When to Get Help for Postpartum Hemorrhage

Overview

Postpartum hemorrhage is defined as a significant amount of blood loss after childbirth. Specifically, it’s defined as a blood loss of 500 milliliters (ml) or more within 24 hours after vaginal birth and 1000 ml or more after a cesarean delivery (C-section). This condition is considered a serious complication of childbirth and is the leading cause of maternal deaths globally. Postpartum hemorrhage can occur after both vaginal and cesarean births. It’s important to note that postpartum hemorrhage can be life-threatening if not promptly diagnosed and treated.

Causes and Risk Factors

Potential causes of postpartum hemorrhage include:

Uterine atony: This occurs when the uterus does not contract properly after delivery, leading to excessive bleeding.
Prolonged third stage of labor: The third stage of labor begins after the birth of the baby and ends with the delivery of the placenta. If this stage is longer than usual, it can increase the risk of postpartum hemorrhage.
Trauma or injury: Any trauma or injury to the birth canal or uterus during childbirth can cause bleeding.
Retained placenta: If the placenta is not completely expelled from the uterus after delivery, it can cause bleeding. This is less likely to occur in women who deliver vaginally but can contribute to postpartum hemorrhage in those who deliver by C-section.
Blood clotting disorders: Certain medical conditions that affect blood clotting can increase the risk of postpartum hemorrhage.
Endometritis: This is inflammation of the lining of the uterus and is one of the most common causes of secondary postpartum hemorrhage.
Uterine pseudoaneurysm: Women who deliver by C-section have a higher risk for uterine pseudoaneurysm, which can lead to severe bleeding.

Non-modifiable risk factors of postpartum hemorrhage are factors that can’t be changed. These include:

Maternal age: Advanced maternal age (35 years or older) has been associated with an increased risk of postpartum hemorrhage.
Number of miscarriages: Women who have had multiple miscarriages may have a higher risk of postpartum hemorrhage.
Gestational weeks at delivery: Preterm births (delivery before 37 weeks) have been linked to an increased risk of postpartum hemorrhage.
Type of conception: Assisted reproductive techniques, such as in vitro fertilization (IVF), may increase the risk of postpartum hemorrhage.

Modifiable risk factors of postpartum hemorrhage are factors that can be influenced or changed. These include:

Maternal health conditions: Certain health conditions during pregnancy, such as gestational diabetes, high blood pressure, and immune system disorders, can increase the risk of postpartum hemorrhage.
Previous history: Women who have had previous C-sections, vaginal deliveries, or a history of previous postpartum hemorrhage are at higher risk.
Delivery factors: Factors related to the delivery process itself, such as prolonged labor, use of oxytocin to induce or augment labor, multiple pregnancies (twins or more), and presence of uterine fibroids, can increase the risk.

By identifying these risk factors and taking appropriate measures during pregnancy and childbirth, healthcare providers can help reduce the incidence and severity of postpartum hemorrhage.

Symptoms

Postpartum hemorrhage can have different symptoms depending on the stage, progression, or severity.

Symptoms of postpartum hemorrhage include:

Heavy vaginal bleeding: This is the most common symptom of postpartum hemorrhage. It is defined as filling more than 2 pads in 12 hours.
Passing large blood clots: If you notice large blood clots during postpartum recovery, it may be a sign of excessive bleeding.
Fever: Having a fever after giving birth could be a symptom of postpartum hemorrhage.
Dizziness or fainting: Feeling lightheaded, dizzy, or even fainting could indicate excessive bleeding.
Blurred vision: Blurry vision is another symptom that may occur early on in postpartum hemorrhage.
Severe, persistent headaches: Experiencing severe and ongoing headaches could be a sign of postpartum hemorrhage.
Vaginal discharge with a foul or strong odor: If you notice an unusual odor along with vaginal discharge, it's important to seek medical attention.
Vomiting: Persistent vomiting after giving birth may be a symptom of postpartum hemorrhage.
Progressively worse abdominal (stomach) pain or new abdominal pain: Increasing or new abdominal pain could indicate a more serious condition like postpartum hemorrhage.
Swelling or pain in the legs: Swelling or pain in the legs could be a sign of deep vein thrombosis (DVT), which can sometimes occur with postpartum hemorrhage.

It's important to note that while some discomfort is normal during postpartum recovery, severe symptoms like heavy bleeding, passing large blood clots, fever, dizziness, blurred vision, severe headaches, and worsening abdominal pain should prompt immediate medical attention. If you experience any symptoms mentioned above or suspect postpartum hemorrhage, it's crucial to contact your doctor right away.

