Postpartum haemorrhage remains leading cause of maternal deaths in Kerala: Report

(Down to Earth: Health)

March 4: Postpartum haemorrhage remains leading cause of maternal deaths in Kerala: Report – https://www.downtoearth.org.in/news/health/postpartum-haemorrhage-remains-leading-cause-of-maternal-deaths-in-kerala-report-81873   

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• GS-2: Health

Postpartum haemorrhage remains leading cause of maternal deaths in Kerala: Report

In News: Postpartum haemorrhage (PPH) has been a leading cause of maternal deaths in Kerala for the better part of the last decade, according to a report prepared by the Kerala Federation of Obstetrics and Gynaecology. The report titled Confidential Review of Maternal deaths was released last year.

• Seventeen of the 133 maternal deaths recorded in 2019-2020 were due to PPH and 19 were due to suicide.
• According the National Health Portal of India, PPH accounts for 35 per cent of all maternal deaths.

Postpartum haemorrhage (PPH)

PPH is defined as a “blood loss of 500 ml or more within 24 hours after birth, while severe PPH is defined as a blood loss of 1,000 ml or more within the same timeframe,” by the World Health Organization. The incidences of postpartum haemorrhage are 1-5 percent only. It most often happens after the placenta is delivered, but it can also happen later.

What causes postpartum haemorrhage?

• Once a baby is delivered, the uterus normally contracts and pushes out the placenta. 
• After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. 
• If the uterus does not contract strongly enough, these blood vessels bleed freely and as a result the proper constriction of the vessels does not happen and they keep bleeding profusely. This is the most common cause of PPH. 
• If small pieces of the placenta stay attached, bleeding is also likely. 

Postpartum hemorrhage may also be caused by:

• Tear in the cervix or tissues of the vagina
• Tear in a blood vessel in the uterus
• Hematoma formation
• Inversion of uterus
• Blood clotting disorders
• Placenta problems

PPH in Kerala

• In spite of near total hospital deliveries, very good antenatal coverage, improvement in blood transfusion facilities and many developments in technology to arrest the bleeding,” deaths due to PPH have remained a persistent concern.
• PPH deaths were highest in the 20-29 age group. This is also the age group that has the highest number of deliveries.
• At 46 per cent, atonic PPH — “failure of the uterus to contract following delivery” leading to excessive bleeding — is the most common type of obstetric haemorrhage.
• Moreover, a third of PPH deaths were recorded in caesarean births, highlighting “the importance of practicing safe caesarean section technique and postoperative monitoring.”

The report said: In interpreting the cause of death, the primary cause is taken into consideration even though the final cause also may be relevant. For instance, a patient who had atonic PPH and later obstetric hysterectomy, recovered but died after a few days due to pulmonary embolism; we have taken the stand that it should be included under PPH as it was the primary cause which set the ball rolling.

The Way Forward

PPH being a leading cause of maternal death is not only a country-wide trend but has also been seen in other low-income countries. 

• The incidences of PPH can be prevented by proper management, correcting anaemia, involving a trained doctor for delivery and sensitising pregnant women regarding regular checkups during pregnancy. 
• A combination of quality antenatal care, skilled care at birth by active management of third stage of labour, the availability of high-quality emergency obstetric care (with trained medical personnel and adequate infrastructure) and improved access to these services are essential to save many maternal lives.
• Government needs to create a wide array of support network for pregnant women – right from 
  • Access to good quality nutrition – Lots of protein, iron, calcium rich food builds their stamina to deal with complications.
  • Reducing cases of Anaemia
  • Provision of access to good antenatal care
  • Counselling for both parents to have 2-3 years gap between babies
  • Tertiary care provision at all government hospitals
  • Pregnant women should be motivated for monthly check up and have their delivery at nearby hospitals. 
  • Grassroots level workers should be appointed at village level to educate women about this.

Can you answer the following questions?

1. One Indian woman dies every 5 minutes from postpartum hemorrhage. Suggest ways to prevent this country-wide trend.