Postpartum haemorrhage – causes, effects, and when negligence occurs

This article, the latest in our A-Z series on birth injuries, explains postpartum haemorrhage, its causes and effects, and when a potential medical negligence claim might arise.

What is postpartum haemorrhage?

Postpartum haemorrhage (PPH) means very heavy bleeding from the vagina after giving birth. A certain amount of bleeding in the weeks following birth is normal, but PPH refers to situations when this reaches a potentially dangerous level. It is categorised as blood loss of 500ml or more in the first 24 hours after childbirth.

What causes postpartum haemorrhage?

After the baby is delivered, the mother’s uterus usually continues to contract, to deliver the placenta and reduce the bleeding through the blood vessels which were supplying the placenta. If the uterus fails to contract, this can cause excessive bleeding. This is more common after a long labour or where multiple babies, or a large baby, have been born.

Sometimes, the placenta does not come away as it should and some parts are retained, which again can cause severe bleeding. Alternatively, the walls of the vagina can tear as the baby is being born, and this can lead to PPH.

What are the effects of postpartum haemorrhage?

Uncontrollable bleeding causes blood pressure to drop sharply and the heart rate to increase. This restricts blood flow to the brain and other organs, and leads to haemorrhagic shock, which can be fatal.

Emergency surgery can be required and there could be a need for a hysterectomy, resulting in infertility and early menopause. A sudden medical emergency such as PPH can also cause psychological damage such as post-traumatic stress disorder.

How should PPH be treated?

Any uncontrolled bleeding is a medical emergency and immediate action needs to be taken to stop the bleeding. Treatment depends on the cause of the haemorrhage and may include:

  • administering medication to stimulate uterine contractions;
  • inserting a vaginal pack, Bakri balloon or Foley catheter into the uterus to apply pressure to bleeding blood vessels;
  • providing intravenous fluids to replace lost fluid;
  • administering an intravenous blood transfusion to replace lost blood;
  • performing surgery to identify and seal the injured blood vessels if the source of the bleeding cannot be determined; and/or
  • carrying out a hysterectomy, if surgical measures are unsuccessful, to prevent fatal blood loss.

When could a medical negligence claim arise in relation to postpartum haemorrhage?

A medical negligence claim can arise if the medical care provided fell below a reasonable standard and this caused injury. Claims may involve:

  • failure to diagnose PPH promptly;
  • delay in initiating appropriate treatment to control bleeding;
  • failure to identify and remove retained placental tissue after delivery (which could be vaginal or caesarean-section);
  • failure to monitor bleeding and/or to investigate ongoing bleeding adequately;
  • failure to recognise a prolonged third stage of labour and seek obstetric assistance or emergency support when required;
  • failure to identify and repair birth-related injuries, such as vaginal tears, that may be causing bleeding; and/or
  • delay in administering medications to help control haemorrhage.

Whether or not postpartum haemorrhage will give rise to a medical negligence claim depends on the cause of the haemorrhage, the standard of medical care, and the severity of the injury.

If you need legal advice about your maternity care, please contact our specialist team. Initial consultations are offered free of charge and without obligation.

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