What is Postpartum Hemorrhage?

What is postpartum hemorrhage?

After the birth of a baby, postpartum hemorrhage occurs when there is more bleeding than usual. Postpartum hemorrhage affects from 1 in 100 to 5 in 100 women. With a cesarean birth, it’s more likely. It usually occurs after the placenta has been delivered, but it can occasionally occur later.

What causes postpartum hemorrhage?

The placenta is generally pushed out of the uterus after the infant is delivered. These contractions help put pressure on the blood vessels in the area where the placenta was connected after it is delivered. These blood veins bleed easily if the uterus does not contract firmly enough. Postpartum hemorrhage is most commonly caused by this. Bleeding is likely if little portions of the placenta remain connected.

Postpartum hemorrhage may also be caused by:

• Tear in the cervix or tissues of the vagina
• Tear in a blood vessel in the uterus
• Bleeding into a hidden tissue area or space in the pelvis. This mass of blood is called a hematoma. It’s usually in the vulva or vagina.
• Blood clotting disorders
• Placenta problems

Who is at risk for postpartum hemorrhage?

Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk include:

• Placental abruption. This is the early detachment of the placenta from the uterus.
• Placenta previa. This is when the placenta covers or is near the opening of the cervix.
• Overdistended uterus. This is when the uterus is larger than normal because of too much amniotic fluid or a large baby.
• Multiple-baby pregnancy
• High blood pressure disorders of pregnancy
• Having many previous births
• Prolonged labor
• Infection
• Obesity
• Use of forceps or vacuum-assisted delivery
• Being of Asian or Hispanic ethnic background

What are the symptoms of postpartum hemorrhage?

These are the most common symptoms of postpartum hemorrhage:

• Uncontrolled bleeding
• Decreased blood pressure
• Increased heart rate
• Decrease in the red blood cell count
• Swelling and pain in the vagina and nearby area if bleeding is from a hematoma 

The symptoms of postpartum hemorrhage may look like other health conditions. Always see your healthcare provider for a diagnosis.

How is postpartum hemorrhage diagnosed?

Your healthcare provider will review your health history and do a physical exam. Lab tests often help with the diagnosis. Other tests may include:

• Estimate of how much blood you have lost
• Measuring pulse and blood pressure
• Red blood cell count
• Clotting factors in the blood

How is postpartum hemorrhage treated?

The goal of postpartum hemorrhage treatment is to locate and stop the bleeding as soon as possible. The following treatments may be used:

To stimulate uterine contractions, use medicine or uterine massage.

Removing any remaining placenta fragments in the uterus

Examine the uterus and other pelvic tissues, as well as the vagina and vulva, for areas that may require repair.

To stop the bleeding inside the uterus, use a Bakri balloon or a Foley catheter. Your healthcare professional may use sponges and sterile materials to fill the uterus. If a Bakri balloon or Foley catheter is not accessible, this can be done.

Laparotomy. This is a procedure that involves opening the abdomen to determine the source of the bleeding.

• Tying off or sealing bleeding blood vessels. This is done using uterine compression sutures, special gel, glue, or coils. The surgery is done during a laparotomy.
• Hysterectomy. This is surgery to remove the uterus. In most cases, this is a last resort.

Replacing lost blood and fluids is important in treating postpartum hemorrhage. You may quickly be given IV (intravenous) fluids, blood, and blood products to prevent shock. Oxygen may also help.

Postpartum hemorrhage can be quite serious. But when your provider quickly finds and treats the cause of bleeding, you often will be able to recover fully.

What are possible complications of postpartum hemorrhage?

Blood pressure might decrease dramatically if you lose a lot of blood suddenly. If not addressed, this can result in shock and death.

Is there anything I can do to avoid a postpartum hemorrhage?

It’s critical to understand what puts you at risk for postpartum hemorrhage before giving birth. It’s critical to have emergency care on hand during labor and delivery, as well as thereafter. Early treatment can help to reduce blood loss.