Postpartum Hemorrhage: Causes, Prevention, and Treatment

In short: Postpartum haemorrhage is the loss of more blood than expected after delivery. The commonest cause is a uterus that does not contract; others are tears of the birth canal, retained pieces of placenta and clotting disorders. The risk is higher with fibroids, excess amniotic fluid, twins and a large baby. It is treated by massaging the uterus and medication, uterine balloons, stitching of tears, blood transfusion and sometimes surgery. Treating anaemia during pregnancy is one of the most important means of prevention.

What is postpartum hemorrhage?

Postpartum hemorrhage is when a mother loses more blood than expected after giving birth: 500 ml or more in the first 24 hours after a vaginal birth, or 1,000 ml or more after a caesarean section. Blood loss of more than 1,000 ml is considered severe. Heavy bleeding that starts later, from 24 hours up to 12 weeks after birth, is called secondary postpartum hemorrhage. It’s a well-known childbirth complication, and knowing about it in advance can help you feel more prepared and less worried.

The most effective way to prevent postpartum hemorrhage is an injection of a medicine that makes the uterus contract (usually oxytocin 10 units), given to every mother straight after the baby is born, as part of the active management of the third stage of labour. Your care team will also check your uterus and your bleeding closely during the first hours after birth.

What are the causes of postpartum hemorrhage?

• Relaxation of the muscles in the wall of the uterus (the most common cause) .. known as uterine atony
• Lacerations in the birth canal (injury to the cervix, injury to the walls of the vagina)
• Hematological diseases that cause bleeding tendency
• Some medications that cause bleeding tendency
• Retained parts of the pregnancy tissue (the placenta) inside the uterus

What are the causes of relaxation of the muscles in the uterine wall after childbirth?

• Primary
• Secondary due to the presence of uterine fibroids or increased amniotic fluid around the fetus or pregnancy with twins or pregnancy with a large sized fetus

How can you prepare for postpartum bleeding?

Your doctor will usually monitor your hemoglobin level throughout pregnancy to help make sure you don’t have anemia at the time of birth, since this can make bleeding harder for your body to manage.

Does postpartum hemorrhage increase the risk of postpartum hemorrhage in subsequent pregnancies?

Yes, the recurrence rate is high, so it’s helpful to share your birth history with your care team early in any future pregnancy.

After you go home, seek medical help urgently if you soak a pad in an hour or less, pass large clots, have sudden heavy bleeding, feel dizzy, faint or have a fast heartbeat, or notice a bad-smelling discharge with fever.

How is postpartum bleeding managed?

• Massage the uterine fundus
• Using medications to increase the uterine muscles tone

Giving tranexamic acid (1 g into a vein) as early as possible, and within 3 hours of birth, to reduce bleeding

• Using a balloon placed inside the uterus to put pressure on the bleeding areas of the uterine wall
• Surgically, which may end with a hysterectomy
• Suturing the lacerations causing bleeding in the birth canal
• Blood and plasma transfusion
• Removing the remnants of the stuck placenta

If you have questions about postpartum hemorrhage or want guidance on a safe delivery plan, Dr. Najeeb Layyous and his team are available to discuss your individual situation.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist