The problem of bleeding in the postpartum period

Imprint

Tatiana E. Onbysh, Anastasia V. Malukha, Ekaterina A. Ponomareva, Ksenia V. Sitnikova. The problem of bleeding in the postpartum period. Cardiometry; Issue No. 27; May 2023; p. 229-232; DOI: 10.18137/cardiometry.2023.27.229232; Available from: problem-bleeding-postpartum

Bleeding in the postpartum period is a serious complication that can lead to the death of a woman. In some cases, it may occur due to insufficient contraction of the uterus after childbirth (uterine atony), in other cases due to damage to the tissues of the birth canal or retention of the placenta.

According to the WHO data, bleeding is one of the leading causes of maternal death worldwide, especially in developing countries. In this regard, understanding the causes and methods for the prevention, as well as treatment of postpartum hemorrhage is an important task for modern obstetric practice.

The purpose of this article is to address the problem of postpartum hemorrhage, explain the causes and symptoms of this complication, and suggest pre- vention and treatment methods to reduce the risk of maternal death.

The postpartum period is the period of time that starts from the moment the baby is born and ranges from a few weeks to a few months. During this period, a woman’s body experiences a number of physiological changes associated with the recovery after pregnancy and childbirth.

In the first few days after delivery, a woman experiences severe pain in the pelvis and abdomen. She may also experience bleeding from the vagina, called lochia. Lochia is a discharge that occurs as a result of removing from the uterus some remnants of the placenta and other tissues after childbirth. It can last up to 6 weeks after delivery.

After the first few days upon giving birth, the woman begins to recover, but this process can take several weeks. In this connection, the woman may experience fatigue, headaches, disturbances in appetite and mood, and problems with urination.

The postpartum period is especially vulnerable for women, since complications such as bleeding, infections, thromboembolism and others are possible during this period [1]. Bleeding in the postpartum period can provoke serious problems, so it is important to seek medical support in a timely manner and follow the recommendations of medical doctors.

There are several causes of bleeding in the postpartum period, which may be attributed to various factors, as listed below:

• 1.    Rupture of uterine vessels.

• 2.    Delayed placenta separation.

• 3.    Disorders in blood coagulation system.

Ruptures of the uterine vessels may occur as a result from delivery or may be associated with previous uterus surgery, such as a caesarean section. Also, ruptures may occur due to premature rupture of the fetal sac or unexpected movements of the baby during the birth process. Ruptures of the uterine vessels can initiate severe bleeding, which can be life-threatening.

Delayed separation of the placenta is a condition, where the placenta does not move away from the wall of the uterus after childbirth. This can lead to severe bleeding, as the uterus cannot contract and close the vessels, which bleed freely after the placenta has been delivered [2].

Blood coagulation disorders may be associated with the presence of some genetic diseases that lead to abnormalities in the blood clotting process. This can take place after long-term use of aspirin or other drugs, which reduce blood clotting. In addition, women who have given birth to a large child or had a long labor process may experience bleeding due to stretching of the uterine wall and bleeding disorders.

All of these causes can initiate heavy bleeding in the postpartum period, so it is important to know the symptoms of this condition and seek medical help in a timely manner [3].

Bleeding in the postpartum period can take place both inside and outside the uterus. As to internal bleeding, it can be difficult to recognize it at the early stages, so it is important to know the main symptoms, which may indicate the potential bleeding and which are as given below:

• 1.    Stitch pain in the lower abdomen.

• 2.    Increased heart rate

• 3.    Low blood pressure.

• 4.    Pale skin.

• 5.    Discharge of blood from the vaginal tract.

• 6.    Severe weakness and dizziness.

Stitch pain in the lower abdomen is one of the first and most characteristic symptoms of bleeding in the postpartum period. It may appear due to rupture of the uterine vessels or due to a delay in the separation of the placenta. The stitch pain can be intense and remain after taking pain relieving drugs. This symptom requires immediate medical help, as the lack of timely treatment may involve serious complications.

Increased heart rate is another symptom of postpartum bleeding. It may appear due to a decrease in the volume of blood in the systemic circulation caused by bleeding. A rapid heart rate can lead to a decrease in blood supply to organs and tissues, which may involve serious consequences, including cardiac arrest.

Bleeding in the postpartum period can result in a drop in blood pressure. This symptom can be associated with feelings of weakness, dizziness, and loss of consciousness. A decrease in blood pressure can be caused by a reduction in the volume of circulating blood in the body. Low blood pressure requires immediate medical support.

With bleeding in the postpartum period, a woman may experience severe weakness, and her skin becomes pale. This is due to a decrease in the circulating blood volume. Paleness of the skin is a serious symptom of bleeding and requires immediate medical assistance. If the bleeding is not stopped in time, it can lead to the development of shock, which is a dangerous condition, where and when the organs cannot be properly supplied with blood and oxygen.

Discharge of blood from the vaginal tract is one of the main symptoms of bleeding in the postpartum period. The normal postpartum discharge represents bright red blood, and it should decrease in volume over time. If the discharge remains bright red, has a large volume and persists for several days after childbirth, then this may indicate abnormal bleeding.

With bleeding in the postpartum period, a woman may feel severe weakness and dizziness caused by a lack of oxygen in the body. These symptoms can lead to loss of consciousness and require immediate medical attention.

All of these symptoms may be associated with bleeding in the postpartum period and require immediate medical support. If a woman has any of these symptoms, she should immediately consult a medical doctor or contact an emergency ambulance [4].

