Postpartum hemorrhage: definition, causes, symptoms, treatment, etc.

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Definition

What is postpartum hemorrhage?

Postpartum hemorrhage or hemorrhagic postpartum is excessive bleeding that occurs postpartum.

Apart from indicating that there is something abnormal in the body, this postpartum bleeding is also a fatal risk to the life of the mother.

Yes, bleeding can occur not only during childbirth, but also after childbirth.

You see, as soon as you give birth to the baby the body will remove the placenta, either after a normal delivery in any labor position or a cesarean section.

When that happens, your uterus has to make strong contractions to release the placenta that sticks to the uterine wall.

This process is what makes you experience postpartum bleeding, aka bleeding after giving birth.

The reason is when the placenta is detached, the blood vessels in the uterus will open.

The open blood vessels cannot just be closed just like that.

The uterus takes time and process to close these blood vessels so that the bleeding stops, by triggering contractions to appear.

Apart from uterine contractions, breastfeeding can also help increase the production of the hormone oxytocin.

The large amount of the hormone oxytocin in your body is useful for stopping bleeding.

Unfortunately, some mothers often experience heavy bleeding after childbirth or what is known as postpartum bleeding alias postpartum hemorrhage or postpartum hemorrhagic (PPH).

Even so, large amounts of bleeding can occur when you have just finished giving birth.

The large amount of bleeding can be due to moving too much or when suddenly standing up from a sitting position.

However, postpartum or postpartum hemorrhage can occur continuously in excessive amounts.

Bleeding after childbirth or postpartum usually appears within 24 hours, or about 12 weeks after delivery.

Types of postpartum hemorrhage

Heavy bleeding shortly after giving birth or known as postpartum hemorrhage or postpartum hemorrhagic is divided into two types, namely:

1.Primary postpartum hemorrhage (primary PPH)

Primary PPH is a condition when postpartum hemorrhage causes you to lose more than 500 milliliters (ml) of blood in the first 24 hours.

This primary postpartum hemorrhage can occur in about 5 in 100 women.

2.Secondary postpartum hemorrhage (secondary PPH)

Postpartum hemorrhagic bleeding or secondary PPH is a condition when you experience severe or abnormal vaginal bleeding from the first 24 hours to 12 weeks postpartum.

This can be experienced by approximately 2 in 100 women or under 1 percent of births.

If you lose 500-1000 ml of blood after delivery (PPH minor), your body may still be able to cope.

However, if you experience blood loss of more than 1000 ml after delivery (PPH major), you will need immediate treatment from a doctor.

How common is postpartum hemorrhage?

Postpartum hemorrhage is very common and can usually occur in women over the age of 35 years.

Bleeding after childbirth can be managed by reducing risk factors.

Talk to your doctor for more information about this postpartum bleeding.

Signs & Symptoms

What are the signs and symptoms of postpartum hemorrhage?

Symptoms of postpartum hemorrhage are sometimes not always obvious. Some mothers may be easily diagnosed with this condition.

Meanwhile, some other mothers may need additional tests to confirm bleeding after giving birth.

The following are symptoms that indicate postpartum hemorrhage or heavy bleeding after childbirth:

• The bleeding does not decrease or stop from day to day
• Lower blood pressure
• Decreased red blood cell count
• Heart rate increases
• Swelling of several parts of the body
• The pain in the stomach after giving birth doesn't get better

Immediately consult a doctor if you experience one or more of the symptoms above or when you experience symptoms that are deemed abnormal.

The doctor can determine the cause and the right treatment according to your condition.

When should I see a doctor?

Bleeding after childbirth or postpartum hemorrhage is an emergency situation.

If you have signs or symptoms above or other questions, immediately go to the nearest emergency room and consult your doctor.

Everyone's body is different. Always consult a doctor to treat your health condition.

Cause

What causes postpartum hemorrhage?

Postpartum bleeding is usually caused by the uterus that is not contracting properly (uterine atony).

According to Stanford Children's Health, once a baby is born, the uterus should contract to push the placenta out.

Right after the placenta leaves the uterus, contractions are still ongoing with the aim of pressing the blood vessels in the area where the placenta is attached.

The stronger the uterine contractions, the less likely the blood vessels will bleed profusely.

Conversely, contractions that are problematic after the discharge of the placenta actually trigger postpartum bleeding.

To prevent heavy bleeding due to this, the doctor can give an injection to help the uterus contract so that the placenta is more easily removed.

In general, there are many causes of bleeding after delivery, both normal and cesarean.

The causes of postpartum bleeding or after delivery can be divided into five main groups, as follows:

1. Atony uteri

Uterine atony is the most common cause of bleeding after childbirth.

Uterine atony is a condition in which the uterus cannot contract properly to expel the placenta.

Finally, this condition can be the cause of heavy bleeding during and after the mother gives birth, whether normal or cesarean.

Various risk factors that can cause uterine atony are multiple pregnancies, macrosomia (large babies), too much amniotic fluid (polyhydramnios), fetal abnormalities, uterine structural abnormalities, and so on.

Mothers are also more at risk of experiencing heavy bleeding if they give birth too long or very quickly.

2. Placental retention

Placental retention occurs when the placenta is still retained in the uterus after you give birth.

This makes the blood vessels in the uterus not yet closed properly, which is why the mother can experience postpartum or postpartum bleeding.

Placental retention is more likely when you give birth at a very early gestational age, especially less than 24 weeks (very preterm birth).

3. Placenta accreta

Placenta accreta occurs when blood vessels and other parts of the placenta get too deep in the uterine wall.

In this condition, the placenta can partially or completely stick to the uterine wall when you have given birth.

