Postpartum haemorrhage (also called Postpartum haemorrhage) is when, after giving birth, a woman experiences serious bleeding. This is a severe but uncommon disorder.
It typically occurs within one day of giving birth, but after delivering a baby, it can occur for up to 12 weeks. Around 1-5 per 100 women (1-5 per cent) who have a baby have Postpartum haemorrhage.
After giving birth, it’s natural to lose some blood. During a vaginal delivery, women generally lose about half a quart (500 millilitres) or about 1 quart (1,000 millilitres) after cesarean birth (also referred to as c-section).
A c-section is surgery in which your baby is born in your abdomen and uterus (womb) through a cut that your doctor produces. You will lose much more blood with Postpartum haemorrhage, which is what makes it a dangerous disease.
A significant drop in blood pressure may be caused by Postpartum haemorrhage. This can lead to shock and death if not treated quickly. Shock is when there’s not enough blood supply to the body’s organs.
When does Postpartum haemorrhage occur?
The uterus usually contracts to force out the placenta after your baby is born. The contractions then help to put pressure on the bleeding vessels in your uterus where the placenta is attached. In your uterus, the placenta develops and provides food and oxygen through the umbilical cord to the infant.
The vessels bleed more if the contractions are not strong enough. When tiny parts of the placenta remain attached, it may also happen.
How are you expected to know if you have Postpartum haemorrhage?
If you have any of these signs or symptoms, you might have Postpartum haemorrhage. If you do, call the provider of health care or 911 right away:
- Severe vaginal bleeding, which doesn’t slow or stops,
- Blood pressure rises, or symptoms of shock.
- Blurred vision, chills, clammy skin or a very quick pulse, which are usually symptoms of low blood pressure and shock; feeling confused, dizzy, tired or weak; or feeling like you’re going to faint.
- Nausea or throwing up (feeling sick in your stomach)
- Pale skin
- Swelling around the vagina or perineum and discomfort. The region between the vagina and the rectum is the perineum.
Are any women more likely to have Postpartum haemorrhage than others?
Yes. There conditions that make one more likely to get Postpartum haemorrhage than others are called risk factors. Having a risk factor doesn’t mean you’re going to have Postpartum haemorrhage for sure. Usually, Postpartum haemorrhage occurs without warning.
However, speak to your health care professional about what you can do to help decrease your risk of Postpartum haemorrhage. You are more likely to have Postpartum haemorrhage than other women if you’ve had it before. This is called having a Postpartum haemorrhage history. Also, Asian and Hispanic females are more likely to have Postpartum haemorrhage than others.
Risk factors for Postpartum haemorrhage include many medical conditions. If you have any of these conditions, you might be more likely to have Postpartum haemorrhage than other women:
Conditions affecting the uterus
- Uterine Atony. This is the most prevalent cause of Postpartum haemorrhage. It occurs when, well after birth, the muscles in your uterus do not contract (tighten). After birth, uterine contractions help avoid bleeding from the place where the placenta breaks apart in the uterus. If your uterus is stretched or swollen (also called distended) from birth to twins or a big baby (more than 8 pounds,13 ounces), you will have uterine atony. It can also happen if you have had many kids already, if you have been in labour for a long time, or if you have too much amniotic fluid. The fluid which surrounds your baby in the womb is amniotic fluid.
- Inversion uterine. This is a rare disorder where, after birth, the uterus turns inside out.
- Uterine breakage. This is where, during labour, the uterus sheds. It seldom occurs. If you have a scar in the uterus from getting a c-section in the past or if you have had other kinds of uterine surgery, it can happen.
Conditions which affects the placenta
- Placental abruption. This is when the placenta divides before birth from the wall of the uterus early on. It can be isolated partly or entirely.
- Placenta accreta, increta placenta or percreta placenta. These problems arise when the placenta develops so far into the uterus wall and does not detach.
- Placenta Previa. This can happen because the placenta in the uterus sits very low and covers all or part of the cervix. The opening to the uterus that lies at the top of the vagina is the cervix.
- Unpassed Placenta. If the placenta is still retained within 30 to 60 minutes after given birth, this condition can occur. And if you pass the placenta shortly after birth, the placenta should be examined by your physician to make sure no tissue is missing. It may cause bleeding if tissue is missing and is not immediately removed from the uterus.
Conditions at birth and labour
- Getting a c-section
- You are having anaesthesia in general. This is a drug that puts you to sleep so that during surgery, you do not feel pain. You can need general anaesthesia if you have an emergency c-section.
- Take labour-inducing drugs. To induce labour, providers often use a drug called Pitocin. The human-made source of oxytocin, a hormone that your body produces to trigger contractions, is Pitocin.
- Take medications during preterm labour to avoid contractions. Your physician can give you medications called tocolytics to delay or stop contractions if you have preterm labour.
