Postpartum Hemorrhage

Mary C Mercurio
 Postpartum Hemorrhage is known as a large amount of blood loss after giving birth

vaginally or after a C-section. Amounts of blood loss ranging from 500ml after having a vaginal

birth to 1000ml after having a C-section. There are two types of postpartum hemorrhages. When

a hemorrhage happens in the first twenty four hours after giving birth it is called early

postpartum hemorrhage. When a hemorrhage happens after the first twenty four hours it is called

a late postpartum hemorrhage.

In early postpartum hemorrhage it usually happens within the first twenty four hours after

delivery and is caused by lack of muscle tone that results in lack of muscle contractions around

blood vessels when the placenta separates. It may also be caused by collections of blood in

tissues or a space, not eliminated all of the placenta fragments, and other blood clotting

disorders. Trauma to the birth canal, vaginal, cervical, perineal lacerations are also causes of

early postpartum hemorrhages.

In late postpartum hemorrhage usual cause is a delayed return of the uterus to its normal

size and consistency before its non-pregnant size and consistency and fragments of the placenta

remain attached after the placenta is delivered. Blood clots form around those fragments and

those clots slowly break away several days after delivery causing excessive bleeding.
 Common factors for postpartum hemorrhage are over distention of the uterus, multiple

births (five or more), precipitate labor or delivery, prolonged labor, use of forceps or vacuum

extractor, cesarean birth, manual removal of placenta, uterine inversion, placenta previa, placenta

accrete or low implantation, drugs, general anesthesia, chorioamnionitis, clotting disorders,

previous postpartum hemorrhage or uterine surgery, disseminated intravascular coagulation and

uterine fibroids. (Page 667, box 29-1).

Initial treatment for postpartum hemorrhage is assessment of predisposing factors for

why hemorrhage is present. Vitals signs should be assessed and recorded every Three to five

minutes. Oxygen administered and carefully monitored, blood draws, fluid administration, blood

product administration and medication administration as hospital protocols require or as ordered

by physician. A urinary catheter may be place for close monitoring of urine output and for

preparation if surgical intervention is needed.

 References

Mckinney/James/Murray/Nelson/Ashwell(2013,2009,2005,2000 by Saunders) Maternal-Child

Nursing 4th Edition (pages 667-673).