Excessive Uterine Bleeding at Delivery – Risks and Treatment of Postpartum Haemorrhage

Excessive Uterine Bleeding at Delivery – Risks and Treatment of Postpartum Haemorrhage

Women who give birth experience some level of bleeding. Whether it is vaginal delivery or cesarean, she will face a decent amount of blood loss. But what when there is excessive bleeding after delivery? Is it a sign of danger? Five women every hour or 45,000 women annually die in India during childbirth. This WHO figure is enough to raise the eyebrows that how fatal childbirth can prove for some women.

These numbers are 17 percent of the total global cases. The major cause of this high mortality rate is the heavy blood loss during delivery which accounts for 37 percent of all the cases. So, why this excessive bleeding occurs? Let’s find out in this article.

Postpartum Haemorrhage

Bleeding or Haemorrhaging is the thing most women do not want to think about, especially when it comes to childbirth. It is estimated that 95 percent of childbirths will not face any problem with bleeding of any kind. However, it is pertinent to know the important risk factors behind bleeding in order to freely discuss it with the doctor or midwife.

Postpartum Haemorrhage is technically referred to as blood loss of more than 500 ml during or after the delivery. This is not the case with cesarean delivery where blood loss can be between 800-1000 ml. Postpartum haemorrhage can be divided into two categories:

  • Primary postpartum haemorrhage – which occurs in the first 24 hours of delivery
  • Secondary postpartum haemorrhage – which occurs after first 24 hours of delivery

What causes Postpartum Haemorrhage?

The doctors typically define the causes by ‘Four Ts’; Tone, Trauma, Tissue, and Thrombin.

Tone or Tension 

Atony of the uterus is responsible for about 70 percent of all postpartum haemorrhage cases. It means tone or degree of tension of the uterus. If the woman won’t deliver the placenta or the uterus doesn't contract, it can lead to haemorrhage. So doctors would be ruling out this first cause.

Trauma

In about 20 percent of cases, haemorrhage is a result of trauma or damage to the uterus. The damage can include hematoma or collection of blood.

Tissue

In about 10 percent of cases, tissue is considered a cause. This tissue is usually defined as retaining a peace of placenta, a condition called as placenta accreta . The placenta needs to be expelled within an expected amount of time. If not then surgery will be required.

Thrombin

It’s a blood clotting protein in the body. Lack of thrombin can cause haemorrhage but it occurs rarely, in about 1 percent of cases.

Symptoms of Postpartum Haemorrhage

While some symptoms are visible, others might require blood testing for a clearer picture.

  • Bleeding that won’t lessen or stop
  • Drop in blood pressure
  • Drop in red blood cell count (hematocrit)
  • Increase in heart rate
  • Swelling
  • Pain occurring post-delivery

Risk Factors of Postpartum Haemorrhage

It’s very much possible to experience postpartum haemorrhage without having any risk factors. However, there are some risk factors that are related to the condition:

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How Postpartum Haemorrhage is Diagnosed?

The first attempt of the doctor in diagnosing the condition will be to evaluate the amount of blood loss during or after the delivery. In case of vaginal delivery, the doctor will put a special fluid collection bag at the delivery table to more accurately assess the blood loss.

Besides this, sponges or soaked pads can also be used to determine the amount of blood lost during the period. Other diagnostic procedures will be focused on measuring these vital signs:

  • Pulse rate
  • Blood pressure
  • Oxygen level
  • Respirations

The doctor will also be taking a sample of your blood for checking the haemoglobin and haematocrit (amount of red blood cells) level. This would help them accurately assess the blood loss.

When to call the doctor?

Even after your discharge, postpartum bleeding continues for several weeks and then taper to normal level on its own. The color of the blood will also turn from bright red to brown and to yellow or whitish tint. This indicates that the uterus is healing.

However, if you see bleeding that soaks a pad every hour or two, it may be a sign of excessive bleeding. It may also be the case of placenta remains in the uterus that could create other problems. In this case, you should call the nurse or doctor and ask their support.

Besides bleeding, also check for symptoms such as fever, foul-smelling vaginal discharge, excessive fatigue and large blood clots.

Treatment Options for Postpartum Haemorrhage

The treatment of postpartum excessive bleeding will depend on the cause.

  • If uterine atony is the reason, the doctor would try to massage the uterus and cause it to contract and become firm. This would stop the bleeding. Medications such as oxytocin can also be given to contract the uterus. It would be either injected into the muscle or placed in the rectum. This medication can also be given in case of c-section.
  • If the reason is placenta remains in the uterus, the team might perform dilation and curettage. An instrument called as curette will be used to remove the tissue remains from the uterus.
  • If the cause of excessive bleeding is trauma, the doctor may insert medical balloon or sponges into the uterus and inflate it. This will put pressure on the bleeding arteries, causing them to halt bleeding. The doctor can also stitch the bottom portion of the uterus to stop bleeding.
  • If the reason behind is lack of thrombin, the treatment will involve providing blood transfusions and fluids. This will prevent you from going into shock.  Shock can happen as a result of losing too much blood and fluid, causing the vital organs to cease functioning.
  • In some rare cases, the doctor can opt for hysterectomy or removal of the uterus.

Ideal prenatal care can reduce the chances of getting postpartum haemorrhage right to some extent. In case of excessive bleeding, you might need a little longer hospital stay. If you had a postpartum haemorrhage in your previous delivery, you must be worried about the risks in your next delivery. Talk to your gynecologist and remove your concerns.

Sources

1. John M.(2016, July 12).Management of Postpartum Hemorrhage: Current State of the Evidence read more
2. Uterine massage for preventing postpartum haemorrhage(2013, July 01) read more
3. Janice M. and Duncan E.(2007, March 15). Prevention and Management of Postpartum Hemorrhage read more