium Pendulum
- Gushing bright red blood, worsened by movement.
- Sensation as if the pelvis is falling apart, better with tight bandaging.
- Dizziness and fainting from excessive blood loss.
- History of previous hemorrhages in pregnancy or labor.
- Common in women with fibroids or uterine structural issues.
4. Millefolium (Yarrow)
- Bright red, painless bleeding, even from slight exertion.
- No clots, bleeding appears fresh and continuous.
- Worse from standing too long or physical activity.
- Dizziness and weakness due to blood loss.
- No associated uterine contractions or cramping pain.
5. Hamamelis Virginiana
- Dark, slow, passive bleeding with venous congestion.
- No clots, blood appears thin and watery.
- Aching sensation in the pelvis and legs.
- Extreme fatigue and sluggish circulation.
- History of varicose veins or venous issues.
Key Takeaways
- Sabina: Bright red, profuse bleeding with severe cramps, worse from movement.
- Secale Cornutum: Slow, dark, continuous bleeding with burning pain and uterine atony.
- Trillium Pendulum: Gushing bright red bleeding, pelvic weakness, better with tight binding.
- Millefolium: Painless, bright red bleeding from minor exertion.
- Hamamelis: Slow, passive, venous bleeding with exhaustion and sluggish circulation.
Important Note:
- PPH is a medical emergency. Immediate medical attention is required.
- Homeopathy can be used as a complementary treatment alongside conventional management.
- Oxytocin, IV fluids, blood transfusion, and uterine massage are essential in severe cases.
- Women with a history of PPH should have regular postpartum monitoring.
