Postpartum hemorrhage is excessive blood loss in a woman after childbirth. It is called primary when it is within the first 24 hours after childbirth. Secondary (or delayed) postpartum hemorrhage occurs between 24 hours to six weeks after childbirth.
Some blood loss is normal. However, postpartum hemorrhage is a potentially serious condition that often goes unrecognized. Any excessive blood loss can put a woman at considerable risk. Talk with your doctor if you have any concerns about blood loss after giving birth.
The following are potential causes of postpartum hemorrhage:
Uterine atony (loss of tone of the muscles of the womb)—most common causeMedicines that relax the uterusFailure to deliver placenta (the organ that links the fetus to the womb)Birth trauma (wounds of cervix and/or vagina)Bleeding disorderAnticoagulant medicinesUterine inversion (caused by failure of the placenta to detach from the uterus)Retained products of conception after delivery of the placenta (eg, small pieces of placenta and/or fetal membranes)
The following factors are thought to increase the risk of postpartum hemorrhage:
Prolonged laborRapid deliveryProblems with the placentaMultiple pregnancyPre-eclampsiaObesityInduced or augmented laborOne or more previous pregnanciesEpisiotomy
—a procedure that involves cutting the perineum (the area of skin and muscle between the vagina and the anus)
Large fetusHigh amniotic fluid levelsHistory of previous postpartum hemorrhageEthnicity—Asian, HispanicMaternal blood disordersForceps or vacuum deliveryCesarean sectionFirst pregnancyStillbirthEpidural anesthesiaLow-dose aspirin during pregnancyChorioamnionitis
(a bacteria infection of the membranes and fluid surrounding the fetus)
The most obvious sign of postpartum hemorrhage is heavy vaginal bleeding. If the bleeding is not obvious, other signs may include:
Decreased blood pressureIncreased heart rateDecreased red blood cell countSwelling and pain in the vaginal and perineal area
Your doctor will ask about your symptoms. A physical exam will be done. The doctor will check your perineum, vagina, cervix, and uterus for bleeding. Other tests may include:
Monitoring the number of saturated pads or sponges that absorb bloodBlood pressure measurementPulse measurementBlood tests to detect blood levels and coagulation propertiesUltrasound
—a test that uses sound waves to examine the body, in this situation the inside of the uterus for retained placental tissue
Angiography
—x-ray exam of the blood vessels when they are filled with a contrast material (a substance that makes the blood vessels visible on an x-ray)
Talk with your doctor about the best plan for you. Treatment options include:
You may need:
IV fluidsOxygen through a mask
In severe cases:
ResuscitationBlood transfusionA massage technique called bimanual uterine massage can control bleeding. A doctor or nurse will place one hand in your vagina to push on your uterus, while the other hand pushes down on your abdomen. This action will cause a relaxed uterus to contract, thus slowing bleeding.
Bleeding can be caused by a tear in your genital tract or other trauma. The tear will be sutured. In addition, tissue from a retained placenta may need to be removed.
Your doctor may prescribe medicines to contract the uterus. Examples include:
Oxytocin
(Pitocin)
Carboprost
(Hemabate)
Misoprostol
(Cytotec)
Methylergonovine
(Methergine)
Ergometrine (Ergonovine)
In some cases, surgery may be needed, such as:
Uterine packing (sterile materials or a special tamponade device is placed inside the uterine cavity to compress the bleeding area)Repair of arteriesHysterectomyUterine curettage (scraping the lining of the uterus)Repair of hematomaRemoval of retained placentaUterine artery embolization (non-invasive procedure to block the uterine artery)
These methods may reduce the risk of postpartum hemorrhage:
Receiving continuous nursing care during laborBeing closely monitored during the third stage of laborLast reviewed September 2012 by Andrea Chisholm
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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