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Postpartum Hemorrhage

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by McCoy K

(Obstetric Hemorrhage)

 

Risk Factors

Postpartum hemorrhage may be more common in Asian and Hispanic women.
Factors leading up to labor that may increase your chance of postpartum hemorrhage include:
Complications of labor and delivery that may increase your chance of postpartum hemorrhage include:
  • Interventions, such as:
    • Augmented labor—methods that stimulate or speed the progression of labor when it is delayed or stopped
    • Forceps or vacuum delivery
    • Episiotomy
    • Cesarean section
  • Prolonged labor
  • Large fetus
  • Chorioamnionitis—a bacteria infection of the membranes and fluid surrounding the fetus
  • Stillbirth
Demonstration of Forceps and Vacuum Delivery
Vacuum and forceps delivery
Copyright © Nucleus Medical Media, Inc.
 

Treatment

Treatment is based on the severity of bleeding. Treatment options include:

Bimanual Uterine Massage

A massage technique called bimanual uterine massage can control bleeding. A doctor or nurse will place one hand in your vagina to push on your uterus, while the other hand pushes down on your abdomen. This action will cause a relaxed uterus to contract, thus slowing bleeding.

Trauma Repair

Bleeding can be caused by a tear in your genital tract or other trauma. The tear will be stitched. In addition, tissue from a retained placenta may need to be removed.

Medications

Your doctor may prescribe uterotonics or prostaglandins to stimulate contraction of the uterus.

Surgery

In some cases, surgery may be needed to stop bleeding. Procedures include:
  • Uterine packing—sterile materials or a special tamponade device is placed inside the uterine cavity to compress the bleeding area
  • Repair of arteries
  • Uterine curettage—scraping the lining of the uterus
  • Repair of hematoma
  • Removal of retained placenta
  • Uterine artery embolization—non-invasive procedure to block the uterine artery
  • Hysterectomy—removal of the uterus
 

RESOURCES

American Congress of Obstetricians and Gynecologists
http://www.acog.org

American Pregnancy Association
http://www.americanpregnancy.org

 

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca

Women's Health Matters
http://www.womenshealthmatters.ca

 

References


American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039-1047. Reaffirmed 2011.


Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;75(6):875-882.


Postpartum hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated July 19, 2013. Accessed August 6, 2013.

 

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