Signs of postpartum hemorrhage

The article was professionally consulted by Specialist Doctor I Truong Nghia Binh - Obstetrician-Gynecologist - Department of Obstetrics and Gynecology - Vinmec Da Nang International General Hospital.

Postpartum hemorrhage is defined as a cumulative blood loss of 1,000 ml or blood loss due to signs of hypovolemia within 24 hours of birth. It is the leading cause of maternal death worldwide.

After giving birth, the uterus usually contracts and pushes the placenta out. When the placenta is removed, women often have these contractions that help put pressure on the blood vessels to limit postpartum bleeding. However, if the uterus does not contract strongly enough, these blood vessels will bleed freely. This is the most common cause of postpartum hemorrhage.
In addition, some causes of postpartum haemorrhage include:
Weak uterine muscles due to multiple births, uterine fibroids, malformed uterus; The uterus is stretched too much due to multiple pregnancy, polyhydramnios,... Prolonged labor, amniotic infection; Residual placenta in the uterine cavity; Maternal weakness, anemia, hypertension, pregnancy toxicity; History of miscarriage, multiple abortions; Ever had vegetative endometritis; After premature birth, handle stillbirth, give birth quickly, especially in the standing position; The vegetable cord is short, wrapped around the neck many times; Taking vegetables improperly; Incorrect birthing.

Signs of vaginal bleeding after vaginal delivery and possible bleeding after cesarean section include:
Uncontrolled bleeding: Bleeding from the genital tract immediately after delivery and placental abruption. The amount of blood that comes out can be more or less, bright red or bruised, blood clots or thin blood. Blood stagnation in the uterine cavity makes the uterus increase in volume, the fundus of the uterus rises gradually, the uterus enlarges horizontally, becoming soft; Blood pressure drops; Increased heart rate, pale skin, thirst; Cold hands and feet, sweating; Decreased red blood cell count; Swelling and pain in the vagina and nearby area if the bleeding is due to a hematoma; The safety sphere is not seen on the scapula.

Depending on the degree of blood loss and whether the resuscitation and hemostasis is active or not, postpartum hemorrhage can cause various serious and mild complications such as shock due to hypovolemia, leading to renal failure, renal failure, and renal failure. multiple organs and mortality. Postpartum haemorrhage is also a predisposing factor for postpartum infection.
Long-term complications of postpartum hemorrhage include anemia, thrombophlebitis, Sheehan's syndrome (due to pituitary necrosis leading to weakness, emaciation, hair loss, loss of milk, amenorrhea), inability to have more children in case of having to have a hysterectomy.

To reduce the frequency and mortality of postpartum haemorrhage, it is important to prevent bleeding before it occurs. Provision should be made for all births. Some prophylactic principles to remember include:
Avoid prolonged labor, by closely monitoring labor progress, on monitoring, uterine contractions, fetal heart rate and cervical dilation; Injection of oxytocin (10 IU) is recommended for the prevention of postpartum haemorrhage; Prevention of amniotic infection, with antibiotics and early termination of pregnancy; Careful use of anesthetics, anesthetics, and analgesics during labor; Correction of coagulation disorders (if any). By relying on a complete coagulation test, platelet count, and a thorough history of blood disease. It is necessary to have a specialist examination in internal hematology to have a positive treatment direction; Do not perform delivery procedures unless clearly indicated or unqualified. When performing the procedure, it must be done gently and with the correct technique; Find the cause and treat immediately the case of strong contractions, weak contractions. Once unfavorable, should cesarean section to ensure safety for mother and baby;

Treat stage 3 aggressively. At present, respecting the physiological rest period of the uterus after the delivery is no longer suitable for the prevention of postpartum haemorrhage. In contrast, the World Health Organization has recommended that all postpartum cases should be applied an active stage 3 management: give oxytocin intramuscularly immediately after the fetus has just come out of the vulva. After the pregnancy is complete, it is necessary to clamp the umbilical cord immediately, then use one hand to pull the umbilical cord, the other hand on the sacrum to push the fundus of the uterus up to both remove the placenta and remove the placenta. After delivery, massage the fundus of the uterus through the abdominal wall to help the uterus contract better. Check the placenta thoroughly, check the uterine cavity as soon as possible if there is a suspicion of placenta. Check the genital tract if there is an assisted delivery procedure, check the uterus if there is an old incision; Women need to plan to get pregnant to have time to recover their health, raise children well, with the method of placing an IUD after giving birth, taking birth control pills for nursing mothers; During pregnancy, regular antenatal care is required. Your doctor will give you iron and folic acid tablets throughout your pregnancy to prevent anemia. This will make postpartum bleeding, if it occurs, less likely to cause serious complications; Special attention should be paid to high-risk pregnant women. Pregnant women should be closely monitored for at least 6 hours after giving birth to promptly detect signs of postpartum haemorrhage, promptly find the cause and deal with it early; In addition to the potential for high maternal mortality, postpartum hemorrhage also causes other important secondary sequelae such as adult respiratory distress syndrome, shock, disseminated intravascular coagulation, and acute renal failure. , loss of fertility and pituitary necrosis. Therefore, it is necessary to be very careful with this phenomenon.
Postpartum care is a continuous, comprehensive process for both mother and baby, including vaginal birth or cesarean section, women need recovery time to ensure that there are no postpartum complications. Postpartum haemorrhage is a dangerous disease that needs to be examined and treated soon, if not treated promptly, the mother will lose blood, which can dangerously lead to death.
After giving birth, the mother's body changes, the mother can suffer from many diseases such as postpartum hemorrhage, urinary incontinence, digestive disorders, bowel and urinary disorders, rectal prolapse,... Especially with Unscientific abstinence can seriously affect your health in the future. Therefore, after giving birth, the mother can perform a general health examination at Vinmec International General Hospital. Mothers will have the opportunity to visit with leading specialists, combined with many other specialties to give advice, care, and help improve their postpartum health quickly.