Postpartum Hemorrhage: What Every Woman Needs to Know

Every woman experiences bleeding following childbirth. It is a normal part of the healing process. However, how much is too much? If a woman bleeds too much after giving birth it can lead to a potentially life-threatening condition known as postpartum hemorrhage.

Postpartum hemorrhage is the leading cause of childbirth-related deaths in the world. In developed nations, postpartum hemorrhage accounts for approximately ten percent of maternal deaths. In developing nations, approximately one-fourth of maternal deaths are caused by the condition. Despite the commonality of postpartum hemorrhage, not everyone is aware of the condition. Even those that are aware of the condition are often misinformed about the true facts regarding postpartum hemorrhage. For example, many believe that postpartum hemorrhage occurs only in the first hours and days following childbirth. This is simply not the case. Postpartum hemorrhage is a very serious condition that every woman needs to be aware of.

Traditionally, postpartum hemorrhage is defined as a blood loss of more than 500 milliliters following childbirth. However, research has shown many problems with this definition. First, caregivers often underestimate the amount of blood loss a patient has. Secondly, it isn’t uncommon for a patient to experience a blood loss of more than 500 milliliters and suffer no ill effects. This is especially true for patients who undergo a caesarean section in which blood loss of up to 1000 milliliters would not be uncommon. On the other hand, some patients have lost less than 500 milliliters and suffered devastating effects to their health. Each individual has a different capacity to cope with blood loss. These findings have led to a broader definition of postpartum hemorrhage. Postpartum hemorrhage is now considered to be any loss in blood that results in symptoms of in hemodynamic (dealing with the circulation of blood) instability or any blood loss that threatens hemodynamic stability (usually defined as greater than 1000 milliliters). A hematocrit level that drops more than ten percent following childbirth is also considered to be postpartum hemorrhage. Postpartum hemorrhage is further defined as being either primary (occuring within 24 hours following delivery) or late (occuring between 24 hours and six weeks following delivery).

The causes of postpartum hemorrhage can be numerous, however, they are generally broken down into four categories (also known as the four T’s): tone, trauma, tissue, and thrombin. Problems with the tone of the uterus are the most common cause of postpartum hemorrhage. A condition known as uterine atony occurs when the uterus does not properly contract following childbirth. Uterine atony can be caused by a variety of factors including prolonged labor, augmented labor, and multiples. The second most common cause of postpartum hemorrhage is trauma. This includes damage to the cervix, uterus, and/or vagina. It can be the result of the delivery itself or the result of medical intervention such as the use of forceps or an episiotomy. Retained tissue is another cause of postpartum hemorrhage. Tissue from the fetus or placenta can be retained thus causing the uterus to not be able to contract properly. Postpartum hemorrhage can also be caused by thrombosis, or the inability of the blood to properly clot. Abnormalities in clotting can be the result of a preexisting condition or acquired secondary to an unrelated condition or the pregnancy itself.

Ideally, the best cure for postpartum hemorrhage is preventing the condition all together. Following birth, all women receive care in order to prevent hemorrhage. This includes careful monitoring, uterine massage, and the administration of Pitocin to aid in uterine contraction. Women who are deemed to be at risk for postpartum hemorrhage are often monitored more closely and treated more aggressively. Women who are at an increased risk for postpartum hemorrhage include those who had a large baby, those pregnant with multiples, a prolonged labor, an augmented labor, those who had a previous postpartum hemorrhage, those attempting a vaginal birth after a caesarean section, and those with certain conditions (including preeclampsia, placenta previa, and systemic blood clotting disorders).

Unfortunately, postpartum hemorrhage cannot be prevented in all cases. If a postpartum hemorrhage does occur, the key is early detection. Primary postpartum hemorrhages almost always occur in the hospital, therefore, they are usually detected by medical professionals. Late postpartum hemorrhages, however, can occur for up to six weeks following childbirth. Therefore, many of these hemorrhages occur outside of the hospital. Because of this, it is important that women be aware of the symptoms of a postpartum hemorrhage. These symptoms can include bleeding that increases instead of decreasing, bright red blood after four days postpartum, soaking a pad or more per hour, blood clots larger than a golf ball, lightheadedness, weakness, heart palpitations, difficulty breathing, racing heartbeat, and confusion. It is important that a woman contact her doctor any time she is concerned.

Treatment for postpartum hemorrhage varies greatly depending on the cause and the severity of the bleed. Treatment can include everything from the administration of Pitocin and other medicines to stop the bleeding to surgery and a blood transfusion. Once the bleeding has been stopped, IV medicines will be continued to keep the uterus contracted. The patient will also be monitored closely to make sure there is no further bleeding. Recovery depends on the severity of the hemorrhage. Most patients generally make a full recovery with no long-term effects.

Every women experiences bleeding following childbirth. However, when a woman bleeds too much it can lead to postpartum hemorrhage. Despite the commonality of it, most people are not aware of postpartum hemorrhage and the true facts regarding the condition. Postpartum hemorrhage is a very serious condition that every woman needs to be aware of.

Sources

Wikipedia

eMedicine

Baby Center