A woman is said to have undergone a postpartum hemorrhage complication if she has lost more than 500ml of blood during a vaginal birth or more than 1000ml during a cesarean section. 

 

In most cases, post partum hemorrhage occurs within the first 24 hours after birth, though in some cases, it can happens within the post partum period (the first 6 weeks after birth). There are four main possible causes of post partum hemorrhage, that we will be discussing on this post; 

 

Causes of Post Partum Hemorrhage

The following are the 4 main causes of post partum hemorrhage;

Retained Placental Fragments 

This happens when a piece or a fragment of the placenta is left behind, inside the woman's uterus. As a result, the uterus cannot contract fully, leading to more bleeding. If the placenta fragments are small in size, bleeding does not occur immediately and usually happens within 6 to 10 days after delivery. 

 

If the left placent fragments are large in size bleeding occurs immediately after birth or within the first 24 hours. To prevent cases of hemorrhage caused by retained placenta fragments, a placenta should be inspected to make sure that it is complete after every delivery.  

 

Uterine Atony  

Uterine atony is one of the main and frequent cause of post partum hemorrhage, that occurs when the uterus relaxes without contracting. After the birth of a child, the uterus is expected to remain contracted so that it can allow the open blood vessels found at the placenta site to heal fast. In the case of an uterine atony, the uterus does not contract, leading to more bleeding.

 

Some possible causes associated with uterine atony are;  

The theory behind the above risk factors is that, they can lead to poor uterine tone, hence increasing the chances of the woman developing an uterine atony during birth. 

 

Laceration 

Laceration is the tearing of the skin as a result of an injury. Small laceration is expected during the vaginal delivery and it is considered a normal process of a child birth. However, having a large laceration is not considered normal. A woman having a large laceration is considered to be experiencing a post partum complication and such laceration can lead to post partum hemorrhage. These kinds of lacerations may happen as a result of a rapid delivery or a late delivery (delivery taking longer time than expected). 

 

Other causes of lacerations are; large for gestational babies (babies who are big in size) and use of instruments during delivery (assisted birth). Women who are having a child for the first time are more likely to have laceration than woman who have given birth, previously. 

 

Types of Vaginal Lacerations  

A woman is suspected to be undergoing a hemorrhage associated with laceration if the bleeding continues and the uterus is firm. 

 

Disseminated Intravascular Coagulation (DIC) 

A very fatal cause of post partum hemorrhage. DIC occurs as a result of vascular injury, leading to massive bleeding on the affected part. The body responds by sending clotting factors to try and conceal the bleeding on injured site. When his happens, platelets and fibrin from the circulation are sent to the bleeding site, leaving the rest of the body with no or very little platelets and fibrin.

 

As a result, the body is unable to produce the required platelets and fibrin for the rest parts of the body, leading to widespread bleeding. This is usually a fatal complication and prompt medical intervention is required. 

 

There is no known cause of DIC, but it is associated with;  

Disseminated Intravascular Coagulation may even happens during the post partum period (6 weeks after child birth). 

 

These are the four main causes of post partum hemorrhage. To prevent and minimize the risks of developing a post partum hemorrhage, there is need for proper monitoring (during pregnancy, birth and after delivery), pregnant woman education and good health care system.