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Postpartum Hemorrhage

(Obstetric Hemorrhage)

Definition

Postpartum hemorrhage is excessive blood loss in a woman after childbirth. It is called primary when it is within the first 24 hours after childbirth. Secondary (or delayed) postpartum hemorrhage occurs between 24 hours-6 weeks after childbirth.
Some blood loss is normal. However, postpartum hemorrhage is a potentially serious condition that often goes unrecognized. Any excessive blood loss can put a woman at considerable risk. Talk with your doctor if you have any concerns about blood loss after giving birth.
Postpartum Hemorrhage
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Causes

Postpartum hemorrhage can be caused by:
In rare cases, uterine inversion or uterine rupture may also cause postpartum hemorrhage.

Risk Factors

Postpartum hemorrhage may be more common in Asian and Hispanic women.
Factors leading up to labor that may increase your chance of postpartum hemorrhage include:
Complications of labor and delivery that may increase your chance of postpartum hemorrhage include:
Forceps and Vacuum Delivery
Vacuum and forceps delivery
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Signs and Symptoms

The most obvious sign of postpartum hemorrhage is heavy vaginal bleeding. If the bleeding is not obvious, other signs may include:

Diagnosis

Your doctor will ask about your symptoms. A physical exam will be done. The doctor will check your perineum, vagina, cervix, and uterus for bleeding. Other tests may include:
Imaging tests evaluate internal body structures. These may include:

Treatment

Treatment is based on the severity of bleeding. Treatment options include:

Fluids, Oxygen, and/or Resuscitation

You may need IV fluids or an oxygen mask. In severe cases, resuscitation or a blood transfusion may be necessary.

Bimanual Uterine Massage

A massage technique called bimanual uterine massage can control bleeding. A doctor or nurse will place one hand in your vagina to push on your uterus, while the other hand pushes down on your abdomen. This action will cause a relaxed uterus to contract, thus slowing bleeding.

Trauma Repair

Bleeding can be caused by a tear in your genital tract or other trauma. The tear will be stitched. In addition, tissue from a retained placenta may need to be removed.

Medications

Your doctor may prescribe uterotonics or prostaglandins to stimulate contraction of the uterus.

Surgery

In some cases, surgery may be needed to stop bleeding. Procedures include:
  • Uterine packing—sterile materials or a special tamponade device is placed inside the uterine cavity to compress the bleeding area
  • Repair of arteries
  • Uterine curettage—scraping the lining of the uterus
  • Repair of hematoma
  • Removal of retained placenta
  • Uterine artery embolization—non-invasive procedure to block the uterine artery
  • Removal of the uterus—hysterectomy

Prevention

To help reduce your chance of postpartum hemorrhage:

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org

American Pregnancy Association http://www.americanpregnancy.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Women's Health Matters http://www.womenshealthmatters.ca

References

American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039-1047. Reaffirmed 2013.

Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;75(6):875-882.

Postpartum hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 19, 2013. Accessed August 6, 2013.

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