- Tearings (called lacerations as well). This may happen if, during birth, the tissues in your vagina or cervix are cut or torn. The opening to the uterus that lies at the top of the vagina is the cervix. If you give birth to a big infant, the baby comes out too fast through the birth canal, or you have a tearing episiotomy, you might have a tearing. A cut made at the opening of the vagina to help let the baby out is an episiotomy. Tearing can also occur if your physician uses devices to help move your baby through the birth canal during birth, such as forceps or a vacuum. Forceps look identical to large tongs. A vacuum is a soft plastic cup that sticks to the head of your infant. As you push during birth, it utilizes suction to pull your infant gently.
- Getting easy labour or being in labour for a long time. Labor, for every woman, is different. When you give birth for the first time, it normally takes about 14 hours for labour to take place. It normally takes around 6 hours if you have given birth before. Augmented labour can raise the risk of Postpartum haemorrhage as well. Augmented labour means that drugs or other means are used to produce further uterine contractions during labour.
- Blood disorders, such as von Willebrand’s disease or disseminated intravascular coagulation (also called DIC). These conditions can increase your risk of hematoma formation. A haematoma occurs when a blood vessel splits, causing the tissue, organ, or other parts of the body to form a blood clot. Some women experience hematoma in the vaginal region or the vulva (the female genitalia outside the body) after giving birth. A condition that makes it difficult for a person to stop bleeding is Von Willebrand’s disease. In small blood vessels, DIC causes blood clots to form, which can lead to severe bleeding. DIC may be caused by some pregnancy and childbirth complications (such as placenta accreta), surgery, sepsis (blood infection) and cancer.
- Like chorioamnionitis, an infection, this is a placenta and amniotic fluid infection.
- Intrahepatic cholestasis of pregnancy (also called ICP). The most common liver disease that occurs during pregnancy is Intrahepatic cholestasis of pregnancy.
- Obesity. Being obese means that you have an excess amount of fat in your body. Your body mass index (also called BMI) is 30 or higher if you’re obese. BMI is a body fat calculation dependent on your height and weight. Go to www.cdc.gov/bmi to figure out your BMI.
- Preeclampsia or gestational hypertension. There are elevated blood pressure forms that can only be acquired by pregnant women. During the 20th week of pregnancy or immediately during pregnancy, preeclampsia is a disease that may occur. It’s when a pregnant woman has elevated blood pressure and signs that some of her organs do not function properly, including her kidneys and liver. Symptoms of preeclampsia include protein in the urine, vision changes, and extreme headache. High blood pressure is gestational hypertension that begins after 20 weeks of pregnancy and goes away after you give birth. Later in pregnancy, some women with gestational hypertension have preeclampsia.
How is Postpartum haemorrhage diagnosed and treated?
To see whether you have Postpartum haemorrhage or try to find the cause of Postpartum haemorrhage, your provider can use these tests:
- Blood tests are known as tests for coagulation factors.
- From hematocrit. This is a blood test that tests the number of red blood cells that make up the blood (called whole blood). Bleeding can lead to a low blood cell count.
- Measuring blood loss. Your health provider can weigh or count the number of pads and sponges used to soak up the blood to see how much blood you’ve lost.
- Pelvic review. Your doctor examines the vagina, uterus and cervix.
- Physical inspection. Your provider monitors your pulse and blood pressure.
- Ultrasonics. An ultrasound can be used by your physician to scan for placenta or uterus issues. Ultrasound is a test used to build an image of your baby inside the womb or your pelvic organs using sound waves and a computer screen.
- Treatment depends on what the bleeding is caused by. It can involve:
- Getting fluids, drugs, or having a blood transfusion (placing fresh blood in the body) (like Pitocin). You get these therapies into your vein (also called intravenous or IV) through a needle, or you can get some directly into the uterus.
- Getting surgery, including a laparotomy or a hysterectomy. A hysterectomy is when the uterus is removed by the provider. When other therapies don’t work, you usually need a hysterectomy. When your physician opens your abdomen to look for the cause of bleeding and prevents the bleeding, a laparotomy is done.
- Hand-massaging the uterus. To help it contract, the provider will massage the uterus to minimize bleeding and help the body move through blood clots. Your physician can also prescribe you drugs to make the uterus contract and minimize bleeding, such as oxytocin.
- Using an oxygen mask for breathing
- Remove any remaining parts of the placenta from the uterus, pack the uterus with gauze, special balloon or sponges, or use surgical instruments or stitches to help avoid bleeding from the blood vessels.
- The blood vessels supplying the uterus would become embolized. A provider uses basic tests in this technique to locate the haemorrhaging vessel and puts substance in the vessel to prevent bleeding. It is used in specific cases and can prevent a woman from needing a hysterectomy.
- It can also help to take extra iron supplements with a prenatal vitamin. Depending on how much blood was lost, your provider can suggest this.
- Postpartum haemorrhage; March of Dimes
- Prevention and Management of Postpartum Haemorrhage; Obstetrics and Gynaecology