Is Bleeding After Delivery Harmful?

What is postpartum haemorrhage?

This is severe bleeding after giving birth. It’s a serious and dangerous condition. It usually occurs within 24 hours of childbirth, but it can happen up to 12 weeks postpartum.  PPH is when the total blood loss is greater than 32 fluid ounces after delivery, regardless of whether it’s a vaginal delivery or a Caesarean section, or C-section, or when bleeding is severe enough to cause indications of too much blood loss or a substantial change in heart rate or blood pressure. When the bleeding is caught early and treated speedily, it leads to more successful outcomes.

What are the types of postpartum haemorrhage?

There are two types of PPH. 

1. Primary postpartum haemorrhage: This occurs within the first 24 hours after delivery.

2. Secondary or late postpartum haemorrhage: This occurs 24 hours to 12 weeks postpartum.

Why does postpartum haemorrhage occur?

There are a few explanations why postpartum haemorrhage occurs.

Placenta adheres to the wall of your uterus and provides food and oxygen to your baby during pregnancy. Your uterus continues to contract to deliver the placenta after your baby is delivered. This is known as the third phase of labour. Contractions also help to squeeze the blood vessels where the placenta was attached to your uterine wall. Occasionally, these contractions aren’t strong enough to stop the bleeding. This is the cause of the maximum number of post partum haemorrhages.

PPH can also happen if parts of the placenta stay attached to your uterine wall or if parts of your reproductive organs are damaged during delivery. You’re at a bigger risk for PPH if you have a blood clotting disorder or certain health conditions.

What are the four most common causes of postpartum haemorrhage?

The causes of postpartum haemorrhage are tone, trauma, tissue and thrombin. The most common causes of PPH are:

Uterine atony: This refers to a soft and weak uterus after delivery. When your uterine muscles don’t contract sufficiently to clamp the placental blood vessels close, it leads to a steady loss of blood after delivery and consequently PPH.

Uterine trauma: Injury to your vagina, cervix, uterus or perineum causes bleeding. This can happen due to devices like forceps or vacuum extraction during delivery that can increase your risk of uterine trauma. Occasionally, a hematoma can form in a concealed area and cause bleeding hours or days after delivery.

Retained placental tissue: This is when the complete placenta doesn’t detach from your uterus wall after delivery. It’s generally caused by conditions of the placenta that disturb your uterus’s capability to contract after delivery.

Blood clotting condition: If you have a coagulation disorder or pregnancy condition like eclampsia, it can inhibit your body’s clotting ability. This can make even a minute bleed irrepressible.

How is postpartum haemorrhage diagnosed?

Doctors diagnose postpartum haemorrhage through visual and physical examinations, lab tests and a thorough review of your health history. They may notice postpartum haemorrhage based on the amount of blood you’ve lost. Gauging the volume of collected blood and weighing the blood-soaked pads or sponges from delivery is one common way to estimate blood loss.

Other procedures to diagnose PPH are:

  • Repeated monitoring of your pulse rate and blood pressure to detect problems.
  • Blood tests to measure red blood cells and clotting factors.
  • Ultrasound to get a thorough image of your uterus and other organs.

How do doctors treat postpartum haemorrhage?

They treat PPH as an emergency in most cases. Discontinuing the source of the bleeding as fast as possible and replacing blood volume are the goals of treating postpartum haemorrhage.

Few of the treatments used are:

  • Uterine massage to help the muscles of your uterus contract.
  • Medication to stimulate contractions.
  • Eliminating retained placental tissue from your uterus.
  • Repairing vaginal, cervical and uterine tears or lacerations.
  • Packing your uterus with sterile gauze or tying off the blood vessels.
  • Using a catheter or balloon to help put pressure on your uterine walls.
  • Uterine artery embolization.
  • Blood transfusion.

In rare cases, or when other methods fail, your doctor may perform a laparotomy or a hysterectomy.