Can postpartum hemorrhage be stopped?

Written by Zhao Li Li
Obstetrics
Updated on September 21, 2024
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Postpartum hemorrhage primarily refers to bleeding from the vagina exceeding 500 milliliters within 24 hours after the delivery of the fetus, and bleeding exceeding 1000 milliliters for cesarean deliveries. It is classified as postpartum hemorrhage. Normally, active hemostatic symptomatic treatment should be pursued in cases of bleeding after childbirth. The majority of cases are often caused by poor uterine contraction, which significantly raises the likelihood of postpartum hemorrhage. Generally, it is necessary to actively use drugs that promote uterine contractions to help in reducing bleeding by aiding the contraction of the uterus.

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Written by Liu Wei Jie
Obstetrics
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Does postpartum hemorrhage count as dystocia?

Postpartum hemorrhage is one of the very important causes that endanger the lives of mothers. Although hemorrhage is not considered as dystocia, conditions of dystocia can induce severe hemorrhage. This is because complications such as trauma to the birth canal and uterine atony might occur after dystocia. These issues are triggers for severe postpartum hemorrhage. Even in normal cesarean sections, there can be cases of severe postpartum hemorrhage, thus postpartum hemorrhage is not counted as dystocia, but dystocia can easily induce severe postpartum hemorrhage.

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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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Postpartum Hemorrhage Etiology

The causes of postpartum hemorrhage can be broadly summarized into four main factors: 1) Inadequate uterine contraction. 2) Lacerations in the soft birth canal. 3) Placental factors. 4) Coagulation dysfunction. The most common cause in clinical settings is inadequate uterine contraction. The manifestation of inadequate uterine contraction primarily appears as the placenta and membranes being expelled intact postpartum, no injuries in the soft birth canal, and an unclear uterine contour upon palpation. The uterus becomes firm when massaged and softens when the massage stops. This condition is indicative of postpartum hemorrhage caused by inadequate uterine contraction. Postpartum hemorrhage due to lacerations in the soft birth canal typically presents as immediate bleeding following the delivery of the baby. The blood is bright red and may contain clots, which mostly suggests lacerations in the soft birth canal. If significant bleeding occurs about five to ten minutes after the delivery of the placenta and baby, this is generally considered to be related to placental factors. If the bleeding is unclotted and continuous, this severe hemorrhage might be due to a coagulation dysfunction.

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Written by Du Rui Xia
Obstetrics
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How long is the critical period for postpartum hemorrhage?

Postpartum hemorrhage generally occurs within 24 hours after giving birth, and sometimes it can occur 1-2 weeks postpartum. It is important to pay special attention during this time to see if there is an increase in vaginal secretions or bleeding. Generally, after giving birth, it is necessary to observe in the delivery room for two hours; if there is no bleeding within those two hours, the patient can be moved back to the ward. The main causes of postpartum hemorrhage include poor contraction of the uterus, retained placental tissue, abnormalities in the coagulation function of the woman's blood, and tears in the birth canal.

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Written by Liu Wei Jie
Obstetrics
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Why is uterine curettage necessary for postpartum hemorrhage?

We encounter a situation where postpartum hemorrhage is caused by the presence of residual material inside the uterus, which can influence the contraction of the uterus. This condition can lead to severe postpartum hemorrhage. The most important solution for postpartum hemorrhage is to immediately stop the bleeding. Therefore, by removing the residual material from the uterine cavity, the uterus can return to its normal contraction, achieving the purpose of immediately stopping the bleeding. It is also very common to need uterine evacuation after childbirth, as this process might cause some trauma to the uterus. Although it can be somewhat traumatic, this trauma is minimal compared to severe postpartum hemorrhage. In such cases, we must carefully weigh the pros and cons and decisively decide to proceed with the evacuation of the uterus.