Postpartum hemorrhage patient care

Written by Zhao Li Li
Obstetrics
Updated on February 28, 2025
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During the process of postpartum hemorrhage, there are several considerations for the care of patients with postpartum hemorrhage. First, during the patient care process, it is necessary to closely monitor whether the contraction of the uterus is good, monitor the height of the uterine fundus, and the specific vaginal bleeding situation. Moreover, it is also necessary to provide a light and nutritious diet, avoiding spicy and irritating foods. Due to the massive bleeding caused by the surgical process, patients are generally weak, so it is recommended to rest more, avoid excessive fatigue, and also avoid looking after the newborn again to prevent various body disorders.

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Postpartum Hemorrhage Emergency Response Process

Firstly, it is necessary to administer IV fluids to the patient and establish two venous accesses to urgently replenish blood volume. Then, it is important to manage breathing to ensure the patient's airway is clear, and provide oxygen if necessary. Patient's vital signs should also be checked for any abnormalities. Additionally, treatment should be given based on the cause of bleeding. If the bleeding is due to poor uterine contraction, it is crucial to promptly enhance uterine contractions to quickly stop the bleeding. At this time, uterotonic agents can be used, or manual uterine massage can be employed to stem the bleeding. If the bleeding is caused by a surgical incision, then the incision needs to be sutured properly.

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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 Zhang Lu
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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 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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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.