Rajasthan Doc Suicide: India's 38% Maternal Deaths Due to Postpartum Haemorrhage

PPH is the 'most common' cause of death of women during childbirth in India. What are the causes and symptoms?

PPH is the 'most common' cause of death of women during childbirth in India.

(Photo: UNICEF)

A doctor who was charged for allegedly causing a pregnant woman's death in a private hospital in Rajasthan's Dausa died by suicide on 29 March.

In her suicide note, she wrote that she had not made a mistake but the patient died by a known complication: postpartum haemorrhage (PPH).

“It is the most common cause of death of pregnant woman during childbirth. The survival chances of a PPH patient is always less. The gynaecologist tried her best, but the patient could not survive. Blaming doctor for this is injustice," said Dr Anju Soni, Chairperson, Federation of Obstetric and Gynaecological Societies of India (FOGSI).

According to National Health Mission (NHM) guidance note, PPH is the 'most common' cause of death of women during childbirth in India – with 38 percent maternal deaths caused by it.

What is PPH?

The National Health Portal defines PPH as a blood loss of more than 500 ml or more within 24 hours of giving birth, thereby affecting the mother's vital signs. Most PPH deaths also occur within the first 24 hours of giving birth, multiple studies show.

A blood loss of more than 1,000 ml within the same 24-hour period is considered 'severe PPH' and is fatal, the World Health Organization (WHO) defines.

Secondary or late postpartum hemorrhage could also occur – between 24 hours and 12 weeks postpartum. However, if the mother is anaemic or malnourished, even lesser bleeding can affect her vital signs.

Loss of large amounts of blood can cause a sharp decline in blood pressure, Cleveland Clinic explains, adding that this may restrict the flow of blood to organs – causing shock that can lead to death.

Failure Of Uterus To Contract & Other Causes

The primary cause, according to the WHO, is the failure of the uterus to contract following delivery. This reportedly accounts to 50 percent of cases of PPH.

It is also caused due to:

• Uterine atony – Soft or a weak uterus after delivery

• Uterine trauma – Damage to vagina during childbirth that causes bleeding

• Retained placetal tissue – When the placenta doesn't separate from the uterine wall

• Blood clotting

Symptoms of PPH

The most common symptom of postpartum hemorrhage is persistent, excessive bleeding within the 24-hour time frame.

Other symptoms are:

• Drop in blood pressure like dizziness, blurred vision, or feeling faint.

• Increased heart rate

• Decreased red blood cell count

• Pale skin

• Nausea or vomiting

• Worsening abdominal or pelvic pain

How Common Is PPH Across the World

It affects two percent of all people who give birth and is associated with nearly one quarter of maternal deaths globally.

Every year about 14 million people suffer from PPH – with 2-4 percent incidents reported after vaginal delivery and 6 percent after cesarean section.

The risk of maternal mortality from hemorrhage is 1 in 1,000 deliveries in developing countries (100 per 100 000 live births), as per WHO statistics between 1990-2010.

Most deaths (about 99 percent) from PPH occur in low and middle-income countries.

"It is a medical emergency and treatment includes immediate diagnosis of the cause and stopping the bleeding as soon as possible. Replacement of IV fluids, blood and blood products needs to be done simultaneously to prevent deterioration. It’s a serious condition but full recovery is possible with timely, quick treatment," gynaecologist Dr Monica Agarwal told The Indian Express.