If the bleeding does not stop in time, it may involve serious consequences such as anemia, infections, inflammation, and even death. Therefore, it is very important to seek for medical help in a timely manner and undergo the necessary treatment.

A number of measures can be taken to prevent bleeding in the postpartum period, beginning with adequate prenatal preparation.

It is important that a woman familiarizes herself with the possible complications of the postpartum period in advance, learns how to breathe correctly and perform a series of exercises that help strengthen the muscles of the pelvic floor. This will reduce the risk of bleeding after childbirth.

It is also necessary to conduct regular check-ups in pregnancy and after delivery. Medical doctors should monitor the condition of the uterus and the level of hemoglobin in blood, as well as timely identify and treat any possible complications that may provoke bleeding [5].

One of the most effective measures is the use of the “active management of the third stage of labor” technique. This means that the medical doctor actively manages the delivery of the placenta, accelerating its separation from the uterine wall and preventing bleeding.

Another effective measure is the use of hormonal drugs. They can reduce the risk of bleeding after childbirth, accelerate uterine contractions and improve the general condition of a woman.

In case of bleeding in the postpartum period, the use of blood clotting agents such as thrombin or fibrinogen may be required. These medical drugs stop bleeding and prevent from severe blood losses.

In some cases, a caesarean section may be a safer option than the vaginal delivery, especially if the woman is at high risk of bleeding.

In general, to prevent bleeding in the postpartum period, it is necessary to provide an adequate prenatal preparation, timely monitoring of the state of the uterus and checking the level of hemoglobin in blood [6].

In case of bleeding in the postpartum period, various methods of treatment can be applied, depending on the severity of the bleeding and the causes thereof. Some of the conventional treatment methods include the following:

• 1.    Infusion of fluids and blood substitutes. This method is aimed at maintaining blood pressure at an optimal level and compensating for blood loss. Fluids and blood substitutes can be supplied into the body through a vein to quickly restore the normal blood volume.

• 2.    The use of medical drugs to accelerate the uterine contraction. This may help stop the bleeding. As a rule, oxytocin and ergometrine are applied as medication agents. Oxytocin stimulates uterine contractions, which leads to less bleeding. Ergometrine assists in contracting the muscles of the uterus and increasing its tone, which can also promote stopping bleeding.

• 3.    Carrying out mechanical compression of the uterus. This method is used in cases where bleeding is caused by incomplete separation of the placenta. The medical doctor may try to manually separate the remaining parts of the placenta and massage the uterus to stimulate contractions.

• 4.    The use of hormonal drugs. In some cases, hormonal medication such as methylergometrine or prostaglandin E1 may be useful to stop bleeding. They initiate constricting the blood vessels and contracting the uterus.

• 5.    Use of blood clotting agents. This method is employed in cases where bleeding appears due to a bleeding disorder. The medical doctor may introduce blood clotting agents, such as thrombin or fibrinogen, to facilitate the clotting process.

• 6.    Surgical intervention. In some cases, surgery may be required, such as removing the rest of the placenta or a hysterectomy (removal of the uterus).

After bleeding in the postpartum period, a woman needs especially careful support and follow-up. It is important to adhere to the doctor’s recommendations and monitor her condition in order to avoid complications [7].

In the first few days after bleeding, a woman should rest and avoid physical loading. The responsible medical doctor may recommend exclude lifting heavy things and limiting motion activity during the first week after delivery. In addition, a woman must adhere to the proper daily regimen and nutrition, receive enough fluid and nutrients.

In the presence of pain in the postpartum period, analgesics can be administered, but it is necessary to consult a doctor to identify safe medication agents. Also, a woman should properly maintain the genital hygiene, regularly change sanitary pads and exclude use of intravaginal agents until complete recovery.

It is important to pay attention to the emotional state in the woman. The postpartum period is accompanied by hormonal changes and can induce depression and anxiety. A woman should discuss her feelings and emotions with loved ones or her medical doctor.

In case of any complications such as repeated bleeding, strong odor or discoloration, clots or fever, the woman should consult a doctor [8].

In addition, a woman should examine her mammary glands and properly breastfeed her baby. If a woman is having difficulty in breastfeeding, she should seek help from a doctor or lactation consultant.

In general, caring for a woman after bleeding in the postpartum period includes adhering to a daily routine, proper nutrition and maintaining feminine hygiene, as well as monitoring her physical and emotional state. However, the most important thing to remember is that every individual is unique, and the recovery process can vary in every case. Therefore, it is important to seek the help of a medical doctor in case of any doubts or unusual symptoms.

In addition, the family and loved ones can play an important role in a woman’s recovery from postpartum bleeding. They can help her cope with some physical and emotional difficulties, provide her with the peace she needs, and help with child care.

In conclusion, it should be noted that bleeding in the postpartum period can involve serious complications for the health of the mother and her child, so it is important to take all the necessary precautions to prevent it.

Regular medical examinations during pregnancy and after delivery will be useful to identify possible problems and take timely measures to eliminate them. It is also important to follow all the recommendations of medical doctors, including the proper nutrition, the necessary medication, the activity and rest regimen, in order to reduce the risk of bleeding in the postpartum period.

If bleeding does occur, it is important to immediately seek medical help and follow all the medical doctor’s instructions. It is necessary to conduct regular monitoring of blood levels and take all recommended measures to quickly and completely restore the health of the mother and her child.