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Postpartum Hemorrhage

(Obstetric Hemorrhage)

Definition

Postpartum hemorrhage is when a woman loses too much blood after giving birth. It is called primary when it happens in the first 24 hours after giving birth. It is called secondary (or delayed) when it happens between 24 hours to 6 weeks after giving birth.
Some blood loss is normal. Too much blood loss can be serious and put you at risk.
Postpartum Hemorrhage
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Causes

This health problem can be caused by:
  • A loss of muscle tone in the womb after birth
  • Wounds in the birth canal
  • Not delivering the placenta completely
  • Bleeding problems in the mother that make the blood unable to clot (rare)
In rare cases, uterine inversion or uterine rupture may also be a cause.

Risk Factors

Risk factors include problems that would lead to this condition, such as:
  • Problems with the placenta
  • Multiple babies in current pregnancy
  • History of previous postpartum hemorrhage
  • A fetus that is larger than average
  • The use of medicine to speed up labor
  • Rapid or lengthy labor
  • Pre-eclampsia

Symptoms

The main symptom is heavy blood loss after having a child. You may also have swelling and pain in the pelvic area.

Diagnosis

Your doctor will ask about your symptoms. The doctor will check for bleeding.
Your blood will be tested.
Pictures will be taken. This can be done with an ultrasound.

Treatment

Treatment is based on how much you are bleeding. You may have:

Fluids and Oxygen

You may need IV fluids or an oxygen mask. If you have lost a lot of blood, a blood transfusion may be needed.

Massage

A massage technique called bimanual uterine massage can help control bleeding. A doctor or nurse will place one hand in your vagina to push on your womb, while the other hand pushes down on your womb from your belly. This action will cause a relaxed womb to contract and slow the bleeding.

Medicines

You may be given medicine to make the womb contract.

Surgery

In some cases, surgery may be needed to stop bleeding. The type of surgery used will depend on the source of your bleeding. For example, if bleeding is caused by trauma, it will be stitched.

Prevention

Make sure you are closely watched during the third stage of labor when the placenta is delivered.

RESOURCES

The American Congress of Obstetricians and Gynecologists
http://www.acog.org
American Pregnancy Association
http://www.americanpregnancy.org

CANADIAN RESOURCES

Health Canada
https://www.canada.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 2015.
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.dynamed.com/topics/dmp~AN~T114247/Postpartum-hemorrhage. Updated January 24, 2018. Accessed August 9, 2018.

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