Postpartum hemorrhage (PPH) is a critical condition that can occur shortly after childbirth and is a leading cause of maternal mortality globally. The mnemonic “4 Ts” is used to categorize the common causes of PPH.
- Tone: Uterine Atony
- Description: Uterine atony involves the inability of the uterus to contract effectively after delivery, leading to significant bleeding.
- Management: Management strategies include uterine massage and administration of uterotonic agents such as Oxytocin or Misoprostol. In cases where these interventions fail, surgical procedures like uterine artery embolization or hysterectomy may be necessary.
- Trauma
- Description: Trauma during childbirth can include vaginal or cervical lacerations, uterine rupture, or injuries at episiotomy sites, which can all cause severe bleeding.
- Management: It’s crucial to perform a detailed examination to identify any trauma. Surgical repair is typically required to suture any tears and control hemorrhage.
- Tissue: Retained Placental Tissue
- Description: Retained placental fragments or membranes in the uterus prevent it from contracting fully, leading to hemorrhage.
- Management: The removal of retained products of conception is typically performed via manual extraction or curettage under anesthesia, often assisted by ultrasonography to ensure complete removal.
- Thrombin: Coagulopathy
- Description: Coagulopathy may be pre-existing or acquired during delivery, leading to conditions such as disseminated intravascular coagulation (DIC), which can severely complicate PPH.
- Management: Treatment focuses on correcting the coagulopathy using transfusions of blood products like fresh frozen plasma, platelets, and cryoprecipitate and on addressing the primary cause of the coagulation disorder.