Postpartum Hemorrhage: Causes and Prevention Tips for Moms

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Hello, doctor.
Recently, I've seen some mothers in parenting groups discussing postpartum hemorrhage during childbirth.
I would like to ask why postpartum hemorrhage occurs during delivery and how it can be prevented.

Xiao, 20~29 year old female. Ask Date: 2015/03/20

Dr. Cao Guotao reply Obstetrics and Gynecology

Childbirth inherently carries risks.
During delivery, inadequate uterine contractions or tears to major blood vessels can lead to severe hemorrhage.
Generally, these complications cannot be anticipated in advance; the focus is on resolving issues as quickly as possible.
However, sometimes even the best efforts by physicians may not be able to save the mother's life.
Therefore, childbirth is indeed a risky process.
Wishing you good health.

Reply Date: 2015/03/20

More Info

Postpartum hemorrhage (PPH) is a significant concern for new mothers, and understanding its causes and prevention strategies is crucial for maternal health. PPH is defined as excessive bleeding following childbirth, typically classified as early (occurring within 24 hours of delivery) or late (occurring from 24 hours to six weeks postpartum).

Causes of Postpartum Hemorrhage
1. Uterine Atony: This is the most common cause of early PPH, accounting for about 70-80% of cases. After delivery, the uterus should contract to expel the placenta and reduce bleeding. If the uterus fails to contract effectively, it can lead to significant blood loss.

2. Retained Placenta: If parts of the placenta remain in the uterus after delivery, it can prevent the uterus from contracting properly, leading to continued bleeding.

3. Trauma: Lacerations or tears in the cervix, vagina, or perineum during delivery can also cause PPH. These injuries may not always be immediately apparent but can lead to significant bleeding.

4. Coagulation Disorders: Some women may have underlying blood clotting disorders that can increase the risk of bleeding after childbirth.

5. Uterine Inversion: This rare condition occurs when the uterus turns inside out during or after delivery, which can cause severe bleeding.

Prevention Strategies
1. Active Management of the Third Stage of Labor: This involves administering uterotonics (medications that stimulate uterine contractions) immediately after the delivery of the baby and before the delivery of the placenta. This practice has been shown to significantly reduce the risk of PPH.

2. Monitoring and Early Intervention: Healthcare providers should closely monitor the mother’s vital signs and uterine tone immediately after delivery. Early detection of any signs of excessive bleeding allows for prompt intervention.

3. Proper Management of the Placenta: Ensuring that the placenta is delivered completely and managing any retained products effectively is crucial. If there is any suspicion of retained placenta, ultrasound or manual examination may be necessary.

4. Education and Awareness: Educating expectant mothers about the signs of PPH and the importance of immediate medical attention if they experience heavy bleeding can empower them to seek help promptly.

5. Addressing Risk Factors: Women with known risk factors for PPH, such as a history of PPH, multiple pregnancies, or certain medical conditions, should discuss their birth plan with their healthcare provider to ensure appropriate precautions are taken.

6. Postpartum Care: After delivery, mothers should receive thorough postpartum care, including monitoring for signs of bleeding and ensuring they understand when to seek medical help.

Conclusion
Understanding the causes of postpartum hemorrhage and implementing preventive measures can significantly reduce the risks associated with childbirth. It is essential for mothers to be informed and proactive about their health during and after pregnancy. If you or someone you know is concerned about postpartum hemorrhage, it is vital to discuss these concerns with a healthcare provider who can provide personalized advice and care.

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