Occupational Medicine & Health Affairs
Open Access

PPH has been declared by WHO {world health organisation} as one the most disastrous reason for the maternity death. The maternal mortality ratio in developing countries in 2015 is 239% of 100000 live births versus 12% of 1000000 live births in developed countries. [1- 5] Thus, 99% of all maternity deaths occur in developing countries, whereas 1% in developed ones. Inside the countries, this rate also varies as per low income and less facilities in rural areas a high income and higher facilities in urban areas. WHO statistics suggests that 35% of maternal death is due to PPH. It can also kill a healthy woman in 2hours if she not treated. This PPH is of two types:

a. Primary PPH: If the blood is loss within the first 24hours of delivery and then stops then it is called as primary PPH.

b. Secondary PPH: If the blood continues to loss continuously 12 weeks after delivery is termed as secondary PPH.

Some causes of PPH are uterine atony, trauma, retained placenta and coagulopathy. Those causes are commonly referred as “4T’s”. Haemorrhage may occur before or after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500ml (or about a half of a quart) and the average amount of blood loss for a caesarean birth is approximately 1000ml (or one quart).As per our research, 2%-4% in normal and 6% in caesarean cases uterine atony (Table 1) being the cause of about 50% cases. N.B. Uterine atony: It is also called as atony of uterus, is a serious condition after childbirth. It occurs when uterus fails to contract after the delivery of the baby, and this can lead to PPH. Every year about 14million women around the world are suffered from PPH (i.e. 26 women every minute). In a survey of INDIAN SAMPLE REGESTRATION SCHEME (ISRS) at 1998, about 30% of maternal death is been recorded due to PPH. And according to ISRS 20001-2003, it is increased to 38% of maternal deaths. Also, by Indian Council of Medical Research (ICMR). In 2003, PPH is the leading cause of maternal death. If the cause of bleeding is not uterine atony, then blood loss may be slower and clinical signs and symptoms of hypovolemia may develop over a longer time period.

Table 1: Management for the causes.

Signs of hypovolemic shock resulting from blood loss are as following.

a. Fall in blood pressure (BP), {BP may be normal initially}

b. Palpitations, Tachylalia, Dizziness

c. Weakness, Sweating

d. Restlessness, Pallor

e. Oliguria (reduced urine volume)

PPH may also be aggravated by pre-existing anaemia.

This process can be done by following two ways:

Non-medical management

This process possesses of uterine massage, bimanual uterine compression, external aortic compression, uterine artery embolization and non-pneumatic anti-shock garments (Table 1). It can also be done by some following facts: Making a close observation to the pregnant women during childbirth and afterwards. All the consideration, about blood level, haemoglobin level, etc. In research, we got that the blood level of a body in (litres) is equals to the weight of the body in (Kg) divided by 12. Also, visually estimating of blood level can become a great harm/hazard to a pregnant woman in her future. Blood estimation. N.B. Some of the clinical examination during third stage labour are most needed, to avoid this PPH problem, some of them are: -

Assessment of uterine tone and size.

Inspection of placenta if delivered.

Manual exploration of uterus for plant.

Inspection of cervix and vagina for any injury.

Medical management

The main aim to treatment of PPH is to find and stop the cause of bleeding. Hence, for its treatment medicines are used to stimulate uterine contraction (Table 2) and removing pieces of the placenta that remain in the uterus. The following (Table 2) is based on the drugs used, their appearance, effect and side effects.

Table 2: Drug action and effectiveness.

History on its management starting and its execution

As per our research, there were many cases all over the world of PPH, but it came in vision of WHO, when a woman started PPH cure foundation [6]. In 1994, Martine Rothblatt (an American lawyer, author and entrepreneur) had an incident. Her young daughter was diagnosed with a fatal orphan disease called as pulmonary arterial hypertension (PAH). Rothblatt scold her telecom stockman started the $3 million PPH cure foundation to found PAH research. By 2002 the FDA had approved their drug for PPH and for the 1st time drug for PPH was introduced to the world. In 2004, it was declared that oxytocin with or without supplemental ergometrine, ergometrine alone, 15-methyl prostaglandin F2α, and misoprostol were the uterotonics used for reducing PPH. Further in 2009 and 2012 WHO makes guidelines for managing PPH mentioned curb tonic, recombinant factor VII a and tranexamic acid as possible therapeutic interventions for PPH [7,8]. N.B. Oxytocin was discovered in 1906 by Henry H. Dale and the concept was given in 1954 by Vincent du Vigneaud. Misoprostol was first discovered in year 1954 by Robert et al [9].

As per research, women and adolescents are the main prospects of improving their own health. Everyone should aware of this health education and equal participation in society. The couples should have the knowledge of regular check-ups and the male couples should be supportive in all prospects. During pregnancy, every woman should have a check-up over anaemia and if it presents, then should take the appropriate diagnosis for it, if this would not be diagnosed it can become a great hazard in the form of PPH in future. The relatives and guardians should encourage the pregnant woman to have institutional delivery, because ANMs cannot attend the woman in home deliveries, and this can be a harm, if the woman does not have access to every health facilities. PPH needed to be reduced by strengthening peripheral deliveries and increasing this in every country.