Obstetrics – Postpartum Haemorrhage (PPH) in NEET PG

Introduction

Postpartum haemorrhage (PPH) is a life-threatening obstetric emergency and a high-yield topic in NEET PG. It remains one of the leading causes of maternal mortality worldwide, making its recognition and timely management crucial. The exam often tests PPH through clinical vignettes, emphasising early identification, classification, and appropriate interventions. Understanding the causes, risk factors, and stepwise management can make this topic easier to recall during preparation and clinical practice. A structured approach ensures both higher exam scores and the ability to save lives in real-world obstetric care.

Definition and Classification

• Primary PPH: Blood loss >500 mL within 24 hours after vaginal delivery.


• Secondary PPH: Blood loss occurring between 24 hours and 12 weeks postpartum.


• Major PPH: Blood loss >1000 mL requiring aggressive intervention.


• Life-threatening PPH: Rapid haemorrhage leading to hypovolemic shock.

Causes of PPH (4 Ts)

• Tone: Uterine atony is the most common cause.


• Tissue: Retained placenta or membranes obstruct uterine contraction.


• Trauma: Birth canal injuries, including lacerations, hematomas, or uterine rupture.


• Thrombin: Coagulopathies like DIC, pre-existing bleeding disorders, or massive transfusion complications.

Risk Factors

• NEET PG Prolonged labour, multiple pregnancies, or polyhydramnios.


• Previous history of PPH or uterine surgery.


• Pre-eclampsia or use of uterotonics during labour.


• High parity or operative vaginal delivery (forceps/vacuum).

Management of PPH

• Immediate measures: Call for help, ensure IV access, monitor vitals, and start fluid resuscitation.


• Uterotonics: Oxytocin, misoprostol, and ergometrine to promote uterine contraction.


• Mechanical and surgical interventions: Uterine massage, balloon tamponade, uterine artery ligation, or hysterectomy if conservative methods fail.


• Address underlying cause: Remove retained tissue, repair trauma, correct coagulopathy.

Monitoring and Supportive Care

• Monitor blood loss, vitals, urine output, and haemoglobin levels.


• Arrange blood transfusion if necessary to manage hypovolemia.


• Educate the patient and family about warning signs before discharge.


• Document interventions and follow-up for anaemia or infection.

Conclusion

Postpartum haemorrhage in NEET PG requires both rapid clinical reasoning and a systematic understanding of causes and management. By memorising the “4 Ts,” practising stepwise interventions, and linking risk factors with preventive strategies, this topic becomes manageable and high-yield. Mastery of PPH not only ensures better exam performance but also equips future physicians to respond effectively in critical, life-threatening obstetric emergencies.