Early Postpartum Hemorrhage

TL;DR

Early postpartum hemorrhage (PPH) is when you lose too much blood within the first 24 hours after birth. It's often caused by the uterus not contracting well, or by trauma during delivery. Recognizing signs early and acting fast can prevent serious complications for your patient.

1. The Mental Model

Think of early PPH as significant blood loss quickly after birth. Your job is to stop the bleeding by finding its source and using interventions to help the body recover.

2. The Core Material

Early postpartum hemorrhage is defined as blood loss of 500 mL or more after a vaginal birth, or 1000 mL or more after a C-section, within the first 24 hours. The most common cause (about 70-80%) is uterine atony, meaning the uterus doesn't contract enough to compress the blood vessels that were supplying the placenta.

Causes of Early PPH (The 4 T's)

Photo by Leeloo The First on Pexels

When you're looking for the cause of PPH, remember the "4 T's":

• Tone: This refers to uterine atony, the most common cause. The uterus is boggy (soft) and relaxed instead of firm.
• Trauma: This includes lacerations (tears) to the cervix, vagina, or perineum, or a ruptured uterus. You might see bright red blood even if the uterus is firm.
• Tissue: This means retained placental fragments or clots within the uterus. If the placenta didn't deliver completely, these pieces can prevent the uterus from clamping down.
• Thrombin: This refers to coagulation disorders (problems with blood clotting). These are less common but can significantly worsen bleeding.

Recognizing Early PPH

Photo by Lemniscate L on Pexels

Look for these signs:
* Exce