Postpartum hemorrhage

KEY POINTS

  • Postpartum hemorrhage (also called PPH) is a serious but rare condition when a woman has heavy haemorrhage subsequently giving nativity.

  • If y'all think you're having PPH, call your health care provider or 911 immediately.

  • Yous may have PPH if yous have heavy bleeding from the vagina that doesn't wearisome or stop, blurred vision or chills, or if y'all feel weak or similar you're going to faint.

  • You're more likely to have PPH if you've had it in the by or if y'all have certain medical conditions, especially conditions that affect the uterus (womb) or the placenta or conditions that bear on how your claret clots.

Postpartum hemorrhage (also called PPH) is when a adult female has heavy bleeding after giving nascence. It's a serious just rare condition. It unremarkably happens within 1 day of giving nascency, but it tin can happen upwards to 12 weeks afterwards having a baby. About 1 to 5 in 100 women who have a baby (1 to five percentage) have PPH.

It's normal to lose some blood after giving birth. Women usually lose about half a quart (500 milliliters) during vaginal birth or about ane quart (1,000 milliliters) later on a cesarean nascency (also called c-section). A c-section is surgery in which your infant is born through a cut that your physician makes in your belly and uterus (womb). With PPH, you can lose much more claret, which is what makes it a unsafe condition. PPH can crusade a severe driblet in blood pressure level. If non treated chop-chop, this tin lead to daze and decease. Shock is when your body organs don't get enough blood menses.

When does PPH happen?

After your baby is delivered, the uterus normally contracts to push button out the placenta.  The contractions then assistance put pressure level on bleeding vessels where the placenta was fastened in your uterus.  The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical string. If the contractions are not strong enough, the vessels bleed more.  It can as well happen if modest pieces of the placenta stay attached.

How do you know if you accept PPH?

You lot may have PPH if you lot have whatever of these signs or symptoms. If you exercise, call your health care provider or 911 right away:

  • Heavy haemorrhage from the vagina that doesn't slow or terminate
  • Drop in claret pressure or signs of stupor. Signs of low blood pressure and shock include blurry vision; having chills, damp skin or a really fast heartbeat; feeling confused  giddy, sleepy or weak; or feeling like you're going to faint.
  • Nausea (feeling sick to your stomach) or throwing up
  • Pale peel
  • Swelling and pain around the vagina or perineum. The perineum is the area between the vagina and rectum.

Are some women more likely than others to have PPH?

Yep. Things that brand you more likely than others to have PPH are called chance factors. Having a risk factor doesn't mean for sure that you will have PPH, but it may increase your chances. PPH commonly happens without warning. Just talk to your wellness care provider about what you can practice to help reduce your run a risk for having PPH.

You're more likely than other women to have PPH if you've had it earlier. This is called having a history of PPH. Asian and Hispanic women also are more likely than others to have PPH.

Several medical conditions are risk factors for PPH. You may exist more likely than other women to take PPH if you have whatever of these conditions:

Conditions that affect the uterus

  • Uterine atony. This is the most common cause of PPH. It happens when the muscles in your uterus don't contract (tighten) well subsequently birth. Uterine contractions subsequently birth assistance stop bleeding from the place in the uterus where the placenta breaks away. You may have uterine atony if your uterus is stretched or enlarged (also chosen distended) from giving birth to twins or a large infant (more than 8 pounds, 13 ounces). It also can happen if you've already had several children, you're in labor for a long time or you lot have likewise much amniotic fluid. Amniotic fluid is the fluid that surrounds your baby in the womb.
  • Uterine inversion. This is a rare status when the uterus turns inside out after birth.
  • Uterine rupture. This is when the uterus tears during labor. Information technology happens rarely. It may happen if you accept a scar in the uterus from having a c-section in the past or if you've had other kinds of surgery on the uterus.

Weather that impact the placenta

  • Placental abruption. This is when the placenta separates early from the wall of the uterus before nativity. It can separate partially or completely.
  • Placenta accreta, placenta increta or placenta percreta. These conditions happen when the placenta grows into the wall of the uterus too deeply and cannot separate.
  • Placenta previa. This is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.
  • Retained placenta. This happens if you don't laissez passer the placenta inside 30 to hour after you requite nativity. Fifty-fifty if y'all pass the placenta soon after birth, your provider checks the placenta to brand sure it's not missing whatever tissue. If tissue is missing and is not removed from the uterus right away, it may cause bleeding.

