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Diagnosis / Postpartum Hemorrhage

Postpartum hemorrhage (PPH) occurs in up to 5% of births and is the leading cause of maternal morbidity in developed countries. Primary PPH is defined as the loss of >500ml of blood from the genital tract, within 24 hours of delivery. Secondary PPH is abnormal bleeding from the genital tract, from 24 hours after delivery until six weeks post partum.

There are 2 classifications primary of PPH:

  • Minor – estimated blood loss of up to 1000mls
  • Major – any estimated blood loss >1000mls

What Causes Postpartum Hemorrhage?

Once a baby is delivered, the uterus normally contracts and pushes out the placenta. After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely. This is called uterine atony and is the most common cause of post partum hemorrhage.

Postpartum hemorrhage can also be caused by the following:

  • Tear in the cervix or tissues of the vagina
  • Tear in a blood vessel in the uterus
  • Bleeding into the hidden tissue area or space in the pelvis. This mass of blood is called a hematoma, and usually occurs in the vulva or vagina.
  • Blood clotting disorders
  • Placenta problems

Risk Factors for Postpartum Hemorrhage

Some women are at greater risk for postpartum hemorrhage than others. Some conditions that may increase the risk include:

  • Placental abruption – early detachment of the placenta from the uterus
  • Placenta previa – occurs when the placenta covers or is near the opening of the cervix
  • Overdistended uterus – when the uterus is larger than normal because of excess amniotic fluid or a large baby
  • Multiple pregnancy
  • High blood pressure disorders of pregnancy
  • Having many previous births
  • Prolonged labor
  • Infection
  • Obesity
  • Use of forceps or vacuum-assisted delivery
  • Ethnicity – Asian or Hispanic decent

Symptoms of Postpartum Hemorrhage

The following are the most common symptoms of postpartum hemorrhage. However, each woman may experience symptoms differently. Symptoms may include:

  • Uncontrolled bleeding
  • Decreased blood pressure
  • Increased heart rate
  • Decrease in the red blood cell count
  • Swelling and pain in the tissues in the vaginal and surrounding area, if bleeding is due to a hematoma

How is Postpartum Hemorrhage Diagnosed?

Diagnosis for postpartum hemorrhage is usually based on symptoms, with laboratory tests often helping to complete the diagnosis. The following laboratory tests may be used:

  • Estimation of blood loss
  • Pulse rate and blood pressure measurement
  • Hematocrit (red blood cell count)
  • Clotting factors in the blood

IVC’s Treatment for Postpartum Hemorrhage

At IVC we offer a minimally invasive treatment for postpartum hemorrhage called embolization. This life-saving treatment for women suffering from postpartum hemorrhage is done using image guidance to direct small particles into the arteries supplying the uterus with blood. These particles block the blood flow to the uterus and stop the bleeding. Studies have shown this treatment eliminates the need for more invasive surgery and does not affect a woman’s fertility.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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