Postpartum haemorrhage (PPH), a condition characterised by excessive bleeding after childbirth, remains one of the leading causes of maternal deaths worldwide.

In Nigeria, where health facilities and emergency care are often inadequate, the condition contributes heavily to the country’s already high maternal mortality rate.

Health experts warn that women with certain pregnancy conditions face a significantly higher risk.

According to the World Health Organisation (WHO), approximately 14 million women experience PPH annually, resulting in about 70,000 maternal deaths globally.

Although PPH can occur in any woman, factors such as fibroids, multiple pregnancies, anaemia, and prolonged labour increase the likelihood of severe bleeding, especially when care is delayed or delivery takes place outside properly equipped health facilities.

Speaking with PT HEALTH WATCH, a consultant gynaecologist and Managing Director, Mother and Child Hospital, Lagos, Sunday Olarewaju, said understanding these risk factors and seeking appropriate care early can help prevent avoidable maternal deaths.

A major maternal health challenge

Mr Olarewaju described postpartum haemorrhage as a major contributor to maternal mortality in the country, noting that the condition affects a notable proportion of deliveries.

He explained that PPH is defined by the volume of blood lost after childbirth.

“When a woman loses about half a litre of blood after vaginal delivery, or about a litre during caesarean section, that is considered postpartum haemorrhage,” he said.

He added that the condition may occur immediately or weeks after delivery.

“There is the immediate one within the first 24 hours, and another that may occur later, up to six weeks or even up to three months after delivery,” he explained.

Causes and risk factors

Mr Olarewaju said high-risk pregnancies including multiple pregnancies such as twins or triplets, over-stretched uterus, significantly affect how the womb behaves after delivery.

He explained that a normal womb is designed for one baby, but when there are more than one, the uterus is stretched and the muscles become weak.

Fibroids, he added, can also interfere with the womb’s ability to contract.

“They make the womb big and flabby and prevent it from contracting well after delivery,” he said.

According to him, poor contraction of the womb is a major reason bleeding continues after childbirth.

Four Ts

The expert said doctors often assess PPH using the “four Ts” which are tone, tissue, trauma, and thrombin.

He explained that tone refers to the ability of the womb to contract after delivery. When the womb fails to contract properly, blood vessels remain open, leading to continued bleeding.

Tissue, he said, involves retained parts of the placenta or membranes in the womb, which can also cause persistent bleeding.

Trauma refers to tears or injuries to the cervix, vagina, or uterus during childbirth.

Thrombin, on the other hand, relates to blood clotting problems, where the blood is unable to clot properly to stop bleeding.

He warned that women who are already weak, anaemic or experience prolonged labour are also at greater risk of complications.

ALSO READ: Nigeria accounts for highest global maternal deaths from postpartum haemorrhage – Research

He also noted that prolonged labour can weaken the uterus, reducing its ability to contract after delivery.

“A woman who has prolonged labour is already exhausted, and the womb itself becomes tired. Because of that, it may not be able to contract effectively after delivery, and this can lead to continued bleeding,” he added.

The expert advised that certain conditions including blood pressure, bleeding during pregnancy, diabetes and unusually large babies should not be ignored.

He also advised that women with such conditions should plan delivery in facilities with skilled healthcare providers.

Access to care

Mr Olarewaju linked many cases of PPH-related deaths to poor access to healthcare and low awareness, emphasising the role of education and access to skilled care.

He expressed concern about the continued reliance on unskilled birth attendants, noting that many people still go to traditional birth attendants where basic medical care may not be available.

He also called for improved healthcare systems, especially at the primary level, to reduce maternal deaths.

According to him, accessible and well-equipped health centres, along with efficient referral systems, are essential.

“By strengthening basic health services and ensuring people use them, we will reduce maternal mortality,” he said.

He stressed that preventing PPH begins before pregnancy, while advising women with known conditions to seek medical evaluation early and follow professional guidance.

PT Health Watch: Fibroids and multiple pregnancies increase risk of postpartum haemorrhage - Expert

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