Postpartum Hemorrhage


What is postpartum hemorrhage?

Postpartum hemorrhage, or maternal hemorrhage, is excessive bleeding after childbirth. It’s defined by the American College of Obstetricians and Gynecologists (ACOG) as blood loss of 1,000mL or more, combined with symptoms of hypovolemia (weakness, fatigue, etc) in the first 24 hours following the birth process. Less common, secondary postpartum hemorrhage can occur up to 12 weeks postpartum.

It occurs in 3-5% of deliveries and cesarean deliveries have a higher likelihood. Postpartum hemorrhage is one of the top preventable causes of maternal deaths, causing around 25% of maternal deaths worldwide and 12% in the US.


What causes postpartum hemorrhage?

The most common cause of postpartum hemorrhage is uterine atony, when the uterus does not contract strongly after birth. Typically, the uterus contracts on its own after delivery, which pushes out the placenta, and then puts pressure on the bleeding vessels where the placenta was attached. If the contractions are not strong enough, the blood vessels will keep bleeding, causing hemorrhage.

Other causes include maternal trauma (lacerations, uterine rupture), retention of placental tissue, and blood clotting (coagulation) disorders.


What are the risk factors for postpartum hemorrhage?

While there are established risk factors, postpartum hemorrhage is fairly unpredictable, so it often occurs without risk factors.

Potential risk factors include:

  • Prolonged labor
  • Chorioamnionitis
  • Placental abruption
  • Placenta previa
  • Overdistended uterus
  • Multiple-baby pregnancy
  • High blood pressure disorders of pregnancy (preeclampsia)
  • Having many previous births
  • Infection
  • Obesity
  • Use of forceps or vacuum-assisted delivery
  • Being of Asian or Hispanic ethnic background
  • General anesthesia
  • Prolonged use of oxytocin

What are the symptoms of Postpartum Hemorrhage?
  • Rapid or irregular heartbeat
  • Low blood pressure
  • Uncontrolled Bleeding
  • Decrease in the red blood cell count (hematocrit)

What is the treatment for Postpartum Hemorrhage?

The treatment for postpartum hemorrhage will vary, depending on factors like your health history and the extent of the condition. However, either way, the goal is to find the cause and stop the bleeding as quickly as possible.

Treatment may include:

  • Medications (oxytocin, methergine, hemabate and cytotec) to strengthen uterine contractions
  • Uterine massage
  • Removal of any placental tissue remaining the uterus
  • A foley catheter to compress the bleeding
  • Tying-off of bleeding blood vessels using uterine compression sutures
  • Applying ring forceps to the cervix to clamp off the vessels supplying the cervix
  • Uterine artery embolization
  • Laparotomy (surgery to open the abdomen to find the cause of the bleeding)
  • Hysterectomy (surgical removal of the uterus). This is usually a last resort

While postpartum hemorrhage can be very serious, with quick detection and treatment, a full recovery is likely.


Who can help diagnose/treat Postpartum Hemorrhage?
  • OB/Gyn
  • Primary Care Physician (PCP)

Source(s)
  • https://clinicalinnovations.com/wp-content/uploads/2017/10/ACOG_Practice_Bulletin_No_183_Postpartum-Hemorrhage-2017.pdf
  • https://www.chop.edu/conditions-diseases/postpartum-hemorrhage
  • https://www.aafp.org/afp/2017/0401/p442.html#afp20170401p442-b4
  • https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02486

Reviewed By
  • Reviewed by Kimberly Langdon M.D September 2019