By The PPH Foundation
Among the Four Ts of postpartum haemorrhage, thrombin represents the body’s ability to form blood clots and stop bleeding after childbirth. Thrombin related PPH occurs when the blood’s natural clotting mechanism is impaired, a condition medically known as coagulopathy. Unlike uterine atony, trauma, or retained tissue, thrombin related haemorrhage is often linked to underlying medical or obstetric complications that affect the woman’s ability to control bleeding.
Coagulation disorders during or after childbirth are relatively less common compared to other causes of PPH, but their consequences can be devastating. When clotting factors are depleted or dysfunctional, even minor bleeding can escalate rapidly into life threatening haemorrhage. This condition may occur in women with severe preeclampsia, placental abruption, severe infection, or pre-existing blood disorders.
Prof Moses Obimbo, the End PPH Initiative Project Lead, explains that thrombin related postpartum haemorrhage is particularly dangerous because it reflects a systemic failure rather than a localized obstetric problem. He notes that in such cases, the uterus may be well contracted, and there may be no visible trauma or retained placental tissue, yet bleeding continues because the body cannot form stable clots.
Prof Obimbo emphasizes that early identification of women at risk is essential. He explains that conditions such as severe anaemia, liver disease, prolonged shock, massive blood loss, and certain obstetric complications can disrupt normal coagulation pathways. In many cases, thrombin related PPH develops as a secondary complication after another cause of bleeding has already begun.
Globally, postpartum haemorrhage remains a major contributor to maternal mortality, accounting for about 27 percent of maternal deaths. While uterine atony is responsible for the majority of PPH cases, coagulopathy contributes to a smaller but clinically significant proportion of deaths, particularly in settings where blood products and laboratory diagnostics are limited.
The warning signs of thrombin related haemorrhage include persistent bleeding despite uterine contraction, failure of bleeding to stop after treatment of other PPH causes, widespread oozing from injection sites or surgical wounds, and laboratory evidence of clotting abnormalities. Clinically, women may show rapid deterioration with signs of shock such as low blood pressure, rapid pulse, pallor, confusion, or restlessness.
Prevention requires strengthening maternal health systems and ensuring early management of conditions associated with coagulopathy. Antenatal care plays a crucial role in identifying high risk pregnancies, monitoring blood counts, and managing underlying medical disorders. During labour and delivery, minimizing unnecessary blood loss is essential.
Management of thrombin related PPH focuses on rapid resuscitation and correction of clotting defects. This may include transfusion of blood components such as fresh frozen plasma, platelets, or cryoprecipitate depending on the specific deficiency. Simultaneously, the underlying cause of bleeding must be treated, whether it is infection, placental complications, or obstetric injury.
Prof Obimbo stresses that thrombin related haemorrhage underscores the importance of comprehensive emergency obstetric care. Ending preventable maternal deaths requires access to safe blood products, laboratory support, trained health workers, and timely referral systems.
Sources
World Health Organization, WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage
World Health Organization, Trends in Maternal Mortality
FIGO Guidelines on Postpartum Haemorrhage Management
Clinical Guidance on Obstetric Coagulopathy in Postpartum Haemorrhage
Image by DC Studio on Freepik</a>