What are the causes of postpartum hemorrhage?

Written by Zhao Li Li
Obstetrics
Updated on March 20, 2025
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Under normal circumstances, postpartum hemorrhage is one of the most severe complications that can occur during childbirth.

Postpartum hemorrhage can be caused by several reasons: The first is mainly due to uterine atony leading to bleeding, which is relatively common and generally requires the administration of potent oxytocics to promote uterine contraction; The second is mainly due to local tears in the vagina or cervix leading to bleeding; The third is primarily caused by issues such as placental adhesion or implantation; The fourth is due to disorders in the body's coagulation function, leading to uncontrolled bleeding.

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Written by Yue Hua
Obstetrics and Gynecology
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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.

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Written by Yue Hua
Obstetrics and Gynecology
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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.

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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 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.

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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Postpartum hemorrhage causes

Postpartum hemorrhage (PPH) has four primary causes: 1. Lacerations from difficult labor; 2. Placental factors; 3. Uterine atony; 4. Coagulopathy. Immediately after childbirth, if there is bright red bleeding that includes blood clots, this is considered to be caused by soft birth canal lacerations. Approximately 10 to 15 minutes after delivery of the fetus, if significant bleeding occurs, placental factors should be considered. After the placenta is delivered, if the placenta and membranes are found to be intact and there is still vaginal bleeding, or if there is intermittent heavy vaginal bleeding, and the uterus feels soft and poorly defined upon light palpation, uterine atony should be considered as a likely cause of the heavy bleeding. Lastly, coagulopathy, which leads to continuous, dark red bleeding without clots, can also cause severe postpartum hemorrhage.