- Placental abruption. The early detachment of the placenta from the uterus.
- Placenta previa. The placenta covers or is near the cervical opening.
- Overdistended uterus. ...
- Multiple pregnancy. ...
- Gestational hypertension or preeclampsia. ...
- Having many previous births.
- Prolonged labor.
- Infection.
Tear in a blood vessel in the uterus
What are the 3 main causes of postpartum hemorrhage?
- Placental abruption. The early detachment of the placenta from the uterus.
- Placenta previa. The placenta covers or is near the cervical opening.
- Overdistended uterus.
- Multiple pregnancy.
- Gestational hypertension or preeclampsia.
- Having many previous births.
- Prolonged labor.
- Infection.
Prolonged labor
Treatment for postpartum hemorrhage may include:
- medication (to stimulate uterine contractions).
- manual massage of the uterus (to stimulate contractions).
- removal of placental pieces that remain in the uterus.
- examination of the uterus and other pelvic tissues.
- packing the uterus with sponges and sterile materials (to compress the bleeding area in the uterus).
- tying-off of bleeding blood vessels.
Anemia and malnutrition
These are the most common symptoms of postpartum hemorrhage:
- Uncontrolled bleeding
- Decreased blood pressure
- Increased heart rate
- Decrease in the red blood cell count
- Swelling and pain in the vagina and nearby area if bleeding is from a hematoma
Trauma
Your provider may use these tests to see if you have PPH or try to find the cause for PPH:
- Blood tests called clotting factors tests or factor assays
- Hematocrit. This is a blood test that checks the percent of your blood (called whole blood) that’s made up of red blood cells. ...
- Blood loss measurement. ...
- Pelvic exam. ...
- Physical exam. ...
- Ultrasound. ...
Drugs
What are the 4 most common causes of postpartum hemorrhage?
What are the risk factors for postpartum hemorrhage?
What are the signs and symptoms of postpartum hemorrhage?
How to eliminate postpartum hemorrhage?
What is the common cause of postpartum hemorrhage?
Uterine atony. This is the most common cause of PPH. It happens when the muscles in your uterus don't contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.
What is the most common cause of delayed postpartum hemorrhage?
Infection and retained products of conception are the leading causes of secondary postpartum hemorrhage. Pelvic ultrasound may be done to detect retained placental fragments.
Who is at risk for postpartum hemorrhage?
Results: Major independent risk factors for PPH included primiparity, prior Caesarean section, placenta previa or low-lying placenta, marginal umbilical cord insertion in the placenta, transverse lie, labour induction and augmentation, uterine or cervical trauma at delivery, gestational age < 32 weeks, and birth weight ...
What are the risk factors for PPH?
Risk factors for PPH include; past history of PPH, multiple pregnancy, fetal macrosomia, primi-gravida, grand multi-parity, older age, preterm births, genital tract injuries, non-use of oxytocics for PPH prophylaxis, labour induction, cesarean birth and intra-uterine fetal deaths [4, 7–10].
What is delayed postpartum hemorrhage?
Haemorrhage between 24 h and 6 weeks post partum is termed "delayed PPH". Common causes include retention of gestational products or endometritis. Bleeding can be sudden and profound, resulting in rapid cardiovascular collapse.
What is Sheehan syndrome?
Excessive blood loss during or after delivery of a baby may affect the function of the pituitary gland, leading to a form of maternal hypopituitarism known as Sheehan syndrome (SS). Such extensive bleeding may reduce the blood flow to the pituitary gland causing the pituitary cells to be damaged or die (necrosis).
When is postpartum hemorrhage most likely to occur?
About 1 in 100 to 5 in 100 women have postpartum hemorrhage. It is more likely with a cesarean birth. It most often happens after the placenta is delivered, but it can also happen later.
What is the greatest risk to a mother during the immediate postpartum period?
The highest risk periods appear to be the delivery period and up to two weeks postpartum, but the risk can continue up to six weeks postpartum. Cardiomyopathy and heart disease.
What Is Postpartum Hemorrhage?
Postpartum hemorrhage is more bleeding than normal after the birth of a baby. About 1 in 100 to 5 in 100 women have postpartum hemorrhage. It is mo...
What Causes Postpartum Hemorrhage?
Once a baby is delivered, the uterus normally contracts and pushes out the placenta. After the placenta is delivered, these contractions help put p...
Who Is at Risk For Postpartum Hemorrhage?
Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk include: 1. Placental abruption. The ea...
What Are The Symptoms of Postpartum Hemorrhage?
These are the most common symptoms of postpartum hemorrhage: 1. Uncontrolled bleeding 2. Decreased blood pressure 3. Increased heart rate 4. Decrea...
