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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.

Causes

Causes may be:

  • 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 some women, uterine inversion or uterine rupture may also be a cause.

Risk Factors

Things that may raise the risk are:

  • 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. There may also be swelling and pain in the pelvic area.

Diagnosis

The doctor will ask about your symptoms and health history. 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 a woman is bleeding. Options are:

  • Replacing lost fluids, such as with a blood transfusion
  • Oxygen therapy
  • Medicines to make the uterus contract
  • Manual massage of the uterus

Some women may need surgery when other methods do not help. The type of surgery done depends on the source of the bleeding.

Prevention

There are no known guidelines to prevent this health problem.

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:

Postpartum hemorrhage. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/postpartum-hemorrhage. Accessed October 19, 2020.

Royal College of Obstetricians and Gynecologists. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG. 2017 Apr;124(5):e106-e149.

Last reviewed September 2020 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG  Last Updated: 10/19/2020