Dra. Ivone Lobo

Obstetrician Gynaecologist 
Sub specialist in Maternal Fetal Medicine
Director of the Gynecology & Obstetrics Unit

Postpartum haemorrhage

HPA Magazine 22 // 2024

Postpartum haemorrhage (PPH) continues to be a leading cause of maternal morbidity and mortality worldwide.
Many women who have PPH have no identifiable risk factors.
PPH is defined as blood loss of 500mL or more during and after birth.
Significant PPH is defined as blood loss of 1,000mL or more, or any amount of postpartum blood loss that causes hemodynamic compromise.
Primary PPH occurs within the first 24 hours after birth.

Secondary PPH occurs between 24 hours and 6 weeks after birth.
PPH is a potentially fatal complication of vaginal births and caesarean sections.
In addition to maternal death, PPH can result in:
• anaemia
• prolonged hospital stays
• delay or failure in breastfeeding
• pituitary infarction
• need for blood products
• haemorrhagic shock and hypotension
• coagulopathy
• acute tubular necrosis/renal failure
• surgical intervention and even hysterectomy

Maternal death is the most serious complication of PPH (25% of all maternal deaths) and can occur “silently”. Therefore, early detection is essential, with an appropriate response and approach in order to improve the outcome, thus avoiding a negative outcome.
A significant number of women who survive severe PPH develop physical and/or emotional sequelae.
Aware that PPH requires prevention and a quick and systematic response to make a difference, in our Service we carry out annual training in Obstetric Emergencies, which includes PPH.
in order to develop skills that allow early recognition and treatment, which are essential in Obstetric Emergencies.
Obstetric emergencies are rare events.
In training, participants can make mistakes, reflect, and learn from them, without exposing the patient to any risk. It is a test of processes to identify and potentially determine gaps in our Service, our teamwork, our communication, and the overall security of the care we provide.
It is also an opportunity to learn and ask questions in a safe environment.