Post-Partum Haemorrhage (PPH) | 18 Dec 2019

Why in News

Recently, an advisory was issued by the Union Health Ministry to States to adopt the Gujarat model of “non-interventional approach during the final stages of labour” as the best obstetric practices.

  • However, obstetricians say the advisory runs contrary to the World Health Organization (WHO) recommendations and this can undo all their efforts to reduce Post-Partum Haemorrhage (PPH) and prevent mothers bleeding to death.
  • PPH is the leading cause of maternal mortality in India.

Post-Partum Haemorrhage

  • Postpartum haemorrhage (PPH) is defined as a blood loss of 500 ml or more within 24 hours after birth.
  • PPH is the leading cause of maternal mortality in low-income countries, and the primary cause of nearly one quarter of all maternal deaths globally.
  • Common Cause: 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.

WHO’s Recommendations

  • WHO-recommended strategy is that of “active management of third stage of labour” (AMTSL).
    • The third stage is the time between the delivery of the baby and the expulsion of the placenta and its duration could be approximately six to 30 minutes.
    • The volume of blood loss during this time depends on how long it takes the placenta to separate from the uterine wall and how effectively the uterine muscle contracts in the immediate post-partum period.
  • WHO recommends the use of uterotonics (drugs to contract uterus and reduce bleeding) as the best critical measure.

Government’s Advisory

  • The new advisory, advocates the physiological management or the “hands-off” approach during the third stage of labour.
  • It says to delay the clamping and cutting of umbilical cord till placenta separates naturally and is expelled from the uterus. And that the uterotonic oxytocin be administered only after the placenta is expelled.

Source: TH