Post-Partum Hemorrhage

Hayley Jacobs

Jackson College RN program

 Postpartum Hemorrhage

Postpartum hemorrhage is excessive bleeding after the birth of a baby. This may occur

before or after the placenta is delivered. The average amount of blood loss for a vaginal birth of a

single baby is about 500 mL. The average blood loss for a cesarean birth is about 1,000 mL. This

can occur right after delivery, but it can occur a few days after as well. About 4 percent of

women have postpartum hemorrhage and it is more likely to happen with a cesarean birth

(chw.org).

After a baby is delivered the uterus should continue to contract and expel the placenta.

Once the placenta is delivered these contractions help compress the bleeding blood vessels in the

area where it was attached. If the uterus doesnt contract strong enough these vessels will bleed

freely. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta

remain attached in the uterus, bleeding is also very likely. There are conditions that may increase

the risk for postpartum hemorrhage and they include (chw.org):

Early detachment of the placenta from the uterus

Placenta covers or is near the cervical opening

Excessive distention of the uterus due to excessive amniotic fluid or a large baby

More than one placenta and over distention of the uterus

High blood pressure during pregnancy

Many pervious births

Prolonged labor

Infection

Obesity
 Medications to induce labor or to stop contractions

Use of forceps or vacuum-assisted delivery

General anesthesia

Other factors include the following:

Tear in the cervix, vaginal tissues, uterine blood vessel

Bleeding into an area or space that is a concealed tissue

Blood clotting disorders

Placenta attached over a prior cesarean scar

Placenta tissue invades the muscle of the uterus

Placenta may go all the way into the uterine muscle and may rupture

Postpartum hemorrhage is a concern because excessive blood loss can cause a severe drop

in blood pressure and may lead to shock and death if not treated quickly. Symptoms include:

uncontrolled bleeding, decreased blood pressure, increased heart rate, decreased red blood cell

count, and swelling and pain in tissues in the vaginal and perineal area.

A diagnosis is usually based on symptoms and laboratory tests. By counting the number of

saturated pads or weighing the packs and sponges can help determine the estimated amount of

blood loss. Pulse rate and blood pressure measurements are also needed. Laboratory test to check

the red blood cell count and clotting factors are also used.

The treatment for postpartum hemorrhage may include (Moldenhauer):

Medication to make the uterus contract

Bimanual massage of the uterus

Removal of placental pieces

 Packing the uterus with sponges and sterile materials

Tying-off bleeding blood vessels

Laparotomy to find the cause of the bleeding

Hysterectomy to surgically remove the uterus, this is a last resort

Replacing blood that is lost and giving IV fluids is very important in treatment. Fluids,

blood, and blood products can be given through IV rapidly to help prevent shock. Supplemental

oxygen may also be given (chw.org). This condition can be very serious. Early detection and of

the cause and treatment often leads to a full recovery.

 References

Anderson, J. M., M.D., & Etches, D., M.D. (2007, March 15). Prevention and Management of

Postpartum Hemorrhage. Retrieved April 1, 2016, from

http://www.aafp.org/afp/2007/0315/p875.html

Moldenhauer, J. S., M.D. (2016, January). Postpartum Hemorrhage. Retrieved April 1, 2016,

from http://www.merckmanuals.com/professional/gynecology-and-

obstetrics/abnormalities-and-complications-of-labor-and-delivery/postpartum-hemorrhage

Postpartum Hemorrhage. (2016). Retrieved April 1, 2016, from http://www.chw.org/medical-

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