How much bleeding is considered postpartum hemorrhage?

Written by Yue Hua
Obstetrics and Gynecology
Updated on September 18, 2024
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Postpartum hemorrhage refers to a condition where, if the patient has vaginal delivery, the bleeding exceeds 500 milliliters within 24 hours after the fetus is delivered. If the delivery is via cesarean section, the bleeding exceeds 1000 milliliters, which is considered significant postpartum hemorrhage. The primary cause is mostly related to poor uterine contractions. Due to inadequate muscle contractions of the uterus, the blood vessels in the uterine muscle layer remain open, leading to bleeding. Another cause relates to placental factors, such as when the placenta is not entirely expelled, leading to remnants of the placenta and membranes remaining in the uterine cavity, which can also cause postpartum bleeding.

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Written by Yue Hua
Obstetrics and Gynecology
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Causes of Late Postpartum Hemorrhage

Late postpartum hemorrhage is most commonly caused by retained placenta and membranes. About ten days after childbirth, the patient may experience significant bleeding due to the degeneration and necrosis of the retained placental and membrane tissues within the uterine cavity. When these necrotic tissues are shed, it can cause the blood vessels to open and lead to bleeding. Additionally, poor healing of the placental site on the uterus can also cause bleeding, as can infections, with endometritis being relatively common. Inflammation can lead to poor healing of the placental attachment site or poor uterine contraction, resulting in significant uterine bleeding.

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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The main causes of postpartum hemorrhage

There are four main causes of postpartum hemorrhage: one is uterine atony, two is due to trauma in the soft birth canal, three is due to placental factors, and four is coagulation dysfunction. Uterine atony is the most common cause of postpartum hemorrhage clinically. Various factors can lead to uterine atony, such as maternal exhaustion during labor due to not eating, leading to physical decay, which can also cause uterine atony. Additionally, an excessively large uterus, such as from excessive amniotic fluid, twins, or triplets, can lead to poor uterine contraction and retraction rates after childbirth. As for injuries in the soft birth canal, they mainly occur due to insufficient protection of the perineum during childbirth or inappropriate use of vacuum assistance during the second stage of labor, causing trauma in the soft birth canal. Placental factors include placental adhesion, placenta accreta, partial placental abruption, and retained placenta, all of which can lead to postpartum bleeding due to placental issues.

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Written by Liu Wei Jie
Obstetrics
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The most common cause of postpartum hemorrhage

Postpartum hemorrhage is divided into two scenarios. The first type occurs within 24 hours after childbirth and is seen in four situations. The first is due to inadequate uterine contraction, the second is trauma to the soft birth canal, the third concerns placental factors, and the fourth involves coagulation disorders. The second type of hemorrhage is late postpartum bleeding, which occurs one to two months after childbirth. This can be associated with postpartum infections, slow recovery of physical condition postpartum, retained products, and poor healing of cesarean section scars.

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Written by Du Rui Xia
Obstetrics
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What should I do if I have postpartum anal fissures that bleed and cause pain?

When experiencing postpartum anal fissures, bleeding, and pain, it is important to use some medications locally to relieve pain and to promote smooth bowel movements. Traditional Chinese Medicine treatments can also be used for sitz baths or fumigation of the anal area. After the sitz bath or fumigation, some traditional Chinese topical medications can be applied; these are generally safe and do not affect breastfeeding women. Moreover, in daily life, it is crucial to drink plenty of water, engage in moderate activities, avoid lying in bed for long periods, and avoid consuming cold, spicy, or irritating foods. Instead, consume plenty of fresh vegetables and fruits to facilitate gastrointestinal motility.

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Written by Liu Wei Jie
Obstetrics
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The difference between postpartum hemorrhage and menstruation

The difference between postpartum hemorrhage and menstruation varies whether it is a vaginal delivery or a cesarean section. The timing of postpartum bleeding varies, and it also relates to postpartum lochia. If the bleeding occurs within 24 hours, it is called severe postpartum hemorrhage; most frequently, we encounter bleeding after 24 hours. Typically, for vaginal deliveries, bleeding occurs within seven days. In cesarean sections, due to the uterine incision, healing is needed, and the duration of bleeding varies by individual and health, commonly lasting from one to two months post-operation. Postpartum bleeding is due to incomplete healing of the uterine lining, which is different from menstrual bleeding. Menstrual bleeding is usually heavier in the initial days and the blood is dark red with a cyclic pattern. In contrast, postpartum bleeding does not have a cyclic nature; it usually consists of fresh red or dark blood, whereas menstrual bleeding typically involves dark blood.