Why does bleeding occur?
After separation of the placenta, an extensive wound surface with open vessels remains on the wall of the uterus. What stops the blood first of all is the contraction of the uterine muscle itself, which compresses the vessels, and only then the coagulation system. Accordingly, the causes of bleeding fit into several groups: the uterus contracts poorly, parts of the placenta or membranes remain in it, there are ruptures in the birth canal, and blood clotting is impaired. The first reason is most common, especially after a long or, conversely, rapid labor, with multiple births, large fetuses and polyhydramnios.
- Weak uterine contractions are the most common cause
- Retention of parts of the placenta and membranes
- Ruptures of the cervix, vagina and perineum
- Blood clotting disorders
- Placenta accreta
- Uterine inversion is a rare serious complication
- Late bleeding due to inflammation or tissue debris
Who's at risk
The risk is higher when the uterus is overstretched: multiple pregnancies, large children, polyhydramnios. The characteristics of childbirth are important: prolonged or very rapid labor, stimulation, surgical delivery, manual intervention in the uterine cavity. Contributors include placenta previa and accreta, preeclampsia, anemia during pregnancy, uterine fibroids, and multiple previous births or cesarean sections. Separately, hereditary and acquired blood clotting disorders and the use of drugs that affect it are taken into account. Many factors are known in advance, which allows you to prepare for childbirth.
- Multiple pregnancy and polyhydramnios
- Large fruit
- Prolonged or rapid labor
- Caesarean section and operative delivery
- Placenta previa and placenta accreta
- Uterine fibroids
- Anemia and preeclampsia
- Blood clotting disorders
- Bleeding in previous births
Signs of danger at home
After discharge, the discharge gradually decreases and becomes lighter: at first it is bloody, then becomes bloody and mucous. The alarm signal is the reverse dynamics. If the pad gets completely wet in less than an hour, large clots come out, the discharge turns bright scarlet again, or a putrid smell appears, you need to urgently seek help. General signs of blood loss should also alert you: increasing weakness, dizziness when standing up, darkening of the eyes, rapid heartbeat, pallor, cold sweat. You cannot wait for a scheduled appointment in such a situation.
- Getting a pad wet in less than an hour
- Large blood clots
- Returning the scarlet color of the discharge
- Unpleasant odor and temperature
- Dizziness and fainting
- Palpitations and shortness of breath with light exertion
- Severe pallor and cold sweat
What do doctors do
Help is provided quickly and according to a proven algorithm. At the same time, the volume of blood loss is assessed, venous access is provided, tests are taken, and actions to stop the bleeding are initiated. The first step is to achieve contraction of the uterus: massage, emptying the bladder, administering contractile drugs. They check the integrity of the birth canal and the uterine cavity, and remove any remaining tissue. If this does not help, balloon tamponade of the uterus, compression sutures, ligation or vascular embolization are used. Replenish blood loss with solutions and, if necessary, blood components.
- Assessment of blood loss and woman's condition
- Uterine massage and contractions
- Emptying the Bladder
- Inspection of the birth canal and suturing of ruptures
- Removal of remaining placental tissue
- Balloon intrauterine tamponade
- Compression sutures and vascular ligation
- Uterine artery embolization
- Transfusion of blood components according to indications
Recovery and prevention
After stopping the bleeding, the main task is to replenish the iron deficiency: anemia almost always develops, due to which weakness, shortness of breath, hair loss and difficulties with lactation persist. Iron supplements are prescribed by a doctor, focusing on hemoglobin and ferritin, the course usually lasts several months. Good nutrition, adequate rest and help from loved ones are important. Prevention begins during pregnancy: treatment of anemia, identification of risk factors, choice of place of birth. During labor, all women undergo active management of the third period, which significantly reduces the risk of bleeding.
- Treatment of anemia with iron supplements
- Hemoglobin and ferritin control
- Good nutrition and rest
- Breastfeeding support
- Treatment of anemia during pregnancy
- Identifying risk factors before birth
- Active management of the third stage of labor
- Giving birth in a facility ready to assist
