A Postpartum Haemorrhage occurs when you have a cumulative blood loss greater than or equal to 500mL for a vaginal delivery and greater than or equal to 1000mL for a c-section. Symptoms generally include vaginal bleeding that doesn’t slow or stop. This can lead to a drop in blood pressure.
Why does a Postpartum Haemorrhage happen?
Trauma: Sometimes, a Postpartum Haemorrhage is a result of uterine, cervical, vaginal, or perineal trauma that causes more significant bleeding.
Tone: This is the most common cause of a Postpartum Haemorrhage! Your uterus is a muscle with a large blood supply, and if it’s not contracting effectively after birth (called atony), you can lose a good amount of blood fairly quickly.
Thrombin: This is a blood-clotting protein in your body. When there’s a blood clotting disorder in play – a Postpartum Haemorrhage is more likely to occur! Keep in mind, thrombin-related disorders are pretty rare.
Retained Tissue: Usually, your placenta comes out shortly after the baby, but when it takes too long, you may need surgery to remove it. Retained pieces of tissue can cause excess bleeding, pain, and even infection!
Signs and symptoms of a Postpartum Haemorrhage
- Heavy bleeding & clotting from the vagina
- Pallor (paleness)
- Excessive sweating
- Increase in heart rate & decrease in BP
How do we monitor for this? We apply fundal pressure to your uterus, while simultaneously checking your pads! This is done to assess how your bleeding is, and if your uterus is firm and acting the way it should after delivery. If it’s not – interventions are necessary!
Postpartum Haemorrhage Treatment Options
- IV fluids
- Extra fundal massage
- Medications to promote contracting
- Pelvic exams (to check for clotting)
- Tamponade devices
- Blood transfusions
If the Postpartum Haemorrhage is severe, your provider may recommend Dilation and Curettage (D&C), embolization of the blood vessels that supply the uterus, or even a hysterectomy or laparotomy (this is rare)!
This USED TO BE the leading cause of maternal death during childbirth. Luckily we’ve made tons of advancements, but there is still work to be done to improve outcomes of Postpartum Haemorrhage.
Most women with Postpartum Haemorrhage improve with routine bedside interventions.
Did you have a Postpartum Haemorrhage? They are scary, but they happen! 😬