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Postpartum hemorrhage
How much bleeding is considered postpartum hemorrhage?
Postpartum hemorrhage refers to a condition where, if the patient has vaginal delivery, the bleeding exceeds 500 milliliters within 24 hours after the fetus is delivered. If the delivery is via cesarean section, the bleeding exceeds 1000 milliliters, which is considered significant postpartum hemorrhage. The primary cause is mostly related to poor uterine contractions. Due to inadequate muscle contractions of the uterus, the blood vessels in the uterine muscle layer remain open, leading to bleeding. Another cause relates to placental factors, such as when the placenta is not entirely expelled, leading to remnants of the placenta and membranes remaining in the uterine cavity, which can also cause postpartum bleeding.
The difference between postpartum hemorrhage and menstruation
The difference between postpartum hemorrhage and menstruation varies whether it is a vaginal delivery or a cesarean section. The timing of postpartum bleeding varies, and it also relates to postpartum lochia. If the bleeding occurs within 24 hours, it is called severe postpartum hemorrhage; most frequently, we encounter bleeding after 24 hours. Typically, for vaginal deliveries, bleeding occurs within seven days. In cesarean sections, due to the uterine incision, healing is needed, and the duration of bleeding varies by individual and health, commonly lasting from one to two months post-operation. Postpartum bleeding is due to incomplete healing of the uterine lining, which is different from menstrual bleeding. Menstrual bleeding is usually heavier in the initial days and the blood is dark red with a cyclic pattern. In contrast, postpartum bleeding does not have a cyclic nature; it usually consists of fresh red or dark blood, whereas menstrual bleeding typically involves dark blood.
Causes of Late Postpartum Hemorrhage
Late postpartum hemorrhage is most commonly caused by retained placenta and membranes. About ten days after childbirth, the patient may experience significant bleeding due to the degeneration and necrosis of the retained placental and membrane tissues within the uterine cavity. When these necrotic tissues are shed, it can cause the blood vessels to open and lead to bleeding. Additionally, poor healing of the placental site on the uterus can also cause bleeding, as can infections, with endometritis being relatively common. Inflammation can lead to poor healing of the placental attachment site or poor uterine contraction, resulting in significant uterine bleeding.
Measures for postpartum hemorrhage
Postpartum hemorrhage refers to a situation where there is blood loss exceeding 500 milliliters within 24 hours after the birth of a child. Initially, massaging the uterus should be performed, as most of this bleeding is due to poor uterine contraction, and the doctor can press on the uterus from above the patient's lower abdomen. Additionally, high doses of uterotonic drugs can be used to induce uterine contraction. If these measures do not reduce bleeding, packing the uterine cavity with gauze can be employed to stop the bleeding from the uterus. Furthermore, if the bleeding is very severe, embolization of the uterine artery or the internal iliac artery can be done to halt the uterine bleeding.
What does postpartum hemorrhage feel like?
Postpartum hemorrhage refers to the condition where, within 24 hours after vaginal delivery, the amount of blood loss reaches 500 milliliters, and in the case of a cesarean section, the blood loss amounts to 1000 milliliters. During this time, the woman may experience a substantial amount of bleeding from the vagina, along with large blood clots. The primary cause of this condition is often significantly associated with poor contraction of the uterine muscles. Post-delivery, the blood sinuses in the uterine muscle layer are open, requiring the uterus to contract. If the contractions are inadequate, it may lead to bleeding from these blood sinuses. Additionally, bleeding could also potentially stem from post-surgical wounds, such as those from a cesarean section or wounds from vaginal delivery.
Postpartum Hemorrhage Emergency Response Process
Firstly, it is necessary to administer IV fluids to the patient and establish two venous accesses to urgently replenish blood volume. Then, it is important to manage breathing to ensure the patient's airway is clear, and provide oxygen if necessary. Patient's vital signs should also be checked for any abnormalities. Additionally, treatment should be given based on the cause of bleeding. If the bleeding is due to poor uterine contraction, it is crucial to promptly enhance uterine contractions to quickly stop the bleeding. At this time, uterotonic agents can be used, or manual uterine massage can be employed to stem the bleeding. If the bleeding is caused by a surgical incision, then the incision needs to be sutured properly.
The main causes of postpartum hemorrhage
There are four main causes of postpartum hemorrhage: one is uterine atony, two is due to trauma in the soft birth canal, three is due to placental factors, and four is coagulation dysfunction. Uterine atony is the most common cause of postpartum hemorrhage clinically. Various factors can lead to uterine atony, such as maternal exhaustion during labor due to not eating, leading to physical decay, which can also cause uterine atony. Additionally, an excessively large uterus, such as from excessive amniotic fluid, twins, or triplets, can lead to poor uterine contraction and retraction rates after childbirth. As for injuries in the soft birth canal, they mainly occur due to insufficient protection of the perineum during childbirth or inappropriate use of vacuum assistance during the second stage of labor, causing trauma in the soft birth canal. Placental factors include placental adhesion, placenta accreta, partial placental abruption, and retained placenta, all of which can lead to postpartum bleeding due to placental issues.
Should the uterus be removed due to severe postpartum hemorrhage?
Whether postpartum hemorrhage requires hysterectomy primarily depends on the severity of the hemorrhage and the specific causes of the postpartum hemorrhage. First, if the amount of postpartum hemorrhage is very substantial, leading to conditions like DIC in the pregnant woman, and if not removing the uterus may cause ongoing bleeding, it is essential to remove the uterus quickly to reduce vaginal bleeding. Second, if the postpartum hemorrhage is caused by issues like amniotic fluid embolism or poor contraction of the uterus, and conservative treatments are ineffective, it is also necessary to make a prompt decision to remove the uterus.
The most common cause of postpartum hemorrhage
Postpartum hemorrhage is divided into two scenarios. The first type occurs within 24 hours after childbirth and is seen in four situations. The first is due to inadequate uterine contraction, the second is trauma to the soft birth canal, the third concerns placental factors, and the fourth involves coagulation disorders. The second type of hemorrhage is late postpartum bleeding, which occurs one to two months after childbirth. This can be associated with postpartum infections, slow recovery of physical condition postpartum, retained products, and poor healing of cesarean section scars.
Late postpartum hemorrhage clinical symptoms
Late postpartum hemorrhage occurs when significant uterine bleeding happens after the first 24 hours following the delivery of the fetus, commonly seen from one to two weeks postpartum. At this time, patients may experience sudden heavy vaginal bleeding, and some may even develop hemorrhagic shock. A minority of patients might not bleed profusely but may experience recurrent bleeding. Additionally, this bleeding is often accompanied by lower abdominal pain, fever, and symptoms of anemia, so it is critical to seek immediate medical treatment upon noticing these symptoms.