Postpartum Haemorrhage: Causes, Warning Signs, and Emergency Management

The period after childbirth is critical and requires constant care and expert monitoring for some hours. Your body is actively healing at this time. This makes you feel extremely tired. Some bleeding is expected, and in most cases, it settles gradually. However, sometimes the bleeding becomes heavier all of a sudden. Or, at times, it may increase slowly without a clear warning.



Postpartum haemorrhage (PPH) is one of the most serious complications after delivery. Many experts consider it the most common reason behind maternal complications worldwide. When you understand its warning signs and causes clearly, you are better prepared to recognise it early and get timely care.



Understanding Postpartum Haemorrhage

Postpartum haemorrhage (PPH) is a maternal complication that is characterised by severe bleeding after childbirth.



It often happens within 24 hours. However, it may also happen up to 6 weeks after delivery (postpartum).



There is a high risk of losing substantial amounts of blood in a very short period. It may be dangerous due to the events that happen thereafter. These are:

• Sudden and sharp drop in blood pressure
• This condition restricts blood flow to your vital organs, like the heart and brain.
• A potentially fatal condition known as hypovolemic shock may develop as a result of inadequate blood supply due to active bleeding.
• If the bleeding is not managed immediately, it may cause serious and life-threatening complications.

Postpartum haemorrhage affects around 1% to 5% of deliveries (1 to 5 out of every 100). However, most cases can be managed well with immediate medical care.



Recovery does not end at discharge. Because of this, you must remain aware even after you return home.



What are the Causes of Postpartum Haemorrhage?

Postpartum haemorrhage usually develops due to a combination of certain factors. These are:







Uterus Not Contracting ProperlyAfter the baby and placenta are delivered, the uterus needs to contract firmly. This contraction helps close blood vessels.



If the uterus remains relaxed, bleeding continues. This is the most common cause.



It is more likely if:

• Labour was long or difficult
• The uterus was overstretched (twins or a large baby)
• Certain medications affected the uterine response

Placenta Not Fully ExpelledSometimes, small fragments of the placenta remain inside the uterus.

• This prevents proper contraction
• There may not be sudden bleeding. It may continue steadily.

You may not always feel this immediately, which is why monitoring after delivery is important.



Tears or Injury During DeliveryDuring the baby’s delivery, tears may damage the surrounding tissues.

• Vaginal or cervical tears
• Surgical cuts during caesarean delivery

These may bleed if not identified and treated promptly.





Blood Clotting ProblemsIn some cases, the body’s clotting ability is reduced.

• Even small bleeding can become excessive
• It may worsen in a very short duration if care is delayed

Factors That May Increase Your Risk

PPH can occur without warning. Still, certain factors make it more likely. These are:

• Previous history of postpartum haemorrhage
• Anaemia during pregnancy
• Prolonged orinduced labour
• Caesarean delivery, especially after long labour
• Multiple pregnancy or a large baby
• Conditions affecting placental attachment

Therefore, awareness in your team of healthcare providers will help them to stay prepared. Because of these factors, your doctor may monitor you closely during the pregnancy.



Subtle and Serious Warning Signs

Your body often signals distress before the situation becomes critical. These signs may appear gradually or suddenly.



Physical signs you may notice include:

• Bleeding that soaks through pads very quickly
• Frequent passing of large clots
• Rapid pulse or pounding heartbeat
• Drop in blood pressure
• Pale, cold, or clammy skin

How you may feel

• Sudden dizziness or light-headedness
• Ringing in the ears
• Excessive weakness
• Unusual restlessness
• Anxiety

Some people may experience a strong sense that something is wrong. That feeling should never be ignored.



How Doctors Manage It in Emergencies

When postpartum haemorrhage is suspected, action begins immediately. There is no delay.



A structured, stage-based approach



Immediate care focuses on stabilisation

• Monitoring vitals, including pulse, oxygen levels, and blood pressure
• Starting intravenous fluids to support adequate circulation
• Providing oxygen support if required
• Controlling the source of bleeding

Doctors act simultaneously to stop the cause.

• Medicines are given to help the uterus contract effectively
• Additional medications may support blood clotting
• Retained placental tissue, if present, is removed
• Tears or injuries are repaired

If bleeding continues

• More advanced measures may be required:
• Blood transfusion may be started early, even before lab confirmation in critical cases
• Balloon devices may be inserted into the uterus to apply pressure
• Special techniques may reduce blood flow to the uterus

As a last step



Surgery may be needed in severe cases. This decision is made carefully, to save life and also preserve health as much as possible.



Why Early Response Matters So Much

Postpartum haemorrhage can progress quickly. Things that appear to be under control initially might rapidly deteriorate within hours.



Experts often stress that treatment should begin based on clinical signs. Waiting for test reports can delay treatment.



A person may lose significant blood before it becomes visibly obvious. Delayed response increases complications.



How Can Postpartum Haemorrhage Be Prevented?

Not all cases can be prevented. However, certain precautions may reduce its risk significantly.



Pregnancy period precautions are:

• Regular antenatal check-ups
• Early treatment of anaemia
• Sharing your complete medical history with your doctor

Precautions to be taken around the time of delivery include:

• Making sure the medical team present during childbirth is highly skilled in managing such cases
• Having prepared emergency protocols
• Ensuring that the necessary equipment and blood support are available

Your care providers will take these precautions.



When Should You Seek Help Urgently?

Even after going home, you should stay alert.



If you notice these signs, seek immediate medical help:



Sudden increase in bleeding

• Dizziness
• Falls
• Fainting
• Extreme weakness
• Persistent rapid heartbeat
• Any unusual symptom that concerns you

Uncontrolled bleeding after childbirth can be terrifying and traumatic. No one anticipates that their delivery journey can unfold this way. If you are really concerned about PPH after childbirth, you must inform your doctor. They will conduct a prompt assessment of your risk and prepare appropriately. Most patients can fully recover if their risk is recognised early and managed accordingly.