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Postpartum Hemorrhage

Is it normal to bleed a lot after delivery?

All women lose some blood as the placenta separates from the uterus and immediately afterward. And women who have C-sections generally lose more than those who give birth vaginally. But because the amount of blood in your body increases by almost 50 percent during your pregnancy, your body is well prepared to deal with this expected blood loss.

Normal bleeding just after childbirth is primarily from open blood vessels in the uterus, where the placenta was attached. (If you had an episiotomy or tear during birth, you may also bleed from that site until it's stitched up.)

As the placenta begins to separate, these vessels bleed into the uterus. After the placenta is delivered, the uterus usually continues to contract, closing off these blood vessels.

Your healthcare practitioner may massage your uterus and give you a synthetic form of the hormone oxytocin (Pitocin) to help the uterus contract. Breastfeeding, which prompts your body to release oxytocin naturally, can also aid in the process.

Unfortunately, some women bleed too much after birth and require special treatment. This excessive blood loss is called a postpartum hemorrhage (PPH) and it happens in up to 6 percent of births.

It's most likely to occur while the placenta is separating or soon after. If it happens within 24 hours after giving birth, it's considered an early PPH (also called an immediate or primary PPH). If it happens in the days or weeks after delivery, it's called a late (or delayed or secondary) PPH.

What else might cause a PPH?

Occasionally, cervical lacerations, deep tears in your vagina or perineum, or even a large episiotomy may be the source of a postpartum hemorrhage. A ruptured or inverted uterus may cause profuse bleeding, but these are relatively rare occurrences.

Finally, a systemic blood clotting disorder may cause a hemorrhage. (A clotting disorder may be an inherited condition or it may develop during pregnancy as a result of certain complications, such as severe preeclampsia or HELLP syndrome or a placental abruption.) And a hemorrhage itself can cause clotting problems, leading to even heavier bleeding.

What's the treatment for PPH?

There are a number of steps that your medical team will take right away if you begin to bleed excessively. Since uterine atony (loss of tone) is the most common cause of PPH, your caregiver will massage your uterus to help it contract while you get intravenous oxytocin. (If you don't already have an IV, the nurse will start one immediately.) You will also be catheterized to make sure your bladder is empty since a full bladder makes it more difficult for your uterus to contract.

If your placenta hasn't come out yet, your practitioner will attempt to deliver it, which in some cases requires her to reach up inside your uterus and remove it manually. You'll receive some pain medication before the procedure, and if you're in a birthing room you'll be moved to an operating room.

If you start bleeding – or continue to bleed – from your uterus after the placenta is out, you'll receive other medications in addition to oxytocin while your caregiver continues to massage your uterus. In most cases, the medication works very quickly and the uterus contracts, stopping the bleeding.

If need be, your practitioner will insert a hand inside your vagina and place her other hand on your belly, and compress your uterus between her two hands. This measure in combination with medication is usually enough to stem the tide.

If you continue to bleed, you'll be transferred to the operating room and given pain medication to keep you comfortable. The doctor will carefully check to make sure that there are no lacerations that appear to be the primary source of your bleeding. She will also "explore" your uterus (via your vagina) to check for fragments of the placenta that may remain. In some cases, you'll need a procedure called dilation and curettage (D&C) to remove them.

If your bleeding is extensive and doesn't stop or your vital signs aren't stable, you'll get a blood transfusion. This is necessary only in rare cases. Even more rarely, you'll need abdominal surgery and possibly a hysterectomy to stop a hemorrhage.

Regardless of the cause of the hemorrhage, your blood pressure and pulse will be taken frequently to help your caregiver gauge how your body is coping with the blood loss. (This is done right after birth anyway to help determine the amount of postpartum blood loss.) An abnormally low blood pressure or high pulse will provide your caregiver with valuable information.

You'll also have blood tests to check for anemia and, if necessary, to see whether your blood is clotting normally.

What's the recovery like?

You'll continue to receive IV fluids and medication after the bleeding is controlled to help your uterus stay contracted, and you'll be watched very closely for further bleeding and to see how you're doing in general. You may feel weak and lightheaded. Don't try to get out of bed on your own.

Your recovery will depend in part on how much blood you lost and what your "reserves" were to begin with – that is, how much your blood volume had increased during pregnancy and whether or not you were anemic to begin with.

You'll probably develop anemia from the blood loss and will have to take it easy when you get home from the hospital. You'll need to get plenty of rest, fluids, and nutritious food. Your doctor will likely prescribe prenatal vitamins with folic acid, as well as additional iron supplements.


Source: Babycenter

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