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Pregnancy Complications: Common Causes of Hemorrhage

Postpartum hemorrhaging

Postpartum hemorrhaging occurs when a woman loses 500 milliliters or more of blood after giving birth. It’s estimated that 18 percent of births involve postpartum hemorrhage.

Losing a lot of blood isn’t uncommon after delivery. However, blood loss can affect your ability to maintain your blood pressure if you lose more than 1,000 milliliters of blood. If you lose significantly more blood than this, it can cause shock or even death.

While most women who experience postpartum hemorrhage do so immediately after their babies are born, it can sometimes occur later. Typically, the uterus continues to contract after a woman delivers the placenta. These contractions help to stop bleeding. If you don’t deliver the placenta or the uterus doesn’t contract, which is known as uterine atony, hemorrhage can occur.

What are the symptoms of postpartum hemorrhaging?

Symptoms

Some symptoms associated with postpartum hemorrhage may be visible. Others may require blood testing. Examples of symptoms include:

  • bleeding that doesn’t lessen or stop
  • a drop in blood pressure
  • a drop in red blood cell count, or hematocrit
  • a rise in heart rate
  • swelling
  • post-delivery pain

Your doctor will begin treatment immediately if they observe these symptoms.

What are the causes of hemorrhaging?

Causes

Doctors consider the “four Ts” when determining the cause of a postpartum hemorrhage. These include:

Tone

An atonic uterus is responsible for 70 percent of postpartum hemorrhage cases. Doctors will usually try to rule out this cause first. Your doctor will evaluate the tone, or degree of tension, in your uterus. If your uterus feels soft after delivery, uterine atony is likely the cause.

Trauma

In 20 percent of postpartum hemorrhage cases, hemorrhage is due to damage, or trauma, to the uterus. This can include a cut or a hematoma, which is a collection of blood.

Tissue

In an estimated 10 percent of postpartum hemorrhages, tissue is the cause. This usually means you’re retaining a piece of the placenta. This condition is called “placenta accreta" or “invasive placenta.” In this condition, the placenta is too deep or attached to the uterus to come out. If you don’t deliver the placenta in an expected amount of time after delivery, it’s likely that you’ll need surgery to remove it.

Thrombin

A blood-clotting disorder can cause hemorrhage. Thrombin is a blood-clotting protein in the body. Conditions that cause a deficiency in thrombin are rare. They occur in less than 1 percent of pregnancies.

Examples of thrombin-related conditions include von Willebrand disease, hemophilia, and idiopathic thrombocytopenia purpura. Your doctor can diagnose these disorders through blood tests, such as:

  • a platelet count
  • a fibrinogen level
  • a partial thromboplastin time
  • a prothrombin time

What are the risks factors for postpartum hemorrhaging?

Risk Factors

It’s possible to experience postpartum hemorrhage without having any risk factors. However, some risk factors exist. These include having:

  • an assisted delivery, such as with a forceps or vacuum
  • excess amniotic fluid
  • an episiotomy
  • a large baby
  • a baby with fetal macrosomia, which means they’re larger than normal
  • a history of postpartum hemorrhage
  • medications to induce labor
  • multiple births
  • a prolonged third stage of labor or delivery of the placenta

If you have these risk factors, your doctor will constantly evaluate your delivery and symptoms to ensure your safety.

How is postpartum hemorrhaging diagnosed?

Diagnosis

Your doctor will first attempt to estimate your blood loss during delivery. If you have a vaginal delivery, they’ll place special collection bag at the end of the labor and delivery table to allow them to more accurately estimate your blood loss. Also, they can weigh soaked pads or sponges to estimate additional blood loss.

Other diagnostic methods include measuring vital signs, such as your:

  • pulse
  • oxygen level
  • blood pressure
  • respirations

Your doctor will also take a sample of your blood to determine your hemoglobin and hematocrit levels. The results can help them evaluate your blood loss.

What are the complications associated with postpartum hemorrhaging?

Complications

Blood loss can cause you to experience:

  • anemia, or low blood levels
  • dizziness upon standing
  • fatigue

It’s easy to mistake these symptoms for what typically happens in the postpartum period.

Severe instances of bleeding can cause very serious complications. These can include myocardial ischemia, or a lack of oxygen to the heart, and even death.

What are the treatments for postpartum hemorrhage?

Treatment

Treatments for postpartum hemorrhage will depend on the cause:

Uterine atony

If uterine atony is causing your hemorrhaging, your doctor may start by massaging your uterus. This can cause your uterus to contract and become firm, stopping the bleeding.

Medications can also help your uterus contract. An example is oxytocin. Your doctor can give you the medicine through a vein, place it in your rectum, or injected it into your muscle. During a C-section, your doctor can also inject oxytocin into your uterus.

Invasive placenta

If placental tissue remains in your uterus, your doctor may perform a dilation and curettage. This procedure involves using an instrument known as a curette to remove tissue fragments that remain in your uterus.

Trauma

Your doctor may repair trauma to your uterus by inserting sponges or a medical balloon into your uterus and inflating it. This places pressure on the bleeding arteries, helping them to stop bleeding. Your doctor can also use stitches around the bottom portion of your uterus to stop bleeding.

Thrombin

After stopping the bleeding, treatments can include providing fluids and blood transfusions. This keeps you from going into shock. Shock occurs when you lose too much fluid and blood, causing your organs to shut down.

In rare cases, your doctor may perform a surgical removal of the uterus, or a hysterectomy.

What are the risks of treatment for hemorrhaging?

Procedures used to treat hemorrhage aren’t usually associated with long-term risks. Even if you need sutures on your uterus, infertility shouldn’t occur. However, in the rare instance of needing a hysterectomy, you won’t be able to have another baby.

If you need a blood transfusion, it’s possible to have an allergic reaction to the transfusion. With today’s lab testing methods, this is rare.

What is the outlook?

Outlook

Quick thinking and attention to symptoms can help stop bleeding and put you on the road to recovery. If you’ve had a postpartum hemorrhage before or you’re worried about your risks, talk to your OB-GYN.

You should be able to recover if you get prompt treatment for hemorrhage. You may need a slightly longer hospital stay for monitoring.

What are ways to prevent postpartum hemorrhaging?

Prevention

Prenatal care throughout your pregnancy is vital for preventing postpartum hemorrhage. During your pregnancy, your doctor will take a full medical history, blood type, and consider any risk factors during the pregnancy.

If you have a rare blood type, bleeding disorder, or a history of postpartum hemorrhage, your doctor may ensure blood of your blood type is available during delivery. Your doctor should also monitor you carefully after delivery to ensure spontaneous hemorrhaging doesn’t occur. 

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