Postpartum hemorrhage: Causes and management of severe bleeding after delivery

Postpartum hemorrhage (PPH) is severe bleeding (more than 500 ml of blood loss) after the delivery of the baby. About four percent of women have postpartum hemorrhage, and the chances of having it increase with a cesarean birth. Usually, PPH occurs right after delivery, but it can occur later as well.

What is postpartum hemorrhage?

Have you heard about the term postpartum hemorrhage and wondered what is it?

The uterus usually tightens once the baby is delivered and this will detach the placenta. The contraction will aid in compressing the bleeding vessels where the placenta was attached. If the uterus is unable to contract strongly, the blood vessels will bleed freely causing a hemorrhage to occur.

Regardless of whether the childbirth is done through vaginal delivery or cesarean section, if there is a total blood loss of more than 32 fluid ounces, then it is considered a PPH.

The most common cause of postpartum hemorrhage 

What are the causes of postpartum hemorrhage? According to Cleveland Clinic, there are four most common causes of postpartum hemorrhage:

1. Retained placental tissue

This is when PPH happened because the entire placenta does not separate from the uterine wall.

2. Uterine atony

Also called uterine tone. It is a condition where the uterus became soft and weak after delivery. This condition may result in a steady loss of blood during delivery. And this commonly happens when your uterine muscles don’t contract enough to brace the placental blood vessels.

3. Uterine trauma

Kind of postpartum hemorrhage caused by the damage to the vagina, cervix, uterus, or the area between your genitals and anus, called the perineum.

Undergoing vaginal assisted delivery like forceps and vacuum delivery may increase the risk of uterine trauma. There are times during assisted delivery when a collection of blood or hematoma can form in a concealed or hidden area. This condition may cause too much bleeding hours or days after you give birth.

4. Blood clotting condition

A postpartum hemorrhage is commonly caused by pregnancy conditions like eclampsia or a coagulation disorder that can affect the clotting ability of your body. If you have this condition, even a tiny bleed can turn out to be uncontrollable. The blood clotting condition is also called thrombin.

What increases the risk of postpartum hemorrhage occurring?

There are many factors that increase the risk of postpartum hemorrhage. Here are a few of the most prominent ones:

• Delivery of a big baby
• Multiple pregnancies with prolonged labor
• Infection
• Obesity
• Medications that induce labor
• The use of forceps
• Tear in the birth canal/ vaginal tissues/ uterine blood vessel
• An increased tendency to bleed easily due to a blood clot disorder

Signs and symptoms of postpartum hemorrhage

Some of the most common signs and symptoms of postpartum hemorrhage are:

• Increased heart rate
• Persistent and severe bleeding after delivery
• Blood pressure falling
• Swelling and pain in tissues around the vaginal area
• Abdominal or pelvic pain
• Dizziness and blurry vision
• Pale skin
• Nausea and vomiting

The symptoms of postpartum hemorrhage may resemble other conditions or medical problems. That is why it is better to always consult your physician for a diagnosis.

It is important to tell your doctor whatever you are feeling after your delivery. There are cases where the signs and symptoms of postpartum hemorrhage occur until after you have left the hospital. If this case happens to you, immediately go back to the hospital and let your doctor check your condition.

Postpartum hemorrhage management

What will the doctor do in terms of the management and treatment of postpartum hemorrhage?
Ultimately every illness comes down to treatment. Here are some things that doctors will do in the case that you have PPH:

• Examine the uterus and pelvic tissues
• Massage the uterus to help the muscles contract.
• Prescribe medications such as prostaglandins, oxytocin, or ergometrine
• Remove any remaining placenta pieces from the uterus
• Repair vaginal, cervical, and uterine tears or lacerations.
• Put pressure on your uterine walls by the use of a catheter or balloon.
• Transfer blood to replace the blood loss.
• Perform surgery that will enable us to find the cause of the bleeding. This surgery is known as laparotomy.
• Surgically remove the uterus. This is known as hysterectomy and is usually a doctor’s last resort when trying to resolve this condition.

Serious dangers

Severe blood loss can cause the new mother’s blood pressure to fall considerably and this may even lead to shock and or death. Because the blood will not flow properly to your liver, brain, heart, or kidneys.

There are also cases where after experiencing postpartum hemorrhage, the new mon developed a so-called Sheenan’s syndrome. This is a condition of the pituitary gland. However, early detection can lead to a successful recovery.

That is why it is always better to consult your doctor whenever you feel something is wrong with your body after you give birth. Prenatal checkups are important too so you can take steps to prevent PPH even before giving birth.

Have you ever dealt with postpartum hemorrhage? Tell us if you have any tips on how to deal with it. We’d love to hear from you!

Preventions

Sometimes just by being more cautious and researching, you can really help in preventing a serious condition. Here are two ways to prevent PPH:

• Prior to delivery, if you’re anemic seek help for it.
• Episiotomies, only if necessary

Providing your doctor with your complete medical history is the first step to lessening the chance of experiencing postpartum hemorrhage. When your doctor knows that you have a high risk of struggling with this condition, then even before the delivery day, they can provide you with steps to do to lessen the possibility of experiencing PPH.

Aside from that, taking medications like oxytocin at the time of delivery may help your uterus to contract. This step may lessen the risk of PPH because it may prevent prolong labor.

Ask your doctor if you can take iron supplements to minimize the effect of postpartum hemorrhage should it happen. Iron intake is important to lessen the impact of PPH but it is better to ask your doctor if you are planning to take iron supplements. Consult your healthcare provider about the dosage or amount of supplements you should take. It varies from one woman to another depending on their situation or condition.

Risk factors

Who is more at risk of experiencing postpartum hemorrhage?

• When your uterus is overstretched due to multiple pregnancies, a large baby, or too much amniotic fluid.
• Women with placental problems such as placenta accrete, placenta previa, placental abruption, and retained placenta. 
• Those who give birth under cesarean section and assisted vaginal delivery using medical instruments such as vacuum and forceps.
• Moms who were given oxytocin during labor
• Women who are given general anesthesia during delivery
• Prolonged labor
• Those who experience perineal lacerations or tearing in the area between the anus and vagina during normal delivery.
• People with blood clotting disorders
• Women with anemia, high blood pressure, or preeclampsia
• Obese

Aside from what is mentioned above, if you happen to experience postpartum hemorrhage after the delivery of your elder child or children, there is a high chance of experiencing it again when you give birth to your next kid.

For more on postpartum hemorrhage, watch this video:

Additional information written by: Jobelle Macayan

Here at theAsianparent Philippines, it’s important for us to give information that is correct, significant, and timely. But this doesn’t serve as an alternative for medical advise or medical treatment. theAsianparent Philippines is not responsible to those that would choose to drink medicines based on information from our website. If you have any doubts, we recommend to consult your doctor for clearer information.