The difference between postpartum hemorrhage and menstruation

Written by Liu Wei Jie
Obstetrics
Updated on September 18, 2024
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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.

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Written by Zhang Lu
Obstetrics
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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).

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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Causes of postpartum hemorrhage

The causes of postpartum hemorrhage can be summarized into four main reasons: First is related to the placenta; second is lacerations in the soft birth canal; third is coagulation dysfunction; fourth is uterine atony, among which uterine atony is the most common cause. So, how can one determine if postpartum hemorrhage is caused by uterine atony? Clinically, after the placenta is delivered, examination of the soft birth canal is conducted. Upon examining the uterus, if it is found that the outline of the uterus is unclear and pressing on it results in a lot of blood and blood clots flowing out from the uterine cavity, then the uterus becomes firm when pressed and softens when not pressed. This situation indicates uterine atony. Other injuries, such as lacerations in the soft birth canal, are generally detected during an examination. There are also factors related to the placenta and coagulation dysfunction, which are the four main causes of postpartum hemorrhage.

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Written by Zhang Yin Xing
Obstetrics
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Does postpartum breastfeeding cause bleeding?

Bleeding caused by postpartum breastfeeding generally occurs within 42 days after delivery, during which the mother has lochia secretion. Breastfeeding promotes the secretion of oxytocin, which acts on the uterus and causes it to contract, facilitating the expulsion of lochia and aiding in the recovery of the uterus. Typically, by 42 days postpartum, the uterus has returned to its non-pregnant size and the expulsion of lochia is essentially complete. Subsequent breastfeeding is not directly related to vaginal bleeding. Another situation is due to the increase in prolactin during lactation; menstrual periods may not have fully resumed in women who are breastfeeding, and abnormal uterine bleeding may occur. As long as the amount and duration of bleeding do not exceed normal menstrual flow, no special treatment is needed.

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Written by Zhao Li Li
Obstetrics
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Can there still be heavy bleeding one year after childbirth?

Under normal circumstances, postpartum hemorrhage is one of the serious obstetric complications that can endanger the life of the mother. It is most commonly due to poor uterine contraction after childbirth, causing bleeding, and generally occurs within 24 hours after childbirth or as late postpartum hemorrhage occurring more than ten days after childbirth. If a year has passed since childbirth, there generally will not be instances of severe hemorrhage. It is advised to undergo an ultrasound examination within 42 days after childbirth to confirm whether the recovery of the uterus and its appendages is satisfactory. If the uterus has recovered back to its normal pre-pregnancy state, it generally will not cause severe hemorrhage.

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Written by Du Rui Xia
Obstetrics
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How many days of postpartum bleeding are normal?

Postpartum hemorrhage typically stops around three weeks. Lochia can be classified into bloody lochia, serous lochia, and white lochia. Another type is abnormal bleeding, which is pathological bleeding. It occurs postpartum, for instance, due to soft birth canal injuries, cervical lacerations, uterine atony, or pre-existing blood disorders, which may extend the bleeding duration even beyond a month. This abnormal condition requires prompt medical attention. Normal lochia during the initial three to four days is bloody. As the bleeding from the uterus gradually decreases, it transitions to serous lochia, which can last about ten days. Finally, it becomes white lochia, which clears up after about three weeks.