Postpartum hemorrhage
Last reviewed: 23.04.2024
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Postpartum hemorrhage is a loss of blood of more than 500 ml during or immediately after the third stage of labor.
The diagnosis is made on the basis of clinical data. Treatment consists of uterine massage and intravenous administration of oxytocin, sometimes in combination with injections of 15-methyl prostaglandin F2a or methylergonovine.
[Causes Postpartum hemorrhage
What causes postpartum bleeding?
Postpartum hemorrhage is most often the result of bleeding from the placental area. Risk factors for bleeding are uterine atony due to overstretch (due to multiple pregnancies, polyhydramnios or excessively large fetuses), prolonged or complicated births, a high number of births (delivery with more than five viable fruits), the use of relaxants, rapid delivery, chorioamnionitis and delayed placental tissue (for example, because of the placenta accreta). Other possible causes of bleeding are vaginal ruptures, rupture of the episiotomy wound, rupture of the uterus, fibroids of the uterus. Early postpartum hemorrhage is associated with subinvolution (incomplete involution) of the placental site, but may also occur 1 month after birth.
Who to contact?
Treatment Postpartum hemorrhage
Treatment of postpartum haemorrhage
The vnugriskosudisty volume is replenished with 0.9% solution of sodium chloride to 2 l intravenously; a blood transfusion is performed if this volume of saline is insufficient. Hemostasis is achieved by two-hand massage of the uterus and by the introduction of oxytocin, a manual examination of the uterine cavity is carried out to detect gaps and debris of placental tissue. In the mirrors, the cervix and vagina are examined to identify gaps; tears are shed. If excessive bleeding continues with the administration of oxytocin, then additionally, 15-methyl prostaglandin F2a is administered 250 mcg intramuscularly every 15-90 min to 8 doses or metergergonovine 0.2 mg intramuscularly once (reception can be continued 0.2 mg orally 34 times in day for 1 week). In cesarean section, these drugs can be injected directly into the myometrium. Prostaglandins are not recommended for patients with asthma; methylergonovine is undesirable to prescribe to women with arterial hypertension. Sometimes misoprostol 800-1000 μg can be used rectally to enhance the uterine contractility. If hemostasis can not be achieved, ligation a is necessary. Hypogastrica or performing a hysterectomy.
Prevention
How to prevent postpartum bleeding?
Risk factors such as uterine fibroids, polyhydramnios, multiple pregnancies, maternal coagulopathy, a rare blood group, a history of postpartum haemorrhage in previous births, are taken into account before birth and, if possible, corrected. The correct is a gentle, unhurried delivery with a minimum of interventions. After separation of the placenta, administer oxytocin at a dose of 10 ED intramuscularly or infusion of diluted oxytocin (10 or 20 units in 1000 ml of 0.9% sodium chloride solution intravenously at 125-200 ml / h for 12 hours), which contributes to improving the contractility of the uterus and reducing blood loss. After the birth of the placenta, it is fully inspected; if placental defects are detected, a manual examination of the uterine cavity with the removal of the remains of the placental tissue is necessary. Curettage of the uterine cavity is rarely required. Control of uterine contraction and bleeding volume should be performed within 1 hour after the completion of the third stage of labor.