Postpartum Bleeding, Severe

What is severe postpartum bleeding?

Severe postpartum bleeding is the loss of more than 1 pint (500 milliliters) of blood soon after a baby is born vaginally, or 2 pints (1000 milliliters) after a C-section. It usually happens within the first 24 hours of childbirth, but it may happen as late as 5 days to 6 weeks after delivery.

The severe bleeding is also called a postpartum hemorrhage.

How does it occur?

Some of the causes of severe bleeding after childbirth are:

• The uterus stays relaxed and does not contract and get smaller after delivery of the baby and placenta.
• Pieces of the placenta are left in the uterus.
• There are cuts or tears in the vagina, uterus, or cervix (opening to the uterus).
• There is bleeding from the cut made in the uterus for a C-section.
• You have an infection in the uterus.
• There is a collection of blood in the tissues of the genital tract (a hematoma).
• You have blood clotting problems.

If you have any of the following problems, you are at risk for severe postpartum bleeding:

• a hemorrhage with a previous pregnancy
• more than 4 previous deliveries
• fibroids, scars, or defects of the uterus
• blood clotting problems
• a uterus that has become very large from a large baby, twins, or too much fluid in the uterus
• the use of oxytocin to induce labor for a long time
• a long labor (longer than about 18 hours)
• separation of the placenta from the uterus before delivery
• an infection of the uterus

What are the symptoms?

The main symptom is a lot of bleeding, usually right after the baby is born. If you are losing too much blood, you may have a fast pulse, weakness, and fainting.

How is it diagnosed?

Your healthcare provider will examine you. You may have the following tests:

• blood tests
• ultrasound scan

How is it treated?

If you are bleeding and the placenta does not come out right after the baby is born, your healthcare provider will try to take the placenta out with his or her hand. If the placenta is already out, your provider will try to make the uterus contract by massaging the uterus. If massaging doesn't work, your provider will give you medicine to help the uterus contract. If the uterus is still bleeding, you may be given anesthesia to numb you while your provider looks at and feels the inside of the uterus and vagina for tears or pieces of placenta. He or she will then repair any areas that are bleeding.

You may be treated for blood clotting problems if no cuts or tears are found. In some cases you may need surgery to look inside your belly for the cause of bleeding.

If you lose a lot of blood quickly and the blood is not replaced right away, there is a risk that you will go into shock. This means that your heart may have trouble pumping enough blood to the rest of your body. If shock is not treated, it can lead to serious problems. The treatment for shock from bleeding too much is to give you fluid or blood transfusions. You may need to be in the intensive care unit for a time while you recover.

If you have severe bleeding later after birth, your treatment will be similar to the treatment for bleeding right after your baby is born. Your healthcare provider may:

• Give you IV fluids.
• Give you medicine to contract the uterus.
• Give you antibiotics to prevent or treat infection.
• Scrape the uterus to remove any placenta left in the uterus.
• Do surgery to find the site of bleeding and remove or repair the cause of bleeding.

How can I help take care of myself?

• Follow your healthcare provider's instructions.
• Don’t be too active too soon at home after your baby is born. Get extra help so you can rest.
• Call your healthcare provider right away if you have a lot of vaginal bleeding, especially if you have clots in the blood.

How can I help prevent severe postpartum bleeding?

There is no sure way to prevent postpartum hemorrhage. If you have had severe postpartum bleeding before or have a high risk of severe bleeding, your healthcare provider may take precautions, such as by giving you:

• fluids intravenously (IV)
• medicine to help the uterus contract after delivery of the placenta

You can help keep your uterus healthy if you:

• Don’t start having sex again until your uterus is fully contracted back to its normal size. This usually takes at least 6 weeks after your baby is born.
• Don’t do any heavy or prolonged work or lifting until your provider says it’s OK.