Bleeding after delivery contributes 34 percent of death to Malawi women – Malewezi

Bleeding after delivery which is also known as postpartum haemorrhage (PPH) accounts for approximately 34 percent of deaths amongst women in Malawi.

According to Bridget Malewezi, a medical officer and head of clinical department at Daeyang Luke Hospital in  the capital, Lilongwe, writing the Malawi News, PPH has many causes, but the most common is failure of the uterus to shrink following delivery of the baby.

“Usually after delivery the uterus should shrink to the size of a small belly button. This shrinking causes the blood vessels to close up, if however, the uterus can’t shrink back to this size the blood vessels remain open and bleeding continues,” said Malewezi.

According to Malewezi, this usually happens if there is something remaining in the uterus for example a placenta or some other tissues that block shrinking at the same time if uterus muscles are weak especially common in those that have had several pregnancies before or have had twins (as muscles were overstretched and are less able to shrink back to normal size).postpartum haemorrhage

“Other causes include having cuts in the birth canal due to delivery (some of which can be very deep) and rarely some people have bleeding disorders that result in them losing blood excessively,” she added.

She said the for one know there is presence of such a problem, often there is heavy bleeding which leads to symptoms such as pallor, dizziness, heart palpitations, weakness, sweating, loss of consciousness and eventually death if untreated.

“And important thing to remember is that sometimes however the bleeding can be slow for maybe up to a period of 2 weeks but still results in the same symptoms,” she said.

She however said women will bleed after any delivery, normally less than 500ml. However, in PPH the woman losses more than 500ml of blood sometimes as much as 2 to 3l. She said it is therefore, important to recall that the human body only has 5litres of blood so losing 1 litre means you have lost over 20 percent of blood volume.

“Management is by treating the underlying cause. As shown there are several reasons why someone may have excessive bleeding after delivery so the treatment has to be targeted to the specific cause. Usually, they will get medication that stops bleeding [especially those that help the uterus shrink].

“Sometimes, surgery is required either to repair cuts, remove contents remaining in the uterus or to remove the uterus altogether. Blood transfusion is often required to replace the blood lost,” Malewezi advised.

But for the prevention side of the problem, Malewezi said women are advised to deliver in a health facility where straight after delivery they are given medications that help the uterus contract. She said this also means that should bleeding progress, they are at a place that is prepared to give the other required treatments.

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