What Is a Postpartum Hemorrhage?

A postpartum hemorrhage, also known as PPH, is a serious but rare condition that causes women to bleed uncontrollably after giving birth. This typically happens within 1 day of giving birth but can occur up to 12 weeks after having a baby.

Although it's normal to lose blood during childbirth, a postpartum hemorrhage is much more serious. Due to significant blood loss, postpartum hemorrhage can cause a drop in your blood pressure. Your organs may not get enough blood flow which can cause you to go into shock and possibly die.

What Does This Mean

When you’re pregnant, your body develops a placenta — an organ that develops inside your uterus. It is a structure for your baby that provides them with the oxygen and nutrients they need to grow. It also removes waste products from your baby’s food. The placenta attaches to the wall of your uterus, and your baby's umbilical cord comes out from it.

After childbirth, the uterus typically contracts to push out the placenta. The contractions help put pressure on the bleeding vessels where the placenta was attached inside your uterus. If the contractions during childbirth aren’t strong enough, the vessels bleed more. Bleeding can also happen if small pieces of the placenta stay attached and don’t leave the body.

If the placenta isn’t delivered within 30 minutes after childbirth, it’s known as a retained placenta. If it or parts of it are still attached to the uterine wall, it can cause severe infection or life-threatening blood loss. Signs of placental problems include:

  • Vaginal bleeding
  • Abdominal pain
  • Back pain
  • Uterine contractions

If you have questions about the placenta or placental problems during pregnancy, talk to your health care provider. They can help you better understand the placenta's role during your pregnancy.

Symptoms of Postpartum Hemorrhage

Each woman is unique and may experience postpartum hemorrhage differently. These are the most common symptoms:

  • Uncontrolled bleeding
  • Decreased blood pressure
  • Increased heart rate
  • Decreased red blood cell count
  • Swelling and pain in the vaginal area

Cause of Postpartum Hemorrhage

Some women are more at risk for postpartum hemorrhage than others. Conditions that increase your risk include:

  • Placental abruption: early detachment of the placenta from the uterus
  • Placenta previa: placenta covers or is near the cervical opening
  • Overstretched uterus: excessive enlargement of the uterus due to too much amniotic fluid or a large baby
  • Multiple pregnancies: more than one placenta and excessive stretching of the uterus
  • Gestational hypertension or preeclampsia: high blood pressure due to pregnancy
  • Having multiple previous births
  • Labor that lasts longer than average
  • Infection
  • Obesity
  • Medications to induce labor
  • Medications to stop contractions (for preterm labor)
  • The use of forceps or vacuum-assisted delivery
  • General anesthesia

Postpartum hemorrhage may also be caused by:

  • Tear in cervix or tissue in the vagina
  • Tear in a blood vessel of the uterus
  • Bleeding into a hidden tissue area (usually the vulva or vagina)
  • Blood clot disorders
  • Placenta problems

Continued

How is Postpartum Hemorrhage Diagnosed?

Your doctor can help diagnose postpartum hemorrhages. They will review your health history and do a variety of tests including:

  • An evaluation of how much blood was lost
  • Measuring pulse and blood pressure
  • Measuring red blood cell count
  • Looking for potential blood clots

How is Postpartum Hemorrhage Treated?

Your doctor can help determine which treatment options will work best for you. They’ll evaluate: 

  • Your health history, overall health, and pregnancy
  • Severity of the postpartum hemorrhage condition
  • Your tolerance for different medications and treatments
  • Your personal preference 

The goal of treatment is to stop you from bleeding as quickly as possible. Treatment for PPH may include: 

  • Medication
  • Massaging the uterus to start contractions
  • Removal of any placenta pieces still in the uterus
  • Examination of the uterus and pelvic tissue
  • Inserting a Bakri balloon or a Foley catheter to compress bleeding in the uterus
  • Packing the uterus with sponges and sterile materials
  • Tying off bleeding blood vessels
  • Surgery where the abdomen is cut open to find the source of the bleeding
  • Surgical removal of the uterus, which may be considered as a last resort

Replacing lost blood and fluids is important in treating postpartum hemorrhage. Intravenous (IV) fluids, blood, and blood products may be given rapidly to prevent shock. The mother may also receive oxygen by mask.

Postpartum hemorrhage can be quite serious. However, quickly detecting and treating the cause of bleeding can often lead to a full recovery.

WebMD Medical Reference Reviewed by Dan Brennan, MD on March 16, 2021

Sources

SOURCES:

CHOP: “Postpartum hemorrhage.”

Mayo Clinic: “Placenta: How it works, what’s normal.”

March of Dimes: “Postpartum hemorrhage.”

Stanford Children’s: “Postpartum hemorrhage.”

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