Postpartum Bleeding, Severe

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KEY POINTS

• Severe postpartum bleeding is the loss of too much blood soon after your baby is born.
• You may receive IV fluids, medicines to make your uterus shrink, a blood transfusion, or surgery.
• Ask your healthcare provider if there are activities you should avoid and when you can return to your normal activities.

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What is severe postpartum bleeding?

Severe postpartum bleeding is the loss of too much blood soon after your baby is born. It usually happens within the first 24 hours of childbirth, but it may happen days or weeks later.

What is the cause?

Some of the causes of severe bleeding after childbirth are:

• Your uterus stays relaxed and does not contract (get smaller) after delivery of the baby and placenta.
• Pieces of the placenta are left in the uterus.
• There are cuts or tears in your vagina, uterus, or cervix (opening to the uterus).

You are at risk for severe postpartum bleeding if you have given birth more than 4 times, or had severe bleeding with a previous pregnancy. Your risk is also higher if you have:

• Blood clotting problems
• Fibroids, scars, or defects of the uterus
• An infection in your uterus
• An enlarged uterus caused by a large baby, twins, or too much fluid in the uterus
• Separation of the placenta from the uterus before your baby is born

You risk is also higher if you were given medicine to start your labor or you were in labor longer than 18 hours.

What are the symptoms?

The main symptom is a lot of bleeding from your vagina, usually right after your baby is born. If you lose too much blood, you may have a fast pulse, feel weak, or faint.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests
• An ultrasound, which uses sound waves to show pictures of your uterus

How is it treated?

If you are bleeding and the placenta does not come out right after the baby is born, your healthcare provider will try to take the placenta out with his or her hand. If the placenta is already out, your healthcare provider will try to make your uterus contract by massaging it. If massaging doesn't work, your provider will give you medicine to help your uterus contract. If your uterus is still bleeding, you may be given anesthesia so your provider can examine the inside of the uterus and vagina for tears or pieces of placenta. Your provider will repair any cut or torn areas that are bleeding. If you have a blood clotting problem, you will be treated for that. In some cases you may need surgery to remove any pieces of placenta still in your uterus or to look inside your belly for the cause of bleeding.

You will be given IV fluids and possibly a blood transfusion, depending on how much blood you have lost. You may need to be in the intensive care unit for a time while you recover.

If you have severe bleeding later after birth, your treatment will be similar to the treatment for bleeding right after your baby is born. Your healthcare provider may:

• Give you IV fluids
• Give you medicine to help your uterus shrink
• Give you antibiotics to prevent or treat infection
• Scrape the uterus to remove any placenta left in the uterus
• Do surgery to find the site of bleeding and remove or repair the cause of bleeding

How can I take care of myself?

Follow your healthcare provider's instructions. Ask your provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent severe postpartum bleeding?

If you have had severe postpartum bleeding before or have a risk of severe bleeding, make sure your healthcare provider has this information. Your provider may take precautions, such as giving you:

• IV fluids
• Medicine to help the uterus contract after delivery of the placenta