Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 4 to 6 percent of women have postpartum hemorrhage and it is more likely with a cesarean birth. Hemorrhage may occur before or after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well.
Once a baby is delivered, the uterus normally continues to contract (tightening of uterine muscles) and expels the placenta. After the placenta is delivered, these contractions help compress the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, called uterine atony, these blood vessels bleed freely and hemorrhage occurs. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta remain attached, bleeding is also likely. It is estimated that as much as 600 ml (more than half a quart) of blood flows through the placenta each minute in a full-term pregnancy.
Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk for postpartum hemorrhage include the following:
Postpartum hemorrhage may also be due to other factors including the following:
Although an uncommon event (one in 2,000 deliveries), uterine rupture can be life threatening for the mother. Conditions that may increase the risk of uterine rupture include surgery to remove fibroid (benign) tumors and a prior cesarean scar in the upper part (fundus) of the uterus. It can also occur before delivery and place the fetus at risk as well.
Excessive and rapid blood loss can cause a severe drop in the mother's blood pressure and may lead to shock and death if not treated.
The following are the most common symptoms of postpartum hemorrhage. However, each woman may experience symptoms differently. Symptoms may include:
The symptoms of postpartum hemorrhage may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnosis is usually based on symptoms, with laboratory tests often helping with the diagnosis. Tests used to diagnose postpartum hemorrhage may include:
Specific treatment for postpartum hemorrhage will be determined by your physician based on:
The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as quickly as possible. Treatment for postpartum hemorrhage may include:
Replacing lost blood and fluids is important in treating postpartum hemorrhage. Intravenous (IV) fluids, blood, and blood products may be given rapidly to prevent shock. The mother may also receive oxygen by mask.
Postpartum hemorrhage can be quite serious. However, quickly detecting and treating the cause of bleeding can often lead to a full recovery.
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