Postpartum haemorrhage (PPH), ie excessive bleeding following birth, can be a traumatic experience for a woman to undergo.
Once a baby has been delivered, the uterus will usually contract again to help expel the placenta and to reduce the bleeding through the blood vessels which were supplying the placenta. When a PPH occurs, it is usually caused by the uterus failing to contract as expected and is more common when the labour has been very long or when the uterus has been stretched more than usual, for example after the delivery of twins, when there has been extra amniotic fluid around the baby, or the delivery of a large baby. Other common causes of PPH are when the placenta does not come away as it should or if the walls of the vagina tear as the baby is being delivered.
If a PPH does occur, the woman will experience uncontrolled bleeding from her genital tract, her blood pressure will drop and her heart rate will increase. When these issues arise following a birth, the obstetric and/or midwifery teams should recognise the possible haemorrhage and take immediate action to stop the bleeding. Treatment then depends on the underlying cause and the extent of blood loss. If the haemorrhage is minor and caused by retained placenta, it may be sufficient to administer medicine to stimulate contractions and insert a vaginal pack, but if it is more severe, a Bakri balloon or Foley catheter should be inserted into the uterus to place pressure on the bleeding vessels. An intravenous blood transfusion and fluids will also be required to replace those that have been lost.
If the source of the bleed cannot be identified, surgery must be performed to locate and seal the injured blood vessels. If this is unsuccessful, a hysterectomy will be performed to avoid the risk of fatal blood loss.
When medical failings cause a woman to suffer life-changing injuries, the care provided may have been substandard and a clinical negligence claim can arise. If the haemorrhage is not diagnosed or stopped quickly enough, and a hysterectomy has to be performed, this will leave the woman infertile and bring about the early onset of menopause. This can be very difficult to deal with, particularly if the woman was hoping to have more children, often causing further psychological trauma.
Alison Johnson, an associate director in the clinical negligence team at Penningtons Manches, who represents a number of women with gynaecological claims following injury during childbirth, comments: “I have recently settled a claim for a woman who haemorrhaged at home, a few days after giving birth, and was rushed back to hospital. The obstetric team initially treated her conservatively with antibiotics, but a scan showed retained products of conception, so uterine evacuation surgery was performed. Just a few hours after surgery she bled again heavily and underwent an emergency repeat evacuation, in traumatic circumstances, this time under ultrasound guidance, when a considerable amount of tissue was removed. The claim related to the negligent failure by the surgical team to perform the uterine evacuation to an acceptable standard the first time around. Had this been the case, the client would have avoided the distressing repeat haemorrhage and need for life-saving surgery, which caused her a psychological injury.
“I am also currently investigating a potential claim relating to a postpartum haemorrhage after incomplete delivery of the placenta in theatre following a planned caesarean section. The midwife felt the placenta was incomplete and raised her concerns, but the obstetrician was confident it was complete. The woman continued to bleed post-delivery, and her obstetrician agreed that the midwifery team should be monitoring blood loss by way of weighing her pads. After a shift change in the midwifery team, this was not properly communicated and so the monitoring did not happen. The woman haemorrhaged again and was rushed to theatre for emergency surgery, with the possibility of a hysterectomy. Retained placental parts were removed in theatre, but the experience has had a huge impact on the client, who is now reluctant to have any further children, as she and her husband had wanted.
“Not all postpartum haemorrhages will give rise to a clinical negligence claim and every case is unique. Much will depend on the cause of the situation, the standard of medical care provided, and whether there has been a long-term injury.