Running head: POSTPARTUM HEMORRHAGE

Postpartum Hemorrhage

Rebecca Heckaman

Jackson College
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Postpartum hemorrhage (PPH) is excessive bleeding after the birth of a baby. During a

vaginal birth the average amount of blood loss is 500 ml and around 1000 ml with a cesarean

birth. About four percent of women have postpartum hemorrhage and it’s more likely to occur

following a cesarean section (Postpartum Hemorrhage, CHW). While most postpartum

hemorrhages occur directly after the birth, it can occur after some time. After delivery of the

baby the uterus contracts to expel the placenta and to put pressure on the blood vessels of where

the placenta detached (Postpartum Hemorrhage, URMC). The most common cause of

postpartum hemorrhage is weak uterine contractions.

Every postpartum mother has a small risk of PPH. However, there are some conditions,

history, and genetic factors that greatly increase the risk. Some of these risk factors include

placental abruption, placenta previa, over distended uterus (i.e. large amounts of amniotic fluid

or multiple pregnancy), pregnancy-induced hypertension (PIH), having many previous births,

prolonged labor, infection, obesity, medications to induce labor (i.e. Oxytocin), medications to

stop contractions (for preterm labor), use of forceps or vacuum-assisted delivery, general

anesthesia, tear in the cervix or vaginal tissues, tear in a uterine blood vessel, bleeding into a

concealed tissue area or space in the pelvis which develops into a hematoma, blood clotting

disorders such as disseminated intravascular coagulation, placenta accrete, placenta increta, and

placenta percreta (Smith & Brennan, 2016). Any of these can be the reason that a mother will

experience postpartum hemorrhage.

A physical examination must be completed to diagnose postpartum hemorrhage. The

signs and symptoms of PPH are uncontrolled bleeding, decreased blood pressure, increased heart

rate, a decrease in the red blood cell count, swelling and pain in the vagina and nearby area if

bleeding is from a hematoma (Postpartum Hemorrhage, URMC). To diagnose postpartum

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hemorrhage, the health care team needs to be monitoring and estimating the amount of blood loss

and taking the mother’s heart rate and blood pressure. Labs that can help to diagnose PPH are

hematocrit and clotting factors in the blood (Postpartum Hemorrhage, CHW). If all the signs and

symptoms point to postpartum hemorrhage it is important to act quickly and control the bleeding

for the mother’s safety. PPH can lead to shock or death if not caught and treated promptly

(Postpartum Hemorrhage, CHW). Treatments for postpartum hemorrhage vary depending on the

severity and the cause of it.

The most important step and aim of treatment for postpartum hemorrhage is replacing

lost blood and fluids. The first step to treatment is commonly the quick administrations of IV

(intravenous) fluids, blood, and blood products to prevent shock (Postpartum Hemorrhage,

CHW). Oxygen may also be given. Finding the cause of the bleeding as quickly as possible is

incredibly important. The treatment option for postpartum hemorrhage may include medication

(that stimulates uterine contractions), manual massage of the uterus (to stimulate contractions),

removal of placental pieces that remain in the uterus, and physical examination of the uterus and

other pelvic tissues (Postpartum Hemorrhage, CHW). More invasive treatment options are

compressing the bleeding area with in the uterus with sponges and sterile materials, tying off

bleeding blood vessels, laparotomy (surgery to open the abdomen to find the cause of the

bleeding), and hysterectomy as a last resort in severe cases (Postpartum, URMC). The treatment

that is chose for each patient is dependent upon the extent of the condition, the patients history

and tolerance, the expected outcome, and the patient’s preference. Postpartum hemorrhage can

be quite serious but treatment can be successful if received quickly.

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References

Postpartum Hemorrhage. (n.d.). Retrieved October 01, 2016, from http://www.chw.org/medical-

care/fetal-concerns-center/conditions/pregnancy-complications/postpartum-hemorrhage

Postpartum Hemorrhage. (n.d.). Retrieved October 01, 2016, from

https://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=90

Smith, J.R., M.D., & Brenann, B.G., M.D., PhD. (2016, March 01). Postpartum Hemorrhage.

Retrieved October 03, 2016, from http://emedicine.medscape.com/article/275038-

overview#a7