Postpartum Hemorrhage

  • Postpartum hemorrhage (PPH) is defined as a cumulative blood loss of 500 mL or more after childbirth. It is the leading cause of maternal mortality worldwide and primarily occurs within the first 24 hours after delivery.

    There are two types of PPH:

    • Primary PPH – Occurs within the first 24 hours postpartum.

    • Secondary PPH – Occurs between 24 hours and 6 weeks postpartum, often due to infection or retained placental tissue.

  • PPH is caused by one or a combination of the 4 Ts:

    • Tone – Uterine atony (failure of the uterus to contract after birth), the most common cause of PPH.

    • Tissue – Retained placental fragments that prevent proper contraction.

    • Trauma – Lacerations, uterine rupture, or instrumental delivery injuries.

    • Thrombin – Blood clotting disorders that prevent coagulation.

    Risk factors include multiple pregnancies, prolonged labor, cesarean delivery, preeclampsia, and previous PPH. However, many cases occur without prior risk factors, making early detection essential.

  • Currently, blood loss after childbirth is visually estimated, a method known to be highly inaccurate. In a survey we conducted in Catalonia, 89% of midwives reported using visual estimation, despite its tendency to severely underestimate actual blood loss.

    Some existing methods for blood loss quantification include:

    • Calibrated Drape Collectors – Effective but uncomfortable, and mainly used in operating rooms.

    • Weighing Absorbent Pads – Time-consuming and impractical for routine postpartum care.

    The lack of an accurate, comfortable, and widely accessible method means that PPH is often detected too late, leading to severe complications and unnecessary interventions.

  • If PPH is detected early, it can often be controlled with uterotonics—medications that help the uterus contract and reduce bleeding.

    Uterotonics include:

    • Oxytocin – The first-line treatment, administered intravenously or intramuscularly.

    • Misoprostol – A heat-stable alternative used in low-resource settings where oxytocin storage is difficult.

    • Carbetocin – A long-acting version of oxytocin, effective for preventing PPH.

    If blood loss continues or exceeds critical levels, more invasive and costly treatments are required, such as:

    • Intrauterine balloon tamponade – A device inserted into the uterus to apply pressure and stop bleeding.

    • Blood transfusions – Often necessary when severe blood loss occurs.

    • Surgical interventions – Including uterine artery embolization, hysterectomy (removal of the uterus), or exploratory laparotomy in extreme cases.

    These advanced treatments increase healthcare costs and may result in long-term complications, including infertility.

Woman in hospital room on a bed; appears to be a medical facility setting.

Maternal Health Disparities Worldwide

Access to PPH treatment varies greatly between countries, leading to significant inequalities in maternal survival rates.

  • High-income countries have access to medications, blood transfusions, and surgical interventions, reducing mortality rates.

  • Low-resource countries often lack these life-saving treatments, making PPH the leading cause of maternal death.

  • In sub-Saharan Africa and South Asia, maternal mortality rates are over 50 times higher than in developed nations due to limited access to trained healthcare providers, uterotonics, and blood banks.

A simple, accessible, and effective solution to measure blood loss could help reduce these disparities and save thousands of lives each year.