Postpartum haemorrhage; what you need to know

A mother and her new-born. It’s important for women to know before delivery what puts them at risk of postpartum haemorrhage, to avoid complications that arise later. / Net photo

In Rwanda, the number one suggestion for blood transfusion is postpartum haemorrhage and other pregnancy-related complications, according to National Centre for Blood Transfusion (NCBT).

Children under five, patients with chronic diseases and those involved in accidents are also among those who need blood.

 

It’s in this regard that Rwanda Biomedical Centre (RBC) in a joint venture with Access Bank and Iby’iWACU organised a three-day blood donation campaign, under the theme ‘maternal healthcare; give blood save a life.’

 

The campaign which took place last week at the car-free zone aimed at donating blood mainly to save the lives of mothers and children and, patients with different ailments.

 

The 2019 NCBT data on demands from hospitals and the supply shows that blood collection sessions were 1,436 and 68,581 blood units were collected.

Whereas, hospitals demand was 102,145 blood components while NCBT managed to supply 91,960 blood components. The hospital satisfaction, therefore, was 90.03 per cent.

According to officials, the fact that mothers are the ones who need blood most, being at the forefront to donate will not only help save their own lives, but also help encourage others to do so,” she says.

Nadine Rutabayiro, the head of women banking, Access Bank, says as a bank, they do more than just banking and that  beyond banking women; they also take care of them in different ways.

“When you want to empower a woman, you can’t focus on the commercial part only. Here, we are talking about mothers who are taking care of the whole family, empowering them means we need to consider the healthcare part as well,” she says.

The initiative, she adds, is one way of contributing to the government’s efforts in blood donation.

Olivier Gakuba, the head of the strategic business unit at the same bank, says their aim is to be part of the platform that fights postpartum mortality rate by giving back to the community through blood donation.

Fiona Cecile Umurisa, the founder of Iby’iWACU Rwanda, says the initiative benefits society at large, adding that giving back to the community not only has a positive impact on an individual, but the nation.

Throughout the campaign, 280 blood units were collected.

Understanding postpartum haemorrhage

Dr Swaibu Gatare, Division Manager of the National Centre for Blood Transfusion (NCBT) at RBC, says postpartum haemorrhage is bleeding more than normal after the birth of a baby.

About 1 in 100 to 5 in 100 women suffer postpartum haemorrhage. It is more likely with a caesarean birth.

Experts say it most often happens after the placenta is delivered, but it can also happen later. 

“Postpartum haemorrhage is heavy bleeding after the birth of the baby. Losing lots of blood quickly can cause a severe drop in blood pressure. It may lead to shock and death if not treated,” he says.

Gatare says the most common cause of postpartum haemorrhage is when the uterus does not contract enough after delivery, adding that finding and treating the cause of bleeding can often lead to full recovery.

He explains that once a baby is delivered, the uterus normally contracts and pushes out the placenta.

After the placenta is delivered, Gatare explains that 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.

This, he says, is the most common cause of postpartum haemorrhage. If small pieces of the placenta stay attached, bleeding is also likely. 

Other causes include; tear in the cervix or tissues of the vagina, tear in a blood vessel in the uterus.

Also, bleeding into a hidden tissue area or space in the pelvis as well as blood clotting disorders and placenta problems are some of the possible causes of postpartum haemorrhage.

Experts point out that some women are at greater risk of postpartum haemorrhage than others.

The conditions that may increase the risk, they say, include; placental abruption which is the early detachment of the placenta from the uterus.

Gatare says another cause is placenta previa. This is when the placenta covers or is near the opening of the cervix.

And there is also what is known as over distended uterus. Gatare says this is when the uterus is larger than normal because of too much amniotic fluid or a large baby.

Other risks are multiple-baby pregnancy and also high blood pressure disorders of pregnancy.

Gatare says symptoms include uncontrolled bleeding, decreased blood pressure, and increased heart rate, among others.

Way forward

According to Iba Mayale, a Kigali-based gynaecologist, the aim of treating postpartum haemorrhage is to find and stop the cause of the bleeding as soon as possible.

He says the treatment may include providing medicine or uterine massage to stimulate uterine contractions.

Also, removing pieces of the placenta that remain in the uterus can control this condition.

He says replacing lost blood and fluids is important in treating postpartum haemorrhage.

For instance, Mayale says one can be given IV (intravenous) fluids, blood, and blood products to prevent shock. Oxygen may also help.

“Losing lots of blood quickly can cause a severe drop in blood pressure. This may lead to shock and death if not treated,” he observes.

Mayale advises that it’s important for a woman to know before delivery what puts her at risk of postpartum haemorrhage, to avoid complications that arise later.

Also, he says that early care in case of postpartum haemorrhage can reduce the amount of blood loss.

editor@newtimesrwanda.com

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