Postpartum Hemorrhage

Although it is not common, it is always wise to be aware of all the possibilities that could happen both during a pregnancy or the actual delivery of your baby. Postpartum hemorrhage is excessive bleeding following the birth of a baby and occurs in about 4 per cent of births and is more likely with a cesarean birth. The actual hemorrhage may occur either before or after the placenta is delivered and usually right after delivery.

When a baby is born, the uterus normally continues to contract so you continue to feel contractions (although the pain is at a lower level) and within 30 minutes the placenta is delivered. After this, the contractions help compress the bleeding vessels in that area where the placenta was attached. However, if the uterus does not contract strongly enough (the condition is called uterine atony) then these blood vessels bleed freely and hemorrhaging occurs. If small pieces of the placenta remain attached, bleeding is also likely.

Symptoms of Postpartum Hemorrhage

Obviously at this stage during the delivery, you are very closely monitored for any of the following symptoms:

o Uncontrolled bleeding
o Decreased blood pressure
o Increased heart rate
o Decrease in the red blood cell count
o Swelling and pain in tissues in the vaginal and perineal area.

Treatment for Postpartum Hemorrhage

Treatment will be commenced quickly to find and stop the cause of the bleeding. As of course replacing lost blood and fluids is very important in treating postpartum hemorrhage, the mother will be given intravenous (IV) fluids, blood and blood products rapidly to prevent shock. She may even receive oxygen by mask. Other treatment may include:

o Medication to stimulate uterine contractions.
o The manual massage of the uterus – again to stimulate contractions.
o The removal of any placental pieces that remain in the uterus.
o The examination of the uterus and other pelvic tissues.
o The packing of the uterus with sponges and other sterile materials to compress the bleeding area of the uterus.
o The tying off of bleeding blood vessels.
o A laparotomy which is surgery to open the abdomen to find the cause of bleeding, and as a very last resort…
o A hysterectomy.

Causes of Postpartum Hemorrhage

There are some women who are more prone to postpartum hemorrhage and usually these are those women who have:

o Had many babies.
o A prolonged labor.
o An infection.
o Been suffering from obesity.
o A multiple pregnancy.
o Medications to induce labor or medications to stop contractions.
o Been assisted by the use of forceps or vacuum-assistance.
o Been given a general anesthetic.

There are also various conditions which can put the mother at greater risk for postpartum hemorrhage and these conditions are:

o A tear in the cervix or vaginal tissues.
o A tear in a uterine blood vessel.
o Bleeding into a concealed tissue area or space in the pelvis which can then develop into a hematoma in the vulva or vaginal area.
o Blood clotting disorders.
o High blood pressure.
o Placenta abruption – where there is early detachment of the placenta from the uterus.
o Placenta previa – where the placenta covers or is near the cervical opening.
o Placenta accreta – where the placenta is abnormally attached to the inside of the uterus.
o Placenta increta – where the placental tissues invade the muscle of the uterus.
o Placenta percreta – where the placental tissues go all the way into the uterine muscle.
o Over distended uterus – where there is too much amniotic fluid or an especially large baby.

Although postpartum hemorrhage can be quite serious and is obviously a concern both to the mother and those who are helping to deliver her baby, the medical team has all the knowledge and equipment to detect and treat the cause of bleeding as quickly as possible to ensure a full recovery.