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Postpartum hemorrhage
Does postpartum hemorrhage count as dystocia?
Postpartum hemorrhage is one of the very important causes that endanger the lives of mothers. Although hemorrhage is not considered as dystocia, conditions of dystocia can induce severe hemorrhage. This is because complications such as trauma to the birth canal and uterine atony might occur after dystocia. These issues are triggers for severe postpartum hemorrhage. Even in normal cesarean sections, there can be cases of severe postpartum hemorrhage, thus postpartum hemorrhage is not counted as dystocia, but dystocia can easily induce severe postpartum hemorrhage.
Does postpartum hemorrhage require a blood transfusion?
The definition of postpartum hemorrhage is bleeding greater than 500 milliliters approximately 24 hours after vaginal delivery. Whether blood transfusion is necessary for postpartum hemorrhage mainly depends on the specific amount of bleeding. For average women, if the hemoglobin level is normal before delivery and the bleeding is between 500-1000 milliliters, the body can compensate for the anemia through normal adjustments, and generally, a blood transfusion is not required. However, if the bleeding exceeds 1000 milliliters, this situation is considered massive hemorrhage and must be treated with a blood transfusion, otherwise it may lead to hemorrhagic shock or DIC (Disseminated Intravascular Coagulation).
Why is uterine curettage necessary for postpartum hemorrhage?
We encounter a situation where postpartum hemorrhage is caused by the presence of residual material inside the uterus, which can influence the contraction of the uterus. This condition can lead to severe postpartum hemorrhage. The most important solution for postpartum hemorrhage is to immediately stop the bleeding. Therefore, by removing the residual material from the uterine cavity, the uterus can return to its normal contraction, achieving the purpose of immediately stopping the bleeding. It is also very common to need uterine evacuation after childbirth, as this process might cause some trauma to the uterus. Although it can be somewhat traumatic, this trauma is minimal compared to severe postpartum hemorrhage. In such cases, we must carefully weigh the pros and cons and decisively decide to proceed with the evacuation of the uterus.
Causes of Late Postpartum Hemorrhage
Late postpartum hemorrhage refers to a significant amount of vaginal bleeding that occurs two to three weeks after a cesarean section or natural childbirth. The causes of late postpartum hemorrhage include the following aspects. First, the presence of residuals in the uterine cavity, such as when the placenta or membranes remain within the uterine cavity after childbirth, can repeatedly stimulate the endometrium causing bleeding. Second, poor healing of the uterine incision during a cesarean section can lead to post-cesarean bleeding, a condition that easily causes late postpartum hemorrhage. Third, poor healing of episiotomy or perineal laceration wounds after natural childbirth can also potentially lead to late postpartum hemorrhage.
Can postpartum hemorrhage be stopped?
Postpartum hemorrhage primarily refers to bleeding from the vagina exceeding 500 milliliters within 24 hours after the delivery of the fetus, and bleeding exceeding 1000 milliliters for cesarean deliveries. It is classified as postpartum hemorrhage. Normally, active hemostatic symptomatic treatment should be pursued in cases of bleeding after childbirth. The majority of cases are often caused by poor uterine contraction, which significantly raises the likelihood of postpartum hemorrhage. Generally, it is necessary to actively use drugs that promote uterine contractions to help in reducing bleeding by aiding the contraction of the uterus.
What should be done for late postpartum hemorrhage?
If there is a small or moderate amount of vaginal bleeding, high doses of antibiotics should be administered, along with medications to induce uterine contractions. This can reduce the amount of bleeding after the uterus contracts. If there is suspicion of placental remnants or other residues in the uterine cavity, then a dilation and curettage (D&C) surgery may be necessary. Before surgery, it is essential to prepare blood for transfusion in case of excessive bleeding. Additionally, the tissue removed during the procedure needs to be sent for pathological examination. After the D&C, it is important to continue treatment with anti-inflammatory medications and drugs that promote uterine contraction.
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.