Postpartum Hemorrhage

Postpartum hemorrhage is excessive blood loss after childbirth. Vaginal bleeding after delivery is normal and should be expected. Bleeding (lochia) will occur for several days after childbirth.

This can be expected with normal vaginal deliveries and cesarean deliveries. However, postpartum hemorrhage is a potentially serious condition.

What are the causes?

This condition is caused by:

• A loss of muscle tone in the uterus after childbirth. This can be caused by:
  • An abnormal placenta.
  • Infection.
  • Bladder swelling (distension).
• Failure to deliver all of the placenta or the retention of clots.
• Wounds in the birth canal caused by delivery of the fetus.
• Infection of the uterus.
• Infection of tissue around the fetus.
• A tear in the uterus.
• Tearing of the vagina or cervix during delivery.
• A maternal bleeding disorder that prevents blood from clotting (rare).

What increases the risk?

This condition is likely to develop in people who:

• Have a history of postpartum hemorrhage.
• Had a delivery that lasted longer than usual.
• Have an excess of amniotic fluid in the amniotic sac (polyhydramnios), leading the uterus to stretch too much.
• Have delivered quintuplets or more babies.
• Had high blood pressure, seizures, or coma during pregnancy.
• Had a condition called preeclampsia or eclampsia during pregnancy.
• Had problems with the placenta.
• Had complications during labor or delivery.
• Are obese.
• Are 40 years old or older.
• Are Asian or Hispanic.

What are the signs or symptoms?

Symptoms of this condition include:

• Passing large clots or pieces of tissue. These may be small pieces of placenta left after delivery.
• Soaking more than one sanitary pad per hour for several hours.
• Heavy, bright-red bleeding that occurs 4 days or more after delivery.
• Discharge that has a bad smell.
• An unexplained fever.
• Nausea or vomiting.
• Pain or swelling near the vagina or perineum.
• A drop in blood pressure.
• Lightheadedness or fainting.
• Shortness of breath.
• A fast heart rate that happens with very little activity.
• Signs of shock, such as:
  • Blurry vision.
  • Chills.
  • Dizziness.
  • Weakness.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• A physical exam of your perineum, vagina, cervix, and uterus.
• Tests, including:
  • Blood pressure and pulse measurements.
  • Blood tests.
  • Blood clotting tests.
  • Ultrasonography.

How is this treated?

Treatment for this condition depends on the severity of your symptoms. It may include:

• Uterine massage.
• Medicines to help the uterus contract.
• Blood transfusions.
• Fluids given through the vein.
• A medical procedure to compress arteries supplying the uterus.

Sometimes bleeding occurs if portions of the placenta are left behind in the uterus after delivery. If this happens, a curettage or scraping of the inside of the uterus must be done (rare). This usually stops the bleeding. If curettage does not stop the bleeding, surgery may be done to remove the uterus (hysterectomy), but this rarely occurs.

If bleeding is due to clotting or bleeding problems that are not related to the pregnancy, other treatments may be needed.

Follow these instructions at home:

• Limit your activity as directed by your health care provider. Your health care provider may order bed rest (getting up to go to the bathroom only) or may allow you to continue light activity.
• Keep track of the number of pads you use each day and how soaked (saturated) they are. Write down this information.
• Do not use tampons.
• Do not douche or have sexual intercourse until your health care provider approves.
• Drink enough fluids to keep your urine clear or pale yellow.
• Get enough rest.
• Eat foods that are rich in iron, such as spinach, red meat, and legumes.
• Take any over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Get help right away if:

• You experience severe cramps in your stomach, back, or abdomen.
• You have a fever.
• You pass large clots or tissue. Save any tissue for your health care provider to look at.
• Your bleeding increases.
• You have heavy bleeding that soaks one pad per hour for 2 hours in a row.
• You faint or become dizzy, weak, or lightheaded.
• Your sanitary pad count per hour is increasing.
• You are urinating less than usual or not at all.
• You have shortness of breath.
• Your heart rate is faster than usual.
• You have sudden chest pain.