Definition

Postpartum hemorrhage is excessive blood loss in a woman after childbirth. It is called primary when it is within the first 24 hours after childbirth. Secondary (or delayed) postpartum hemorrhage occurs between 24 hours to six weeks after childbirth.

Some blood loss is normal. However, postpartum hemorrhage is a potentially serious condition that often goes unrecognized. Any excessive blood loss can put a woman at considerable risk. Talk with your doctor if you have any concerns about blood loss after giving birth.

Postpartum Hemorrhage

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Causes

The following are potential causes of postpartum hemorrhage:

• Uterine atony (loss of tone of the muscles of the womb)—most common cause
• Medicines that relax the uterus
• Failure to deliver placenta (the organ that links the fetus to the womb)
• Birth trauma (wounds of cervix and/or vagina)
• Bleeding disorder
• Anticoagulant medicines
• Uterine inversion (caused by failure of the placenta to detach from the uterus)
• Retained products of conception after delivery of the placenta (eg, small pieces of placenta and/or fetal membranes)

Risk Factors

The following factors are thought to increase the risk of postpartum hemorrhage:

Signs and Symptoms

The most obvious sign of postpartum hemorrhage is heavy vaginal bleeding. If the bleeding is not obvious, other signs may include:

• Decreased blood pressure
• Increased heart rate
• Decreased red blood cell count
• Swelling and pain in the vaginal and perineal area

Diagnosis

Your doctor will ask about your symptoms. A physical exam will be done. The doctor will check your perineum, vagina, cervix, and uterus for bleeding. Other tests may include:

Treatment

Talk with your doctor about the best plan for you. Treatment options include:

Prevention

These methods may reduce the risk of postpartum hemorrhage:

• Receiving continuous nursing care during labor
• Being closely monitored during the third stage of labor