17/07/2026
CONTINUING MEDICAL EDUCATION (CME)
This week the CME session was on Post partum hemorrhage(Pph) from all our facilities ;
Leopards hill medical center, kabelenga family hospital, Lilayi family clinic and Halfway family hospital
Postpartum Hemorrhage (PPH)
Definition
Postpartum hemorrhage (PPH) is excessive bleeding after childbirth.
- Primary PPH: Blood loss β₯500 mL after va**nal delivery or β₯1,000 mL after cesarean section within the first 24 hours.
- Secondary PPH: Excessive bleeding occurring from 24 hours to 12 weeks after delivery.
Causes (The 4 Ts)
- Tone: Uterine atony (most common cause)
- Tissue: Retained placental tissue
- Trauma: Tears of the cervix, va**na, perineum, or uterine rupture
- Thrombin: Blood clotting disorders
Risk Factors
- Prolonged or rapid labor
- Multiple pregnancy
- Large baby (macrosomia)
- Previous PPH
- Placenta previa or placental abruption
- Induction or augmentation of labor
- Coagulation disorders
Signs and Symptoms
- Heavy va**nal bleeding
- Low blood pressure
- Fast pulse
- Pale, cold, clammy skin
- Dizziness or fainting
- Reduced urine output
Management
1. Call for help and assess Airway, Breathing, Circulation (ABC).
2. Start two large-bore IV lines and give crystalloids.
3. Administer uterotonics:
- Oxytocin (first-line)
- Tranexamic acid within 3 hours of birth if PPH is diagnosed
- Misoprostol or ergometrine (if appropriate)
4. Identify and treat the cause (4 Ts).
5. Perform uterine massage if uterine atony is present.
6. Blood transfusion if significant blood loss.
7. Surgical intervention if bleeding persists.
Prevention
- Active management of the third stage of labor
- Routine oxytocin after delivery
- Early identification of high-risk women
- Prompt recognition and treatment of excessive bleeding
Key Message
Postpartum hemorrhage is a leading cause of maternal death but is preventable and treatable with early recognition, rapid resuscitation, uterotonics, and timely management of the underlying cause.
Visit any of our facilities for your antenatal services. Early and regular antenatal care helps identify risk factors, promotes a safe pregnancy, and improves outcomes for both mother and baby.