Emmoragia postpartum

Postpartum hemorrhage occurs when a woman after delivery and delivery of the placenta has blood loss greater than 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Postpartum hemorrhage is a serious but rare condition that can occur one day to 12 weeks after delivery. Approximately 1 to 5 out of 100 women are affected.

Cause dell’emmoragia postpartum

After delivery, the uterus continues to contract and expels the placenta. After the placenta has been delivered, the contractions normally continue and help compress the bleeding vessels in the area where the placenta was attached. Contractions of the uterus help close these vessels until they heal.

If the uterus does not contract strongly enough, or if there is uterine hypotonia, the blood vessels continue to bleed freely and bleeding occurs.

This is the most common cause of postpartum hemorrhage.

Some women are at greater risk of postpartum bleeding than others. Conditions that can increase your risk of postpartum bleeding include:

  • early detachment of the placenta from the uterus
  • placenta previa, a condition when the placenta sits (implants) over the opening of the cervix
  • excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with a birth weight of more than 4,000 grams
  • uterine overdistension (due to multiple pregnancy, polyhydramnios, or a large-for-gestational-age fetus)
  • high multiparity
  • gestational hypertension or preeclampsia.
  • numerous previous parts
  • prolonged labor
  • infection
  • obesity
  • use of drugs to induce labor
  • using drugs to stop contractions (for preterm labor)
  • assisted delivery with vacuum or forceps
  • general anesthesia

Postpartum bleeding can also be due to other factors, including the following:

  • tear in the cervix or vaginal tissues
  • rupture in a uterine blood vessel
  • bleeding into an area of ​​hidden tissue or space in the pelvis that develops into a hematoma, usually in the vulva or vaginal area
  • blood clotting disorders, such as disseminated intravascular coagulation
  • placenta accreta
  • placenta increta
  • cake passed

Although a rare occurrence, uterine rupture can be dangerous as it can cause a severe drop in the mother’s blood pressure and can lead to shock and death if left untreated.

Symptoms of a postpartum hemorrhage

The following are the most common symptoms of postpartum hemorrhage, however each woman may experience symptoms differently:

  • uncontrolled and profuse bleeding (blood loss greater than 1000 mL)
  • decrease in blood pressure
  • increased heart rate
  • decreased red blood cell count (hematocrit)
  • swelling and pain in the tissues of the vaginal and perineal area

Symptoms of postpartum hemorrhage can resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Treatment of a postpartum hemorrhage

The goal of postpartum bleeding treatment is to find and stop the cause of the bleeding as quickly as possible. Treatment for postpartum hemorrhage can include:

  • drugs to stimulate uterine contractions
  • manual massage of the uterus to stimulate contractions
  • removing any pieces of placenta that remain attached to the uterus
  • examination of the uterus and other pelvic tissue
  • Bakri balloon or Foley catheter to compress bleeding inside the uterus
  • ligation of bleeding blood vessels using uterine compression sutures
  • laparotomy, a surgery to open up the abdomen to find the cause of the bleeding.
  • hysterectomy, the surgical removal of the uterus (as a last resort)
  • fluid therapy and sometimes transfusion

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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