Bleeding after delivery
| Postpartum bleeding | |
|---|---|
| Synonyms | Postpartum hemorrhage |
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| A non-pneumatic anti-shock garment (NASG) | |
| Specialty | Obstetrics |
| Symptoms | Loss of lots of blood after childbirth, increased heart rate, feeling faint upon standing, increased breath rate |
| Causes | Poor contraction of the uterus, not all the placenta removed, tear of the uterus, poor blood clotting |
| Risk factors | Anemia, Asian, more than one baby, obese, older than 40 years |
| Prevention | , misoprostol |
| Treatment | Intravenous fluids, non-pneumatic anti-shock garment, blood transfusions, ergotamine, tranexamic acid |
| Prognosis | 3% risk of death (developing world) |
| Frequency | 8.7 million (global) / 1.2% of births (developing world) |
| Deaths | 83,100 (2015) |
| Classification | |
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| External resources |
Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breath rate. As more blood is lost the women may feel cold, their blood pressure may drop, and they may become restless or unconscious. The condition can occur up to six weeks following delivery.
The most common cause is poor contraction of the uterus following childbirth. Not all of the placenta being delivered, a tear of the uterus, or poor blood clotting are other possible causes. It occurs more commonly in those who: already have a low amount of red blood, are Asian, with bigger or more than one baby, are obese or are older than 40 years of age. It also occurs more commonly following caesarean sections, those in whom medications are used to start labor, and those who have an episiotomy.
Prevention involves decreasing known risk factors including if possible procedures associated with the condition and giving the medication to stimulate the uterus to contract shortly after the baby is born. Misoprostol may be used instead of oxytocin in resource poor settings. Treatments may include: intravenous fluids, blood transfusions, and the medication ergotamine to cause further uterine contraction. Efforts to compress the uterus using the hands may be effective if other treatments do not work. The aorta may also be compressed by pressing on the abdomen. The World Health Organization has recommended non-pneumatic anti-shock garment to help until other measures such as surgery can be carried out. In 2017 study found that tranexamic acid decreased a woman's risk of death.
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