Post Partum Haemorrhage (PPH), a leading cause of maternal mortality due to excessive bleeding after childbirth, has traditionally been viewed as an acute obstetric emergency with potentially permanent complications like damage to the kidneys, oxygen deprivation to the brain besides a range of severe psychological impacts. Bleeding can occur because of injury or other problems with the cervix, vagina, uterus (womb) or placenta of the woman during delivery of the baby.
However, a new global study has sounded alarm that the PPH can have long-term heart health complications too. Cardiovascular diseases or blood clots can persist for up to 15 years, says the research, prompting medical experts to advocate for further study in the Indian context.
In India as in the world, maternal health continues to be a critical issue, with PPH accounting for nearly one-fourth of maternal deaths, driving up hospital costs and increasing the risk of serious complications.
The pan countries study, published in The Journal of Maternal-Fetal& Neonatal Medicine analysed data from over 9.7 million women across Asia, Europe, and North America. It found women with a history of severe PPH are 1.76 times more likely to develop heart conditions such as stroke or heart failure. They are also 2.1 times more likely to experience thromboembolic events, such as deep vein thrombosis or pulmonary embolism, said the study.
PPH is defined by the World Health Organization (WHO) as a blood loss of 500 ml or more within 24 hours of childbirth, with severe PPH involving blood loss of 1,000 ml or more. It can have a range of serious medical issues in a woman. According to studies, more than two-thirds of women who suffer PPH report having a negative overall memory of the birth of their child, while one in five fear another instance of PPH so much so that they decide against becoming pregnant again.
Speaking to The Outlook Health, senior obstetricians and cardiologists while underscoring the urgent need to cut down PPH also called for a focused pilot study to evaluate the long-term cardiovascular risks associated with PPH among Indian mothers. They noted that such data would be critical for shaping national guidelines and postpartum care strategies.
Dr. Amrinder Kaur Bajaj, senior gynaecologist FMRI (Fortis Memorial Research Institute) at Gurgaon underscored the need to look into this life-threatening association. “Recent studies have highlighted an alarming long-term effect of PPH – an increased risk of cardiovascular events later in life. These include heart failure and stroke. Moreover, the risk can persist for as long as 15 years after PPH. The more severe the PPH, the higher the risk.”
“The exact cause is still being investigated. To avoid this, we need to have a two-pronged strategy. Firstly, identification of patients at risk for PPH like twin pregnancy, pregnancy induced hypertension, prolonged labour and take pre-emptive measures to prevent it. Secondly, diligent long- term follow-up of patients who have had PPH is a must,” she said.
Experts believe that understanding the chronic implications of such complications could help improve both survival and quality of life in the postpartum period.
Their concern follows observations that despite improvements in emergency management at tertiary care centers, the focus often remains on short-term survival rather than the long-term health care of such PPH; others remain ignored.
“Usually, women are vulnerable to heart risk in old age or after menopause. However, now there is a growing recognition globally that childbirth complications may carry chronic health consequences too. In a country like India, where postpartum follow-up is limited, this warrants serious attention," added Dr Rajneesh Malhotra, Chairman and Head – Cardiothoracic Vascular Surgery (CTVS) department at Max Hospital (Saket) Delhi.
Dr. Anubhav Gupta, Head of the Department of (CTVS) at Safdarjung Hospital, said: “I have not yet seen the study, so I’m not in a position to comment on the association. However, such a study could certainly be relevant in the Indian context, where the rate of postpartum hemorrhage (PPH) is high. Typically, we do not delve into these specific details while treating women with cardiovascular diseases. But, greater awareness of this potential risk could definitely help women take better care of their heart health.”
Dr Neera Bhatla, a senior gynaecologist at All India Institute of Medical Sciences (AIIMS), Delhi, in a report published in the National Medical Journal of India, noted that quick response during the initial stages of PPH is key to reducing maternal mortality. However, she noted that in India, particularly in rural areas, follow-up care is typically limited to the first six weeks postpartum.
