Postpartum haemorrhage (PPH), defined as excessive bleeding after childbirth, continues to be a primary driver of maternal fatalities worldwide.
In Nigeria, where access to healthcare facilities and emergency interventions is frequently limited, PPH significantly contributes to the nation's high maternal mortality rate.
Health professionals are cautioning that women experiencing specific pregnancy-related conditions face a considerably higher danger of this complication.
According to data from the World Health Organisation (WHO), an estimated 14 million women worldwide experience PPH each year, resulting in approximately 70,000 maternal deaths.
Health experts indicate that women with certain pregnancy complications are at a substantially elevated risk of this serious condition.
Speaking to PT HEALTH WATCH, Sunday Olarewaju, a consultant gynaecologist and the Managing Director of Mother and Child Hospital in Lagos, stated that recognizing these risk factors and seeking timely, appropriate medical care can help avert preventable maternal deaths.
Mr. Olarewaju characterized postpartum haemorrhage as a critical factor in Nigeria's maternal mortality figures, noting its prevalence among deliveries.
He clarified that PPH is determined by the volume of blood loss post-delivery.
"When a woman loses approximately half a litre of blood after a vaginal delivery, or about a litre following a caesarean section, it is considered postpartum haemorrhage," he stated.
He further explained that the condition can manifest either immediately after delivery or extend for weeks.
"There is the immediate onset, occurring within the first 24 hours, and another form that may appear later, up to six weeks or even three months post- delivery," he elaborated.
Mr. Olarewaju noted that high-risk pregnancies, such as those involving multiple babies like twins or triplets, and an excessively stretched uterus, profoundly impact the womb's function after birth.
He explained that while the uterus is designed for a single foetus, multiple pregnancies lead to overstretching, weakening its muscular capacity.
Fibroids, he added, can also impede the uterus's ability to contract effectively.
"They cause the womb to become large and flaccid, hindering proper contraction after childbirth," he explained.
He highlighted that insufficient uterine contraction is a major reason for persistent bleeding following childbirth.
The expert mentioned that medical professionals often evaluate PPH using the "four Ts": tone, tissue, trauma, and thrombin.
He elaborated that 'tone' refers to the uterus's capacity to contract post- delivery; inadequate contraction leaves blood vessels open, leading to ongoing bleeding.
'Tissue,' he continued, pertains to retained placental fragments or membranes within the uterus, which can also cause persistent bleeding.
'Trauma' encompasses tears or injuries to the cervix, vagina, or uterus sustained during delivery.
Conversely, 'thrombin' relates to issues with blood clotting, where the blood fails to coagulate effectively to stop bleeding.
He warned that women who are already weakened, suffer from anaemia, or endure prolonged labour are also more susceptible to complications.
He also noted that extended labour can exhaust the uterus, diminishing its contractile strength after birth.
"A woman experiencing prolonged labour is already fatigued, and the uterus itself becomes tired. As a result, it may not contract effectively post- delivery, which can lead to continued bleeding," he added.
The specialist advised that specific conditions, including high blood pressure, bleeding during pregnancy, diabetes, and unusually large babies, should not be overlooked.
He also recommended that women with such conditions should plan their deliveries in facilities staffed by skilled healthcare providers.
Mr. Olarewaju attributed many PPH-related fatalities to inadequate healthcare access and low public awareness, underscoring the crucial role of education and access to skilled medical care.
He expressed concern over the continued reliance on unskilled birth attendants, noting that many individuals still seek services from traditional birth attendants who may lack essential medical resources.
He also advocated for enhancements in healthcare systems, particularly at the primary care level, to reduce maternal deaths.
According to him, accessible and well-equipped health centres, coupled with effective referral pathways, are indispensable.
"By strengthening primary health services and encouraging their use, we will achieve a reduction in maternal mortality," he stated.
He emphasized that PPH prevention begins even before conception, advising women with known medical conditions to undergo early medical evaluations and adhere to professional medical advice.
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