Postpartum haemorrhage driving high maternal mortality in India: Experts

New Delhi: Postpartum haemorrhage is the biggest contributor to high maternal mortality in India, experts said on Wednesday.

The World Health Organization (WHO) defines postpartum haemorrhage (PPH) as a blood loss of more than 1,000 ml within 24 hours of giving birth and is considered severe PPH and fatal.

As per the National Health Portal of India, PPH is a blood loss of more than 500 ml within 24 hours of giving birth. Several studies have shown that most deaths related to PPH occur within the first 24 hours of giving birth, stressing the importance of post maternal care.

The National Health Mission (NHM) guidance note states that PPH is the ‘most common’ cause of death of women during childbirth in India — with 38 per cent maternal deaths caused by it.

“PPH is the leading cause of maternal morbidity and mortality in India. It is always a nightmare and the quickest of all the causes for maternal deaths. Management of severe PPH is always an emergency and delay often leads to severe complications,” Dr Alpesh Gandhi, Obstetrician and Gynaecologist associated with The Federation of Obstetric and Gynaecological Societies of India (FOGSI), told IANS.

However, Gandhi noted that the majority of these deaths can be prevented by timely and appropriate management of immediate bleeding control.

From 130 in 2014 to 97 in 2020, India has seen a decline in the maternal mortality ratio (MMR).

“But there is still a long way to go to attain the UN sustainability goal in maternal health for MMR of 70. Institutional delivery has helped reduce MMR but for severe cases multi-speciality care is required and there is a need for non-invasive treatment options in such cases,” Dr Fessy Louis, Associate Professor and senior Consultant at Amrita Institute of Medical Sciences, Kochi, Kerala, told IANS.

It is also the leading cause of maternal mortality worldwide. Each year, about 14 million women experience PPH resulting in about 70,000 maternal deaths globally.

Even when women survive, they often need urgent surgical interventions to control the bleeding and may be left with lifelong reproductive disability, according to the WHO.

The global health body accounts for the failure of the uterus to contract following delivery as the primary cause of PPH, about 50 per cent.

Other causes include uterine atony — soft or a weak uterus after delivery; uterine trauma — damage to vagina during childbirth that causes bleeding; retained placental tissue — when the placenta doesn’t separate from the uterine wall; and blood clotting.

“Even though with adequate medical and surgical interventions, there has been a lowering of maternal mortality secondary to PPH, there is still an unmet need of new modalities to control bleeding faster and reduce the mortality rates further,” Dr Mala Srivastava, senior Consultant, Obstetrics and Gynaecology, Sir Ganga Ram Hospital, told IANS.

“Newer advances in terms of medical management can be helpful in reducing the complications, need for massive transfusions, obstetric surgical interventions and deaths due to PPH,” Gandhi said.