Can there still be heavy bleeding one year after childbirth?

Written by Zhao Li Li
Obstetrics
Updated on January 31, 2025
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Under normal circumstances, postpartum hemorrhage is one of the serious obstetric complications that can endanger the life of the mother. It is most commonly due to poor uterine contraction after childbirth, causing bleeding, and generally occurs within 24 hours after childbirth or as late postpartum hemorrhage occurring more than ten days after childbirth. If a year has passed since childbirth, there generally will not be instances of severe hemorrhage. It is advised to undergo an ultrasound examination within 42 days after childbirth to confirm whether the recovery of the uterus and its appendages is satisfactory. If the uterus has recovered back to its normal pre-pregnancy state, it generally will not cause severe hemorrhage.

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Written by Zhang Lu
Obstetrics
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Symptoms of Postpartum Hemorrhage

Postpartum hemorrhage is the leading cause of death in pregnant women. The symptoms of postpartum hemorrhage include the following aspects: First, it initially presents as significant vaginal bleeding, where the bleeding may exceed 500 milliliters in a short period or 800-1000 milliliters within 24 hours, predominantly featuring fresh blood. Second, there can be abdominal pain or other symptoms caused by the underlying etiology, such as postpartum hemorrhage due to soft birth canal injuries, which can manifest as tears in the vagina or cervix. Third, there can be signs of shock, such as confusion, lowered blood pressure, and an increased heart rate, all of which are symptoms used to diagnose postpartum hemorrhage.

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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Causes of postpartum hemorrhage

The causes of postpartum hemorrhage can be summarized into four main reasons: First is related to the placenta; second is lacerations in the soft birth canal; third is coagulation dysfunction; fourth is uterine atony, among which uterine atony is the most common cause. So, how can one determine if postpartum hemorrhage is caused by uterine atony? Clinically, after the placenta is delivered, examination of the soft birth canal is conducted. Upon examining the uterus, if it is found that the outline of the uterus is unclear and pressing on it results in a lot of blood and blood clots flowing out from the uterine cavity, then the uterus becomes firm when pressed and softens when not pressed. This situation indicates uterine atony. Other injuries, such as lacerations in the soft birth canal, are generally detected during an examination. There are also factors related to the placenta and coagulation dysfunction, which are the four main causes of postpartum hemorrhage.

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Written by Zhang Lu
Obstetrics
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Does postpartum hemorrhage require a blood transfusion?

The definition of postpartum hemorrhage is bleeding greater than 500 milliliters approximately 24 hours after vaginal delivery. Whether blood transfusion is necessary for postpartum hemorrhage mainly depends on the specific amount of bleeding. For average women, if the hemoglobin level is normal before delivery and the bleeding is between 500-1000 milliliters, the body can compensate for the anemia through normal adjustments, and generally, a blood transfusion is not required. However, if the bleeding exceeds 1000 milliliters, this situation is considered massive hemorrhage and must be treated with a blood transfusion, otherwise it may lead to hemorrhagic shock or DIC (Disseminated Intravascular Coagulation).

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Written by Zhang Lu
Obstetrics
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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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Written by Zhao Li Li
Obstetrics
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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.