How Is Postpartum Hemorrhage Diagnosed?
Your healthcare provider will review your health history and do a physical exam. Lab tests often help with the diagnosis. Other tests may include:...
How Is Postpartum Hemorrhage Treated?
The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as soon as possible. Treatment may include: 1. Medicine...
What Are The Complications of Postpartum Hemorrhage?
Losing lots of blood quickly can cause a severe drop in your blood pressure. This may lead to shock and death if not treated.
Can Postpartum Hemorrhage Be Prevented?
It’s important to know before delivery what puts you at risk for postpartum hemorrhage. It is important to have emergency care available in case it...
When Should I Call My Healthcare Provider?
Most cases of postpartum hemorrhage occur at delivery or soon after. But you may bleed heavily after you go home from the hospital. If this happens...
Key Points About Postpartum Hemorrhage
1. Postpartum hemorrhage is heavy bleeding after the birth of your baby. 2. Losing lots of blood quickly can cause a severe drop in your blood pres...
What are the risk factors for postpartum hemorrhage?
Risk factors for postpartum hemorrhage include the following: placental abruption - the early detachment of the placenta from the uterus. placenta previa - the placenta covers or is near the cervical opening. overdistended uterus - excessive enlargement of the uterus due to too much amniotic fluid or a large baby, ...
What percentage of women have postpartum hemorrhage?
Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 4 percent of women have postpartum hemorrhage and it is more likely with a cesarean birth. Hemorrhage may occur before or after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml ...
What happens to the uterus after a baby is born?
Once a baby is delivered, the uterus normally continues to contract (tightening of uterine muscles) and expels the placenta. After the placenta is delivered, these contractions help compress the bleeding vessels in the area where the placenta was attached.
How much blood loss is there after a cesarean birth?
The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well.
What is overdistended uterus?
overdistended uterus - excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds). multiple pregnancy - more than one placenta and overdistention of the uterus. pregnancy-induced hypertension (PIH) - high blood pressure of pregnancy.
What are the conditions that increase the risk of postpartum hemorrhage?
Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk include: Placental abruption. This is the early detachment of the placenta from the uterus. Placenta previa. This is when the placenta covers or is near the opening of the cervix. Overdistended uterus.
Why is it important to know before delivery what puts you at risk for postpartum hemorrhage?
It’s important to know before delivery what puts you at risk for postpartum hemorrhage. It's important to have emergency care available in case it is needed at the time of delivery and after birth. Early care can reduce the amount of blood loss.
How to stop postpartum bleeding?
Treatment may include: Medicine or uterine massage to stimulate uterine contractions. Removing pieces of the placenta that remain in the uterus.
Why does my uterus bleed?
If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta stay attached, bleeding is also likely. Postpartum hemorrhage may also be caused by: Bleeding into a hidden tissue area or space in the pelvis.
What happens to the uterus after a baby is born?
Once a baby is delivered, the uterus normally contracts and pushes out the placenta. After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely.
How do you know if you have postpartum hemorrhage?
These are the most common symptoms of postpartum hemorrhage: Uncontrolled bleeding. Decreased blood pressure. Increased heart rate. Decrease in the red blood cell count. Swelling and pain in the vagina and nearby area if bleeding is from a hematoma.
What is the procedure to open the abdomen to find the cause of bleeding?
Laparotomy. This is surgery to open the abdomen to find the cause of bleeding. Tying off or sealing bleeding blood vessels. This is done using uterine compression sutures, special gel, glue, or coils.
What is the most common cause of postpartum hemorrhage?
This is the most common cause of postpartum hemorrhage. If small pieces of the placenta stay attached, bleeding is also likely. Postpartum hemorrhage may also be caused by: Bleeding into a hidden tissue area or space in the pelvis. This mass of blood is called a hematoma. It is usually in the vulva or vagina.
What are the conditions that increase the risk of postpartum hemorrhage?
Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk include: Placental abruption. This is the early detachment of the placenta from the uterus. Placenta previa. This is when the placenta covers or is near the opening of the cervix. Overdistended uterus.
How to stop postpartum bleeding?
Treatment may include: Medicine or uterine massage to stimulate uterine contractions. Removing pieces of the placenta that remain in the uterus.
Why does my placenta bleed after delivery?
After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta stay attached, bleeding is also likely.
What does postpartum hemorrhage feel like?
Swelling and pain in the vagina and nearby area if bleeding is from a hematoma. The symptoms of postpartum hemorrhage may look like other health conditions. Always see your healthcare provider for a diagnosis.
How many women have postpartum hemorrhage?
