Postpartum Hemorrhage: Risks and Effects of Blood Loss From Delivery

Medically reviewed by Peter Weiss, MD

Postpartum hemorrhage (PPH) refers to serious blood loss that occurs after childbirth. Usually, this happens in the first 24 hours after giving birth, but it’s possible up to 12 weeks postpartum.

It’s typical to experience some bleeding, known as lochia, after having a baby. Postpartum hemorrhage is excessive bleeding that can become life-threatening. It requires emergency treatment to prevent further blood loss.

This article will go over the symptoms of postpartum hemorrhage, as well as risk factors, treatment options, and more.

Emergency Postpartum Hemorrhage Symptoms

The main symptom of postpartum hemorrhage is heavy bleeding, which is often accompanied by clots. It may feel like blood is pouring from the vagina. You may soak through two or more pads or towels per hour.

Other symptoms of PPH include:

• Hypotension (low blood pressure)

• Pelvic pain

• Swelling in the vagina and/or perineum

• Heart palpitations

• Disorientation

• Light-headedness

• Weakness

• Pale, cool skin

The primary cause of postpartum hemorrhage is uterine atony, which refers to the uterus not contracting as normal after childbirth. This could lead to a retained placenta, meaning that part of the placenta (the organ that supplies the fetus with essential nutrients and oxygen during pregnancy) stays in the uterus after delivery. This can cause excessive bleeding.

Other potential causes of PPH include:

• Other problems with the placenta, such as placenta previa (low-lying placenta), placental abruption (sudden separation of the placenta from the uterine wall), or placenta accreta (growth of the placenta into the uterine wall)

• Tearing of the uterus during labor

• Inversion of the uterus

How Much Blood Loss Is Dangerous?

The exact amount of blood loss that constitutes postpartum hemorrhage is not universally agreed upon. However, it is typically defined as 1,000 milliliters (mL) or more of blood loss after a cesarean section (C-section, a surgical delivery) and 500 mL or more of blood loss after a vaginal delivery.

That said, if you experience symptoms of hypovolemia (severe loss of blood and other fluids), you should typically be treated for PPH regardless of the exact amount of blood loss.

Postpartum Hemorrhage Prognosis

Postpartum hemorrhage can be a life-threatening condition. Globally, it is the most common cause of maternal mortality. It is also responsible for a quarter of all maternal deaths in the postpartum period. In the United States, it is the cause of approximately 11% of maternal deaths.

However, the condition can be effectively treated. The risks associated with PPH are significantly reduced if you notice the signs and reach out to a healthcare provider right away.

Immediate Postpartum Hemorrhage Treatment

If you’re experiencing symptoms of postpartum hemorrhage, it’s crucial to get medical help right away to stop the bleeding.

While you’re still in the hospital, let a nurse or another healthcare provider know immediately if you are bleeding heavily. If you’re at home when you start to notice symptoms, call 911 or go to the emergency room immediately.

What Stops Bleeding?

The main goals of treating postpartum hemorrhage are to stop the bleeding and replace blood that’s been lost, if necessary. Often, this is accomplished through medical means of trying to make the uterus contract in order to push out the retained placenta (if that is the cause of the bleeding).

Treatment options may include:

• Medications such as tranexamic acid to slow down or stop bleeding

• Intravenous (IV) administration of uterotonics, or medications that cause the uterus to contract, such as Pitocin (synthetic oxytocin)

• Insertion of a device known as a intrauterine balloon, if uterotonics do not work

• Blood transfusions

• A hysterectomy (surgical removal of the uterus) in severe cases in which all other treatments have failed
  

What Increases Postpartum Hemorrhage Risk?

Most people with PPH have no known risk factors. However, there are many factors that may increase your chance of experiencing severe postpartum bleeding, including:

• Having experienced PPH in the past

• Delivering via C-section

• Labor induction

• A very fast or very long labor

• Having experienced multiple pregnancies

• Underlying blood disorders, such as von Willebrand disease

• Obesity

• Giving birth to a large baby

• Preeclampsia or gestational hypertension (high blood pressure during pregnancy)

• Chorioamnionitis (infection of the amniotic fluid and placenta)

• Intrahepatic cholestasis of pregnancy (ICP), a liver condition that develops during pregnancy
  

Inducing Labor and Postpartum Hemorrhage

Taking medication such as Pitocin to induce (bring on) labor may increase your risk of postpartum hemorrhage.

However, the benefits of labor induction sometimes outweigh the risks. For example, if you labor for too long without giving birth, you may need to have an emergency C-section, which can also increase your chance of developing PPH.

Talk to your healthcare provider about the benefits and potential side effects associated with labor induction. They can make the right recommendation for you based on your needs.

Is Postpartum Hemorrhage Preventable?

Postpartum hemorrhage isn’t always preventable. However, you can work to lower your risk and ensure that you get treatment right away if necessary by:

• Maintaining a healthy body weight when trying to get pregnant and during pregnancy

• Taking medications for any comorbid or underlying health conditions as prescribed

• Monitoring your blood pressure at home if you have gestational hypertension or preeclampsia

• Quitting smoking

• Avoiding drugs and alcohol while pregnant

• Letting your healthcare provider, including an obstetrician-gynecologist (ob-gyn), know about any complications you've experienced with past births

• Getting consistent prenatal care

Healing After Postpartum Hemorrhage

After leaving the hospital, your healthcare provider may recommend that you continue to monitor your bleeding at home. If you continue to soak through pads, contact your provider right away.

Your healthcare provider may also suggest that you take an iron supplement to treat anemia, especially if your blood loss was extreme. It’s also important to prioritize rest, stay off your feet as much as possible, and drink plenty of fluids as you recover. You’ll most likely be asked to follow up with your medical team at several postpartum appointments.

Summary

Postpartum hemorrhage (PPH) refers to blood loss of over 1,000 mL after delivering a baby. It’s usually caused by uterine atony, or the inability of the uterus to contract as usual after childbirth. Healthcare providers can take several different approaches to stop the bleeding, including uterine massage, medication, removal of the retained placenta, or (in rare cases) a hysterectomy.

PPH is a serious condition, but it can be treated effectively. Seek emergency medical help right away if you notice any signs of heavy bleeding within the first 12 weeks after giving birth.

Read the original article on Verywell Health.