Postpartum Hemorrhage Etiology

Written by Tang Mei Xiang
Obstetrics and Gynecology
Updated on April 24, 2025
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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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How long will it take for postpartum anal fissure bleeding to heal?

Generally, anal fissures that occur postpartum may heal on their own within about a week. For more severe cases, timely surgical treatment is necessary. The specific recovery time also depends on the physical condition of the mother, such as nutritional status, diet, and everyday habits—whether her diet is balanced, whether she drinks enough water, etc., all of which can affect the recovery and progression of the condition. If postpartum women improve their diet by eating more fresh vegetables and fruits, drinking more soups, and developing regular bowel habits to alleviate constipation, the anal fissures can also improve on their own.

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Should the uterus be removed due to severe postpartum hemorrhage?

Whether postpartum hemorrhage requires hysterectomy primarily depends on the severity of the hemorrhage and the specific causes of the postpartum hemorrhage. First, if the amount of postpartum hemorrhage is very substantial, leading to conditions like DIC in the pregnant woman, and if not removing the uterus may cause ongoing bleeding, it is essential to remove the uterus quickly to reduce vaginal bleeding. Second, if the postpartum hemorrhage is caused by issues like amniotic fluid embolism or poor contraction of the uterus, and conservative treatments are ineffective, it is also necessary to make a prompt decision to remove the uterus.

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Postpartum hemorrhage uterine suturing method

If postpartum hemorrhage occurs, it is foremost important to actively seek the specific causes of the bleeding to achieve timely and rapid hemostasis. It is also necessary to quickly replenish blood volume to prevent shock and infection. Meanwhile, if there is localized bleeding, active local suturing treatment should be pursued to control the bleeding. Normally, if the postpartum bleeding is light, suturing the uterus in the conventional way will suffice. However, if the bleeding is caused by uterine atony or similar reasons and oxytocics are ineffective, procedures like ascending ligation of the uterine arteries or uterine compression sutures and binding can be performed to effectively stop the bleeding.

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Methods of assessing postpartum hemorrhage

There are several methods to assess the approximate amount of bleeding when postpartum hemorrhage occurs. Normally, a curved dish can be placed at the vaginal opening after childbirth. By collecting blood in this curved dish, you can understand the specific amount of bleeding. Alternatively, the gauze method can be used, estimating the amount of bleeding based on the specific area of each piece of gauze. Another method involves monitoring changes in the patient's vital signs and using the specific timing of shock indices to determine the amount of bleeding. However, it is crucial to promptly implement hemostasis to avoid severe consequences.

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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.