Postpartum haemorrhage (PPH) is one of the most feared complications of childbirth and a leading cause of maternal deaths worldwide.
In Nigeria, where health facilities and emergency care are often inadequate, the condition contributes heavily to the country’s already high maternal mortality rate.
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Health experts describe PPH as excessive bleeding after childbirth, a complication that can turn a moment of joy into a life threatening emergency.
It occurs either within the first 24 hours of delivery, known as primary PPH, or any time up to six weeks after childbirth, known as secondary PPH.
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According to the World Health Organisation (WHO), approximately 14 million women experience PPH annually, resulting in about 70,000 maternal deaths globally.
Why PPH is deadly
Speaking with PT Health Watch, Lewis Aituma, a senior resident doctor in Obstetrics and Gynaecology, describes PPH as “the obstetrician’s nightmare, especially in low and middle income countries like ours, which are challenged with poor healthcare indices and paucity of emergency obstetric care services.”
According to Mr Aituma, who is also the Secretary of the Nigerian Medical Association (NMA), Edo Central Zone, PPH is responsible for over 25 per cent of direct maternal death globally, with the toll higher in resource-poor countries.
“Any woman with risk factors such as multiple pregnancies, prolonged labour, fibroids, anaemia, or previous Caesarean deliveries may be more vulnerable,” he explained.
He said the consequences are severe, noting that women who develop PPH may die from shock and organ failure if bleeding is not controlled quickly.
He added that survivors sometimes face infertility after surgical interventions like hysterectomy, prolonged hospitalisation, or long-term complications.
Causes, risk factors
Mr Aituma noted that the condition can arise from several causes, like weak uterine contractions after delivery, tears in the birth canal, retained placenta or foetal membranes, and disorders that prevent blood from clotting properly.
Also, Modupe Adedeji, a consultant obstetrician and gynaecologist at Lagos State University Teaching Hospital (LASUTH), adds that the quality of care during delivery is a decisive factor.
Mrs Adedeji said PPH is bleeding within the first 24 hours, often more than 500ml after a vaginal birth or 1000ml after a Caesarean section.
“Who is taking the delivery matters because skilled attendants know the steps, medications, and manoeuvres required to prevent uncontrolled bleeding,” she said.
Both experts highlighted that multiple pregnancies, coexisting fibroids, poorly managed labour, or attempts at vaginal birth after repeated Caesarean sections can heighten risks.
Secondary PPH, which happens beyond 24 hours, may result from retained tissue, uterine infection, or unnoticed lacerations.
Prevention, early Action
Mr Aituma further highlighted the importance of hospital deliveries under the supervision of trained birth attendants.
He also emphasises that “education of women on the benefits of family planning, compliance with antenatal visits, and discouraging aversion to Caesarean deliveries when indicated are key preventive strategies.”
Mrs Adedeji points out that every woman, regardless of risk profile, should be treated as a potential PPH case.
“Every patient must be managed in a facility equipped with skilled personnel, a functional blood bank, and essential medications like oxytocin and tranexamic acid,” she said.
She added that awareness campaigns should help women and families understand the dangers of home births and reliance on unskilled attendants.
Challenges in Nigeria
The experts also cited poor road infrastructure, inadequate emergency obstetric care centres, and the shortage of skilled healthcare workers as major obstacles.
“Poor decision-making by victims who first report to worship centres, quacks, or unskilled attendants in emergencies contributes to delays. Even when women get to the hospitals, the lack of blood products, poor equipment, and underfunded facilities limit survival chances,” Mr Aituma warned.
Mrs Adedeji also highlighted the concern of the mass emigration of healthcare workers, which worsens the shortage of skilled attendants, leaving many facilities understaffed.
What needs to change
Both experts agree that to address PPH, solutions include investment in emergency obstetric care, training and retention of skilled personnel, and ensuring the availability of essential medicines and blood banks are crucial.
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They noted that family planning and education of the girl child can also reduce the risks linked to multiple pregnancies and poor health seeking behaviour.
“No woman should die in labour because the road to maternal death is very long and torturous with so many opportunities available to prevent it,” Mr Aituma said.
Mrs Adedeji added that government support to make maternal healthcare affordable, accessible, and equipped with the right personnel is essential.