Diagnosis

To diagnose and determine the stage or severity of postpartum hemorrhage, healthcare providers may perform the following examinations, tests, and procedures:

Clinical examination: A thorough clinical examination is conducted immediately after childbirth or in the postpartum period. This examination takes into account factors, such as labor, mode of delivery, and associated or suspected injuries. It helps healthcare providers identify any acute interventions needed to address postpartum hemorrhage or perform surgical repairs for complex trauma.
Digital vaginal-anorectal examination: This examination involves a doctor or midwife inserting a lubricated, gloved finger into the rectum and a thumb in the vagina. The examiner looks for injured structures and feels the sphincter muscles to detect tears or other injuries to the vaginal or rectal tissues, perineal muscles, and anal sphincter muscles. It may also be used to check for unintentionally perforated sutures after a repair.
Vaginal examination: A vaginal examination is performed to assess factors, such as vaginal length and mobility, and presence of scarring and/or pain. This examination provides additional information about the condition of the vaginal area.
Blood tests: Blood tests help determine blood loss estimation and assess various factors related to prenatal care.

These examinations, tests, and procedures play an important role in diagnosing postpartum hemorrhage and determining its stage or severity. They help healthcare providers make informed decisions about appropriate interventions and treatments to address this condition effectively.

Treatment Options

The goals of treatment for postpartum hemorrhage are to stop the bleeding, restore blood volume, and prevent complications. To achieve these goals, various treatment options are recommended. These include:

Uterine compression maneuver: This involves applying pressure to the uterus to reduce bleeding. It’s a simple and effective technique that can be performed by healthcare providers. The compression helps to control the bleeding and promote clot formation.
Medications: Healthcare providers may prescribe certain medications to treat postpartum hemorrhage, including:
- Tranexamic Acid: This medication helps to prevent excessive bleeding by stabilizing blood clots and reducing the breakdown of fibrin, a protein involved in clot formation.
- Uterotonics: These medications, such as oxytocin or misoprostol, help to stimulate uterine contractions, which can help control bleeding by compressing blood vessels in the uterus.
- Antibiotics: In some cases, antibiotic therapy may be recommended to prevent infection, especially if there is prolonged or excessive bleeding.
Blood volume replacement: In cases of severe bleeding, blood volume replacement is necessary to restore the lost blood. This may involve transfusing blood or using intravenous fluids to replace the volume.
Therapeutic procedures: Healthcare providers may perform certain procedures to treat postpartum hemorrhage, including:
- Uterine compression suture: This procedure involves using sutures to compress and close off bleeding vessels in the uterus. It is a safe and effective method for controlling bleeding.
- Pelvic artery embolization: In cases where other treatments have failed or if there is stable maternal condition, this procedure involves temporarily blocking the blood vessels that supply the uterus with tiny particles or coils.
- Peripartum hysterectomy: In rare and severe cases where all other measures fail, removal of the uterus may be necessary to stop the bleeding and save the mother's life.
Health behavior changes: Healthcare providers may recommend certain health behavior changes to treat postpartum hemorrhage, including:
- Resting and recovery: After childbirth, it is important for individuals with postpartum hemorrhage to rest and allow their bodies to recover. This includes avoiding strenuous activities and getting enough sleep.
- Good nutrition: Maintaining a healthy diet with warm food options can promote faster recovery and support breast milk production.
- Hygiene practices: Taking baths with chamomile water in the genital area can help with postnatal care and promote healing.

It's important to note that these treatment options should be determined by healthcare professionals based on individual circumstances and severity of postpartum hemorrhage. Prompt medical attention is crucial in managing postpartum hemorrhage effectively and preventing complications.

Progression or Complications

Key points about the natural progression of postpartum hemorrhage include:

After giving birth, a woman's uterus should contract and become smaller. However, in some cases, the uterus may not contract as it should.
This is the most common reason for postpartum hemorrhage.
Other reasons for excessive bleeding include injury to the birth canal, cervix, or other structures, clotting problems, or part of the placenta remaining attached to the uterus.
If a woman is experiencing continued bleeding or if her uterus feels soft and floppy, emergency medical care is needed.

Postpartum hemorrhage can lead to severe and life-threatening blood loss if not treated promptly. Common complications of postpartum hemorrhage include:

Anemia (low red blood cell count)
Hypovolemic shock (severe drop in blood volume)
Organ damage due to lack of oxygenated blood
Long-term effects on overall health

Treatment for postpartum hemorrhage aims to stop bleeding and prevent further complications. The specific treatment options depend on the severity of the bleeding and the underlying cause.

The impact of treatment can vary depending on individual circumstances. Prompt and effective treatment can help control bleeding, prevent complications, and improve outcomes. However, it’s important to note that every case is unique, and treatment plans should be tailored to each individual's needs. It’s always recommended to consult with healthcare professionals for appropriate diagnosis and guidance regarding postpartum hemorrhage treatment options.