This is far too short a time to detect and manage the ongoing risks of cardiovascular complications, noted Dr Archana Bajaj Dhawan, a Delhi-based reputed gynecologist and IVF expert.
No doubt, said the gynaecologists, the primary focus should be on reducing PPH. One beacon of hope lies in E-MOTIVE, a new evidence-based approach to early PPH detection and treatment. A 2024 Lancet Global Health study found that E-MOTIVE, which includes calibrated blood-collection drapes and a rapid treatment bundle (including uterine massage, oxytocics, IV fluids, and escalation protocols), reduced adverse PPH outcomes by 60%.”
India, as a low- and middle-income country (LMIC), stands to benefit immensely from large-scale rollout of E-MOTIVE, especially in public health facilities where basic diagnostic tools and training can save lives and reduce future disease burden, said Dr Neerja Bhatala.
Rural areas, such as those in India, experience particularly high rates, with PPH affecting approximately 12% of deliveries and increasing to 15% in subsequent pregnancies.
Dr. Archana Dhawan Bajaj, a senior obstetrician and fertility specialist, gave insight of this serious issue, noting that India’s high rates of PPH stem from multiple systemic challenges — including widespread anemia, nutritional deficiencies among women, and inequities in access to skilled obstetric care, particularly in rural regions.
"We are seeing PPH at much higher levels than in developed countries, not just because of our population size but due to structural health gaps. Most of our women are anemic, iron-deficient, and malnourished, making them vulnerable not only to PPH but also to conditions like anemia-induced hypertension," Dr. Bajaj said.
She noted that in rural and semi-urban India, substandard care continues to be the norm. Many deliveries are still being handled by untrained or semi-trained personnel such as dais and midwives. While these frontline workers are indispensable, she said, they urgently need formal training on safe delivery practices and early recognition and management of PPH.
In contrast, while PPH does occur in urban centres and Tier-2 cities, maternal mortality is significantly lower due to better access to healthcare infrastructure, drugs, and timely interventions.
Dr. Bajaj echoed the need for a systemic overhaul. “Some countries, like the UK, have conducted full audits on maternal deaths and built robust response systems. India needs a similar, aggressive approach — a national-level organisation focused solely on maternal mortality and long-term outcomes,” she said.
Until we have systematic data and institutional accountability, our interventions will remain fragmented. The need for a comprehensive approach — from nutrition to training, from data collection to policy — is long overdue, she added.
Dr. Ashwini Anil Kumar Sirapanasetty, Obstetrics and Gynaecological Surgeon and senior counsellor with the Army Wives Welfare Association, who works closely with tribal communities, emphasised that the maternal health situation in these regions remains deeply concerning. “Contributing factors include widespread anaemia, uterine atony, and deliveries conducted by untrained Accredited Social Health Activists (ASHAs) or traditional birth attendants (TBAs), many of whom lack formal training in sterile techniques or emergency obstetric care.”
“While training TBAs and ASHAs to recognize danger signs, ensuring the availability of life-saving uterotonics like misoprostol, strengthening antenatal care, and promoting institutional deliveries are all critical steps, the long-term health care of such women is also important.”
With new evidence linking PPH to long-term cardiovascular complications, experts echoed the views of Dr. Manggala Pasca Wardhana, lead author of a global study, who observed that “routine cardiovascular screening for women who experience PPH could be a low-cost, high-impact intervention.” Co-author Dr. FiqihFaizaraUstadi stressed the need to expand the scope of maternal healthcare, stating, “We need to redefine maternal care as lifelong care, not just maternity care. The heart doesn’t forget. And neither should we.”
Key Facts:
PPH occurs in 2%–4% of vaginal deliveries in India
PPH is responsible for 19.9% of maternal deaths in India
Globally, there are 14 million cases of PPH annually
Study Highlights:
The risk of heart disease post-PPH is 1.76 times higher.
The risk of blood clots is 2.1 times higher
Heart risks related to PPH can persist for up to 15 years post-delivery