About 1 in 100 to 5 in 100 women have postpartum hemorrhage. It is more likely with a cesarean birth. It most often happens after the placenta is delivered, but it can also happen later.
Why is it important to know before delivery what puts you at risk for postpartum hemorrhage?
It’s important to know before delivery what puts you at risk for postpartum hemorrhage. It is important to have emergency care available in case it is needed at the time of delivery and after birth. Early care can reduce the amount of blood loss.
How much blood does a postpartum hemorrhage take?
The World Health Organization (WHO) generally defines postpartum hemorrhage as losing more than 500 milliliters (mL)—about a half of a quart—of blood 24 hours after vaginal birth, and more than 100 mL of blood (or about a quart) after a cesarean (C-section) birth. 3.
What is the second most common cause of PPH?
Retained placenta fragments, the second most common cause of PPH, happens when the placenta doesn't fully separate and partially remains in the body. Uterine inversion is a more rare condition where the uterus turns inside out after birth. Uterine rupture is another rare condition where the uterus ruptures during labor.
What are the symptoms of PPH?
For example, you’re more likely to have PPH if you’ve had it in the past or if you have certain medical conditions that affect the uterus, placenta, or blood clotting. These can include: 8 1 Placental abruption: Early detachment of the placenta from the uterus 2 Placenta previa: Placenta covering or near the cervical opening 3 Overdistended uterus: Larger-than-normal uterus due to a large baby 4 Gestational hypertension or preeclampsia: High blood pressure during pregnancy 5 Twin or multiples pregnancy 6 Several prior pregnancies 7 Prolonged labor 8 Obesity 9 Certain medications used during labor 9
What is PPH in pregnancy?
Prevention. Postpartum hemorrhage (PPH) is excessive bleeding and loss of blood after childbirth. It usually occurs shortly after giving birth, but it can also happen in the days and weeks after delivery. The most common cause of PPH is the uterus not contracting properly after birth.
What to do after birth?
After birth, medical care teams at hospitals and birth centers will take routine steps to prevent postpartum hemorrhage. This includes watching for signs of placental separation to indicate the placenta is ready to be delivered.
Is postpartum hemorrhage dangerous?
Postpartum hemorrhage is dangerous and should be treated immediately. It can quickly cause a severe drop in blood pressure, which could lead to shock or even death. If you think you're experiencing PPH, contact your doctor or other healthcare professional right away, or call 911.
Is PPH a serious condition?
While PPH is fully treatable if your medical team can find the cause and stop the bleeding quickly enough, it's a serious condition that can lead to shock and sometimes death due to a dangerous drop in blood pressure. Roughly 1 to 5 out of 100 people will experience PPH, which is one of the leading causes of maternal mortality. 1.
What causes postpartum hemorrhage?
Uterine atony, or lack of effective contraction of the uterus, is the most common cause of postpartum hemorrhage. Postpartum hemorrhage in a previous pregnancy is a significant risk factor and providers should make all the effort to establish its severity and cause.
How long does it take for a postpartum hemorrhage to occur?
Primary postpartum hemorrhage is bleeding that occurs in the first 24 hours after delivery, while secondary postpartum hemorrhage is characterized as bleeding that occurs 24 hours to 12 weeks postpartum.[1][2][3] Obstetric hemorrhage is the most common and dangerous complication of childbirth. Traditionally, postpartum hemorrhage (PPH) has been ...
What is the leading cause of morbidity and mortality in childbirth?
Postpartum hemorrhage is the leading cause of morbidity and mortality in childbirth. PPH occurs in approximately 1% to 6% of all deliveries. Uterine atony, the primary cause of PPH, accounts for 70% to 80% of all hemorrhage. [8]
What is the most common complication of childbirth?
Obstetric hemorrhage is the most common and dangerous complication of childbirth. Traditionally, postpartum hemorrhage (PPH) has been defined as greater than 500 mL estimated blood loss in a vaginal delivery or greater than 1000 mL estimated blood loss at the time of cesarean delivery. This was redefined in 2017 by the American College ...
What is the risk of postpartum blood loss?
In postpartum women, signs or symptoms of blood loss such as tachycardia and hypotension may be masked, so if these signs are present, there should be a concern for considerable blood volume loss (greater than 25% of total blood volume).
What are the risk factors for uterine atony?
Risk factors for uterine atony include high maternal parity, chorioamnionitis, prolonged use of oxytocin, general anesthesia, and conditions that cause increased distention of the uterus such as multiple gestation, polyhydramnios, fetal macrosomia, and uterine fibroids.
What are the risk factors for genital tract trauma?
