Learn More About The Risks Of Excessive Bleeding

A postpartum hemorrhage (PPH) is a condition in which a new mother has a very large amount of bleeding after her baby is born. It can occur after a vaginal birth or cesarean section.

A postpartum hemorrhage in a new mother is a serious condition and can be life-threatening. It is extremely important that immediate actions be taken. The National Partnership for Maternal Safety created specific guidelines that should be followed in every maternity unit in the United States when a postpartum hemorrhage occurs.²

Why Does Postpartum Hemorrhaging Occur?

After delivery, the uterus normally contracts (tightens) to control the amount of bleeding that occurs. In most cases, it occurs because the uterus did not contract as much as it should. This is called uterine atony. In some cases, the large amount of bleeding is caused from a piece, or pieces, of the placenta still in the uterus. It can also happen due to a tear in the uterus, cervix or vagina.

Other causes of PPH may include:

• Placental abruption
• Uterine rupture
• Uterine inversion (where the uterus turns itself inside out after you give birth)
• Placenta previa
• Having a C-section
• Excessive or prolonged labor
• Excessive contractions from drugs like Pitocin
• Medication conditions like pre-eclampsia
• Maternal infections such as chorioamnionitis
• Genetic condition that affect the blood, such as hemophilia

Symptoms Of Postpartum Hemorrhage

An excessive amount of bleeding is, of course, the primary sign of PPH. This bleeding, however, does not necessarily occur directly after childbirth. While most cases occur within a day, it can sometimes take up to 12 weeks before a mother hemorrhages. The mother could also experience blurred vision, a dangerous drop in blood pressure (from the blood loss), chills, nausea or weakness. Some women may feel faint swelling of the vagina or perineum may also occur.

What Will The Doctor Or Midwife Do To Stop The Bleeding?

In cases of uterine atony, a physician, midwife or nurse will place his or her hand (sometimes both hands) on the mom's abdomen, over her uterus, and massage it. Massaging the uterus will help it to become firmer and tighter. If the uterus, cervix or vagina is torn, the doctor can make the repair. If the placenta remains in the body, the doctor can remove the pieces that are left.

There are also medical treatments to stop PPH.

Medications. Medication may be added to the mother's intravenous infusion to help the uterus contract. Additional medication (Hemabate, Methergine and Cytotec) may also be given to tighten the uterus.¹

Catheters. If mom's bladder has a lot of urine in it, the uterus may not tighten. Her physician, midwife or nurse will drain the urine out of the bladder with a small tube, or catheter. The tube may be left in the bladder and connected to a bag to allow the urine to flow out of the bladder. The amount of urine that the mother is producing can be measured as well. Extra intravenous catheters may be placed in the mother's veins so that extra fluids can be given quickly. Blood transfusions may also be necessary. An oxygen mask may be placed on mom's face, and her blood pressure and pulse will be monitored closely. Blood may be drawn from a vein and sent to the lab for testing (complete blood count, platelets and blood clotting tests).¹

Packing device. If cases in which the lower part of the uterus isn't contracting, the physician or midwife may place a special balloon device, or packing inside of the uterus called a uterine tamponade.

Surgical intervention. In some situations, the bleeding is unable to be controlled, and surgery is necessary to remove the mother's uterus.

Ensuring The Mother's Safety

Every maternity department should have all of the supplies needed to care for a mother experiencing a postpartum hemorrhage in one place (on a specific cart or in a kit), preferably located in the department so they can be accessed and used quickly.

Every maternity department should have a plan or protocol regarding calling for additional assistance from other departments such as the hospital's blood bank and surgery department. A checklist should be kept that contains specific instructions and guidelines for treatment of PPH There should also be a written protocol for a blood transfusion in case of an emergency. If this protocol is ignored, or if it fails, the mother may be able to make a claim for damages for labor and delivery negligence.

1. Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, B., Sheffield, J. (2013). Obstetrical Hemorrhage. In Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, B., & Sheffield, J. (Eds). Williams obstetrics (24^th ed.). New York, NY: McGraw-Hill
2. Main, E., Goffman, D., Scavone, B., Low, L., Bingham, D., Fontaine, P., Gorlin, J., Lagrew, D., Levy, B., (2015). National partnership for maternal safety: Consensus bundle on obstetric hemorrhage. Journal of Obstetrics and Gynecology, 126(1), 155-162. doi: 10.1097/AOG.0000000000000869