Causes of Late Postpartum Hemorrhage

Written by Yue Hua
Obstetrics and Gynecology
Updated on September 16, 2024
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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.

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Written by Yue Hua
Obstetrics and Gynecology
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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.

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Written by Yue Hua
Obstetrics and Gynecology
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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.

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Written by Liu Wei Jie
Obstetrics
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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.

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Written by Zhao Li Li
Obstetrics
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Postpartum hemorrhage uterine suturing method

If postpartum hemorrhage occurs, it is foremost important to actively seek the specific causes of the bleeding to achieve timely and rapid hemostasis. It is also necessary to quickly replenish blood volume to prevent shock and infection. Meanwhile, if there is localized bleeding, active local suturing treatment should be pursued to control the bleeding. Normally, if the postpartum bleeding is light, suturing the uterus in the conventional way will suffice. However, if the bleeding is caused by uterine atony or similar reasons and oxytocics are ineffective, procedures like ascending ligation of the uterine arteries or uterine compression sutures and binding can be performed to effectively stop the bleeding.

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Written by Liu Wei Jie
Obstetrics
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Can you drink brown sugar water after childbirth bleeding?

Can you drink brown sugar water after childbirth, including after natural childbirth and cesarean section? If it is after natural childbirth, you can drink brown sugar water, but you must check if it contains jujube components. If it does contain jujube, do not drink such brown sugar water. If it is after a cesarean section, do not drink brown sugar water because there are gastrointestinal recovery issues post-cesarean section, especially in the first 1-2 days when there hasn't been gas passing yet. Drinking a lot of brown sugar water can cause abdominal bloating, intestinal obstruction, and other issues. Generally, after a cesarean section, you can drink some brown sugar water after 10 days, but also do not drink brown sugar water that contains jujube.