Genital tract trauma risk factors include operative vaginal delivery and precipitous delivery. Retained placenta and abnormal placentation are more common if an incomplete placenta is noted at delivery, a succenturiate lobe of the placenta is present, or if the patient has a history of previous uterine surgery.
What causes postpartum hemorrhage?
Uterine atony is the most common cause of postpartum hemorrhage, causing up to 80% of all cases. 1 Uterine atony is caused by dysfunctional hypocontractility of the myometrium during the immediate puerperium.
What causes uterine atony and subsequent postpartum hemorrhage?
Chorioamnionitis, placental abruption, and a placenta that implants into the lower uterine segment can cause uterine atony and subsequent postpartum hemorrhage. 1,6. TABLE 1.: Risk factors for postpartum hemorrhage 1. Box 2.
What is the leading cause of maternal morbidity and mortality worldwide?
Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and incidence in the United States, although lower than in some resource-limited countries, remains high. Women of color are at a disproportionate risk of developing a life-threatening postpartum hemorrhage. Risk assessment tools are available but because they lack specificity and sensitivity, all pregnant women are considered at risk. Early identification of and intervention in a hemorrhage requires an interdisciplinary team approach to care and can save the lives of thousands of women each year.
What to do if you have a massive hemorrhage?
If the patient has a massive hemorrhage, notify the rapid response team and use life support measures. Two essential initial interventions for postpartum hemorrhage are oxytocin and uterine massage. Bimanual compression of the uterus also can be performed.
How many women are at risk for postpartum hemorrhage?
Although risk assessment tools can help identify women who may experience a postpartum hemorrhage, they may only identify up to 85% of women with postpartum hemorrhage. As such, all pregnant women should be considered at risk for postpartum hemorrhage. 1
Can vaginal bleeding be intrauterine?
Vaginal bleeding may not always be present if bleeding is intrauterine, and if the patient is being monitored with a tocodynamometer, uterine tachysystole (rapid contractions) will be evident. Patients with an amniotic fluid embolism develop rapid respiratory and hemodynamic compromise and DIC.
Is postpartum hemorrhage considered a risk factor?
Identifying patients at risk of developing postpartum hemorrhage is advised, but all pregnant women should be considered at risk, as many without known risk factors will develop postpartum hemorrhage. Early identification and intervention are critical to help reduce morbidity and mortality.
Definition
Symptoms
- Although some vaginal bleeding—even bleeding that's moderate or slightly heavy—is expected after giving birth, you shouldn't be soaking through more than one pad per hour. In addition to abnormally heavy bleeding, there are some other signs to look out for that may indicate you're experiencing PPH and need to seek medical attention as soon as possible:4 1. Acute pain 2. Fev…
Causes
- Issues with the delivery of the placenta are common causes of postpartum hemorrhage.5 This includes conditions such as:6 1. Uterine atony, the most common cause of PPH, happens when the muscles in the uterus don't contract or tighten well enough after birth to control bleeding where the placenta was attached. 2. Retained placenta fragments, the sec...
Diagnosis
- Because postpartum hemorrhage is serious, your healthcare provider will likely want to quickly perform a few tests to confirm the diagnosis and try to find the cause of it. Along with considering your symptoms and medical history, this could include tests such as:7 1. Checking your pulse and blood pressure 2. Pelvic examto evaluate your vagina, uterus, and cervix to help find the source …
Treatment
- Treatment for postpartum hemorrhage is critical to avoid shock—when your body’s organs don’t get enough blood flow—and even death. You’ll need medical attention and treatment right away to find and stop the cause of bleeding as quickly as possible. The exact treatment will often depend upon the severity of the postpartum hemorrhage. This could include steps such as uterine mass…
Risk Factors
- Postpartum hemorrhage can happen in people with or without any risk factors. That said, those with certain risk factors are considered to have a higher chance of experiencing PPH. For example, you’re more likely to have PPH if you’ve had it in the past or if you have certain medical conditions that affect the uterus, placenta, or blood clotting. These can include:8 1. Placental ab…
Prevention
- After birth, medical care teams at hospitals and birth centers will take routine steps to prevent postpartum hemorrhage. This includes watching for signs of placental separation to indicate the placenta is ready to be delivered. An injection of Pitocin(synthetic oxytocin) or similar medication is often used to prompt a quick and complete placental delivery. In addition, some experts reco…
A Word from Verywell
- While postpartum hemorrhage happens in 5% of births or less, it's still a leading cause for maternal deaths worldwide.13Your healthcare provider is aware of this and will follow necessary protocols to help prevent it from happening, but it's also important to keep an eye on your own postpartum bleeding. Excessive bleeding should be checked out right away, and any bleeding th…