Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality across India. The majority of women, who experience PPH complications have no identifiable clinical or historical risk factors. It has been observed that the condition gets aggravated by pre-existing anaemia, when the loss of a smaller volume of blood may result in adverse clinical sequelae.

Dr. Malvika Sabharwal, Chief- Department of Gynaecology & Obstetrics, Jeewan Mala & Apollo Spectra Hospitals said that PPH is a largely preventable and manageable condition. Anticipation, preparedness, taking prophylactic measures, and vigilance for PPH are the cornerstones of PPH prevention. Anticipation involves knowing the risk factors which can cause PPH. The preparedness involves PPH trolley in the labour room, which should have everything required for the management of bleeding patients. Training of labour room staff for estimation of blood loss and PPH Drill is pivotal.”

She further said, “Active management of the third stage of labour (AMTSL) is essential and includes uterotonics at anterior shoulder delivery or immediately after the delivery of baby, preferably within one minute after birth,”

“Delayed cord clamping and controlled cord traction (CCT) to deliver the placenta and Uterine massage after delivery of placenta to keep the uterus contracted. The patient should be observed for blood loss by visual inspection and vital monitoring over the next hour, with an assessment of uterine tone and size at least every 15 minutes. Early breastfeeding should be done as it promotes endogenous oxytocin release,” said Dr Malvika.

Bharat Serums and Vaccines Limited (BSV), which is a leader in women healthcare products and solutions,  has also unveiled a new women’s health product “Carbetocin”. It’s an injectable drug that is currently recommended for the prevention of postpartum haemorrhage.

According to a report from WHO, it suggests that 25 per cent of maternal deaths are due to PPH. In India, PPH, which is exacerbated by widespread anaemia among pregnant women accounts for 38 per cent of maternal deaths.  As per the Sample Registration System (SRS) report by Registrar General of India(RGI), the Maternal Mortality Ratio (MMR) of India has reduced from 130 per 100,000 live births in SRS 2014-16 to 122 in SRS 2015-17 and to 113 per 100,000 live births in SRS 2016-18.

The condition of PPH occurs when there is a blood loss of 500 ml or more within 24 hours after delivery. PPH could be severe when the blood loss is of 1000 ml or more within the same time frame. In practice, blood loss after delivery is seldom measured and it is not clear whether measuring blood loss improves the care and outcome for the women. In addition, some women may require interventions to manage PPH with less blood loss than others if they are anaemic.