Weather condition during labor and birth

  • Having a c-section
  • Getting general anesthesia. This is medicine that puts you to slumber then you don't experience pain during surgery. If you have an emergency c-section, you may need full general anesthesia.
  • Taking medicines to induce labor. Providers often utilise a medicine called Pitocin to induce labor. Pitocin is the human being-made form of oxytocin, a hormone your body makes to first contractions.
  • Taking medicines to terminate contractions during preterm labor. If you have preterm labor, your provider may give y'all medicines called tocolytics to wearisome or stop contractions.
  • Violent (besides chosen lacerations). This may happen if the tissues in your vagina or cervix are cutting or torn during birth. The cervix is the opening to the uterus that sits at the top of the vagina. Y'all may have tearing if you lot give birth to a large babe, your baby is born through the birth culvert likewise quickly or you take an episiotomy that tears. An episiotomy is a cutting made at the opening of the vagina to aid let the baby out. Tearing likewise can happen if your provider uses tools, like forceps or a vacuum, to help move your baby through the nascence canal during birth. Forceps wait like big tongs. A vacuum is a soft plastic cup that attaches to your baby's head. It uses suction to gently pull your baby as you button during birth.
  • Having quick labor or beingness in labor a long time. Labor is dissimilar for every woman. If yous're giving birth for the first time, labor usually takes about xiv hours. If y'all've given nativity before, it commonly takes virtually six hours.  Augmented labor may also increase risk of PPH.  Augmentation of labor ways medications or other ways are used to make more contractions of the uterus during labor.

Other conditions

  • Claret conditions, like von Willebrand disease or disseminated intravascular coagulation (as well called DIC). These conditions tin increment your gamble of forming a hematoma. A hematoma happens when a blood vessel breaks causing a claret clot to form in tissue, an organ or some other part of the body. After giving birth, some women develop a hematoma in the vaginal area or the vulva (the female person ballocks exterior of the torso). Von Willebrand'southward affliction is a haemorrhage disorder that makes it hard for a person to stop haemorrhage. DIC causes blood clots to course in small blood vessels and can lead to serious bleeding. Certain pregnancy and childbirth complications (similar placenta accreta), surgery, sepsis (claret infection) and cancer can crusade DIC.
  • Infection, like chorioamnionitis. This is an infection of the placenta and amniotic fluid.
  • Intrahepatic cholestasis of pregnancy (also called ICP). This is the nigh common liver condition that happens during pregnancy.
  • Obesity. Being obese ways you accept an excess amount of torso fat. If you're obese, your trunk mass index (likewise chosen BMI) is 30 or higher. BMI is a measure of body fat based on your peak and weight. To discover out your BMI, become to www.cdc.gov/bmi.
  • Preeclampsia or gestational hypertension. These are types of high blood pressure that only significant women tin get. Preeclampsia is a condition that tin can happen subsequently the 20th week of pregnancy or right afterwards pregnancy. It's when a pregnant adult female has high blood pressure level and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having poly peptide in the urine, changes in vision and severe headache.  Gestational hypertension is high blood pressure that starts after 20 weeks of pregnancy and goes away after you give nascency. Some women with gestational hypertension have preeclampsia afterwards in pregnancy.

How is PPH tested for and treated?

Your provider may use these tests to see if you have PPH or try to observe the cause for PPH:

  • Claret tests called clotting factors tests or factor assays
  • Hematocrit. This is a claret test that checks the per centum of your blood (called whole blood) that'due south made upwards of red claret cells. Haemorrhage can cause a low hematocrit.
  • Blood loss measurement. To come across how much blood you've lost, your provider may weigh or count the number of pads and sponges used to soak up the claret.
  • Pelvic exam. Your provider checks your vagina, uterus and cervix.
  • Physical exam. Your provider checks your pulse and blood pressure level.
  • Ultrasound. Your provider can utilize ultrasound to cheque for bug with the placenta or uterus. Ultrasound is a test that uses audio waves and a estimator screen to make a picture of your infant within the womb or your pelvic organs.

Treatment depends on what's causing your bleeding. Information technology may include:

  • Getting fluids, medicine (like Pitocin) or having a blood transfusion (having new claret put into your torso). You become these treatments through a needle into your vein (too chosen intravenous or Iv), or yous may get some directly in the uterus.
  • Having surgery, like a hysterectomy or a laparotomy. A hysterectomy is when your provider removes your uterus. You lot normally merely need a hysterectomy if other treatments don't piece of work. A laparotomy is when your provider opens your abdomen to check for the source of bleeding and stops the bleeding.
  • Massaging the uterus by hand. Your provider can massage the uterus to help it contract, lessen bleeding and help the body pass blood clots. Your provider may as well give you medications similar oxytocin to make the uterus contract and lessen haemorrhage.
  • Getting oxygen by wearing an oxygen mask
  • Removing any remaining pieces of the placenta from the uterus, packing the uterus with gauze, a special balloon or sponges, or using medical tools or stitches to help stop haemorrhage from blood vessels.
  • Embolization of the blood vessels that supply the uterus. In this procedure, a provider uses special tests to find the bleeding blood vessel and injects material into the vessel to terminate the bleeding. Information technology's used in special cases and may preclude you lot from needing a hysterectomy.
  • Taking extra fe supplements forth with a prenatal vitamin may besides help. Your provider may recommend this depending on how much blood was lost.

See besides: Maternal death

Last reviewed March 2020