This refers to a condition in which severe bleeding is encountered after the delivery of a pregnant woman. It could be after a normal delivery, instrumental delivery (forceps, vacuum etc) or after a cesarean section.

Reasons:
There are several reasons for heavy bleeding. In up to 80% of cases, the muscular walls of the womb lose its contractility, become lax and are unable to compress the traversing blood vessels. Alternately, trauma to the womb or the birth passage could be responsible. Retained afterbirth and coagulation disorders are the other reasons for PPH. Women at greatest risk include - Multigravidas, those with over distended wombs, prolonged or induced labor, bleeding early in pregnancy and women who have been given epidural analgesia.

Symptoms:
With heavy bleeding - pulse rate increases and blood pressure falls. This is a serious condition and needs urgent medical attention. There may be associated giddiness, fainting, confusion and black outs.

Precautions:
PPH should be anticipated for every delivery, more so for high-risk cases. For prevention of PPH, drugs to contract the womb may be given in anticipation before the bleeding actually occurs. Massage of the womb through the tummy is another useful method for temporary control of bleeding.

General Treatment:
Treatment of PPH starts with resuscitation of the woman. This means starting IV lines and administering fluids and blood. Stabilizing pulse and blood pressure is a priority along with identifying the cause of the bleeding and then arresting it. Tears in the passage need to be stitched up, while relaxed wombs need to be contracted by medicines. In exceptional cases when medicines do not work - surgical methods are resorted to. Removal of the uterus may be required as a life saving measure in some cases.