The 4 T's — Causes of PPH
| Cause | % of Cases | Description |
|---|---|---|
| Tone | 70% | Uterine atony — the womb fails to contract properly after birth |
| Trauma | 20% | Tears to cervix, vagina, or perineum |
| Tissue | 10% | Retained placenta or membranes |
| Thrombin | <1% | Clotting disorders (rare) |
Warning Signs
- Heavy, continuous vaginal bleeding after birth
- Feeling faint, dizzy, or confused
- Rapid heart rate
- Low blood pressure
- Pale, clammy skin
Emergency Treatment
- Uterine massage to encourage contraction
- IV oxytocin and other uterotonic drugs
- IV fluids and blood transfusion if needed
- Examination to identify and repair any tears
- Balloon tamponade or surgical intervention if bleeding continues
- In severe, life-threatening cases: hysterectomy as a last resort to save life
Secondary PPH — Seek Urgent CareHeavy bleeding, feeling unwell, fever, or foul-smelling discharge occurring days to weeks after birth can indicate secondary PPH from infection or retained tissue — contact your midwife or maternity unit urgently, don't wait.
Active Management of Third StageRoutine use of oxytocin immediately after birth (active management of the third stage of labour) significantly reduces PPH risk and is now standard practice in most hospital births.
Am I at higher risk of PPH?
Risk factors include: multiple pregnancy, large baby, prolonged labour, previous PPH, placenta praevia, and having several previous babies. Your midwife will discuss your individual risk and birth plan.
Will I need a blood transfusion?
Only in more significant PPH. Iron supplements are often given afterward regardless, as most women lose more blood than usual and can become anaemic.
Can PPH be prevented completely?
No method eliminates risk entirely, but active management of the third stage (oxytocin injection) substantially reduces the risk and severity of PPH.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.