As a result, when the placenta is about to be born, there is some remaining placenta that is still attached to the uterine wall.

Any abnormalities in the uterine wall can cause placenta accreta.

This is what later can cause heavy bleeding after childbirth, reports the Mayo Clinic.

4. Trauma to the birth canal

Trauma to the birth canal is a fairly frequent case (about 20%) of the cause of postpartum or postpartum hemorrhage.

This condition usually occurs due to tearing of the perineum (skin between the vagina and anus) that occurs during vaginal delivery.

5. Coagulation disorders (blood clots)

Blood clotting disorders can also be the cause of the mother to experience bleeding during and after childbirth.

Some of the conditions associated with blood clotting are hemophilia and idiopathic thrombocytopenia purpura.

In addition, pregnancy complications, such as preeclampsia and hypertension in pregnancy, can also affect the ability of blood to clot.

Risk Factors

What increases my risk for postpartum hemorrhage?

If you have any of the following risk factors, you are more likely to experience postpartum or postpartum bleeding:

• Giving birth to twins
• Large baby size (baby weighs more than 4000 grams)
• The delivery process and the removal of the placenta take a long time.
• Have given birth several times before
• The uterus is torn during childbirth (uterine rupture)
• Experiencing placental abruption, which is the placenta that detaches prematurely
• Experiencing placenta previa or the location of the placenta under the uterus
• Excessive maternal weight (obesity)
• There is a problem with the baby's placenta
• Excess amniotic fluid (polyhydramnios)
• Have had postpartum hemorrhage in a previous pregnancy
• Use of drugs to aid induction of labor
• Assisted use of forceps or vacuum extraction during delivery

Complications

What are the possible complications of postpartum hemorrhage?

Postpartum bleeding or bleeding after childbirth is at risk of making you experience complications such as:

• Anemia
• Dizziness when standing
• Fatigue

In addition, severe postpartum hemorrhage can lead to serious complications in the form of myocardial ischemia, which can be fatal.

On that basis, it's good to know your best health condition during pregnancy in order to decide the right place of delivery.

The choice of pregnant women to give birth in a hospital is considered more appropriate than giving birth at home if their pregnancy is at risk of complications of childbirth.

So, when the mother experiences various signs of childbirth such as ruptured waters, labor contractions, labor opening, and others, immediately go to the hospital.

Therefore, make sure the mother has arranged various preparations for childbirth to the delivery equipment that needs to be brought along on the D-day.

Diagnosis & Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is postpartum hemorrhage diagnosed?

As explained earlier, bleeding is normal after delivery.

However, if the amount is too much and doesn't go away from day to day, it is possible that your bleeding is heavy or severe.

Therefore, the doctor can perform an examination to confirm the bleeding that you are experiencing.

Usually, you will be asked to use a large bandage that will collect all the blood from the postpartum hemorrhage.

The doctor will observe how much blood you pass so that he can estimate whether the bleeding is normal or not.

Your doctor may also take a blood sample to check your red blood cell (hemoglobin) and hematocrit levels.

In addition, the doctor will also measure your pulse, blood pressure, and respiratory rate.

What are the treatments for postpartum hemorrhage?

The treatment given by doctors to help with heavy bleeding after childbirth usually varies.

This is determined by the initial cause of bleeding that the mother experienced.

Following are the treatments for post partum or postpartum hemorrhage:

1. Massaging the uterus and giving medicines

Uterine massage is usually done for cases of uterine atony, aka the uterus cannot contract.

Massage can at least make the uterus tighten a little so that it helps stop heavy bleeding after childbirth.

Apart from massage, administration of several types of drugs can also help trigger the uterus to contract.

The medicine can be given by injection into a vein or muscle, or by inserting it through the rectum.

2. Perform curettage procedures on the uterus

If you have placental retention, your doctor may take a curettage while pregnant to remove the placenta from the uterus.

This procedure aims to remove any remaining tissue in the mother's uterus and stop heavy bleeding after childbirth.

3. Other ways

Apart from the above measures, some other ways that doctors can treat postpartum hemorrhage are as follows:

• Perform a laparotomy procedure to find the cause of bleeding and stop it.
• Giving blood transfusions to help replace lost blood.
• Giving special drugs by injection to help stop bleeding.
• Using a Bakri balloon in the uterus to put pressure on the blood vessels and stop bleeding.

In rare cases, the doctor may also perform surgical removal of the uterus or hysterectomy.

This medical procedure aims to help stop postpartum bleeding or after childbirth.

Home Remedies

What are some lifestyle changes or home remedies that can be used to treat postpartum hemorrhage?

Here are lifestyle and home remedies that can help you deal with postpartum bleeding:

Iron supplements

Taking iron supplements can reduce the chance of needing blood transfusions if you have postpartum or postpartum bleeding.

Some women can also be given iron supplements if they are at risk for anemia.

Set up a doctor's appointment

If you have had a cesarean section in a previous pregnancy, it is important to check that the placenta is not attached to the area of ​​the previous wound.

Prevention

Can postpartum hemorrhage be prevented?

One way to prevent postpartum hemorrhage or after childbirth is to routinely perform pregnancy checks.

By carrying out regular checks, the doctor will always pay attention to the development and health of you and the baby in the womb.

Doctors can also find out any risk factors during pregnancy by checking your blood type, bleeding disorders, and your medical history.

So, if it is found that there is a risk of problems during pregnancy, the doctor can immediately take the best action to minimize the worst risk of childbirth later.

Even after delivery is over, the doctor will continue to monitor you and your baby's condition. This includes ensuring that heavy bleeding after delivery does not occur.

If you have any questions, consult your doctor for the best solution to your problem.