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.
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.
While there are established risk factors, postpartum hemorrhage is fairly unpredictable, so it often occurs without risk factors.
Potential risk factors include:
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:
While postpartum hemorrhage can be very serious, with quick detection and treatment, a full recovery is likely.