Question

What are the causes of PPH?

Hint:

The "four T's" (tone, trauma, tissue, and thrombin) are the key causes of PPH and should be systematically addressed during management.

Answer 1

Step 1: Causes of Post-Partum Hemorrhage (PPH).
The causes of PPH can be broadly classified into four T's:
(1) Tone (Uterine Atony):
- The most common cause of PPH, occurring when the uterus fails to contract adequately after delivery. This leads to continuous bleeding from the placental site. Risk factors include prolonged labor, overdistended uterus (due to multiple pregnancies or large babies), or uterine infections.
(2) Trauma (Birth Canal Traum:
- Injury to the birth canal, such as tears to the cervix, vagina, or perineum, or uterine rupture, can result in significant bleeding. Use of instruments like forceps during assisted delivery increases the risk of trauma.
(3) Tissue (Retained Placental Tissue):
- Retained placenta or placental fragments in the uterus can prevent complete uterine contraction and cause continued bleeding. This can occur with placenta accreta or if the placenta does not detach properly.
(4) Thrombin (Coagulopathy):
- Coagulation disorders, such as disseminated intravascular coagulation (DI or bleeding disorders (e.g., hemophili, can impair blood clotting and contribute to PPH. Coagulopathy can be triggered by factors such as infection, pre-eclampsia, or amniotic fluid embolism.