Discussing Postpartum Bleeding

Postpartum Bleeding

Normal postpartum bleeding occurs if the blood that comes out is still within normal limits and is called lochia. However, if there is a very large blood loss of more than 500cc within 24 hours after giving birth, this is an abnormal condition. Abnormal postpartum bleeding is excessive bleeding that comes out of the birth canal immediately after delivery. In medical terms, this condition is called postpartum hemorrhage. Abnormal postpartum bleeding needs to be treated immediately because it has the potential to cause serious complications, and can even cause death in the woman giving birth.

Causes of Postpartum Bleeding

During the birth process, the uterine muscles will naturally contract and push the placenta out of the uterus. After the placenta is successfully expelled, contractions in the uterus aim to stop the bleeding by pressing on the blood vessels in the uterine wall where the placenta (placenta) was attached. In normal bleeding, the blood will gradually decrease and finally stop within a few weeks after giving birth. However, if a disturbance occurs, bleeding can continue to occur in excessive amounts.

Based on the cause, abnormal postpartum bleeding is divided into two types, namely primary and secondary postpartum bleeding.
Here’s the explanation:

1. Primary postpartum hemorrhage
   Primary postpartum bleeding occurs within the first 24 hours after giving birth. Generally, this bleeding is caused by weak uterine muscles (uterine atony), but it can also be due to retained placenta, torn wounds on the uterus, cervix or vagina, and blood clotting disorders.
2. Secondary postpartum hemorrhage
   Secondary postpartum bleeding occurs after 24 hours to 6 weeks after delivery. Generally, this condition is caused by infection of the uterus (endometritis), which is the most common cause of death in mothers giving birth. Apart from endometritis, retained placenta and sacs of amniotic fluid remaining in the uterus can also cause secondary postpartum bleeding. The reason is that the placenta or amniotic sac that remains in the uterus can prevent the uterus from contracting normally to stop bleeding. The following are several factors that put women at risk of experiencing abnormal bleeding after childbirth, namely:
3. 1. Mother gave birth to twins.
   2. The mother has placenta previa.
   3. Mothers give birth to babies weighing more than 4000 grams (4 kg).
   4. The mother experienced bleeding in a previous pregnancy.
   5. Mothers who are overweight or obese.
   6. Mother’s age was more than 40 years at birth.
   7. Mother has preeclampsia.
   8. The mother experienced anemia during pregnancy.
   9. The mother underwent delivery by caesarean section.
   10. The mother underwent labor by induction.
   11. The mother underwent labor for more than 12 hours.

Symptoms of Postpartum Hemorrhage

Normal postpartum bleeding is characterized by the discharge of bright red lochia which within a few days after giving birth will turn pink and brown. Generally, this bleeding will stop gradually within 3-6 weeks. The blood that comes out during abnormal postpartum bleeding is generally accompanied by the release of blood clots that can be larger than a golf ball. Women who experience abnormal bleeding may also experience the following symptoms:

1. Headache, like I’m going to faint
2. Fever
3. Weak
4. Heart beat
5. Hard to breathe
6. Sweating
7. Restless or confused
8. Abdominal pain
9. Pain when urinating
10. Pelvic pain
11. The blood smells strong

Be aware of these symptoms, especially if they are accompanied by a drop in blood pressure. The reason is, this can be a sign that hypovolemic shock will occur which can be life threatening. Contact a doctor if the bleeding is severe enough, indicated by the sanitary pad being full in less than 1 hour, or the bleeding does not subside after a few days.

Examinations also need to be carried out if the mother experiences the following symptoms:

1. Signs of infection appear, such as smelly discharge from the vagina or surgical wound, chills, and fever up to a body temperature above 38oC.
2. The blood that comes out is bright red and thick in the second week.
3. One or both sides of the stomach feel tender.
4. Dizziness or feeling like fainting.
5. Heartbeat is irregular and faster.
6. The blood clots that come out are very large or numerous.

Seek immediate medical attention if the blood comes out so much that it causes symptoms of shock, such as:

1. Headache
2. Body limp
3. Heart palpitations (palpitations)
4. Hard to breathe
5. Sweating
6. Nervous
7. Confused or absent-minded

Postpartum Hemorrhage Treatment

Postpartum bleeding requires a quick diagnosis, so usually the obstetrician will start the diagnosis process with a physical examination. During a physical examination, if the birth canal is still open, the doctor may insert his fist into the patient’s uterus to feel the strength of the uterine muscles and check whether there are still placental remains or tears in the uterus. If a physical examination is not enough to determine the cause of postpartum bleeding, supporting examinations, such as a pelvic ultrasound, can be carried out to see the source of the bleeding. Blood tests can also be carried out to determine the possibility of blood clotting disorders and estimate the amount of blood lost for blood transfusion needs.

The first step that a doctor will take to treat postpartum hemorrhage is to save the patient’s life, especially if hypovolemic shock occurs. The reason is, shock can cause the body’s organs to stop working quickly. Doctors can give intravenous fluids or blood transfusions to replace lost blood. Once the patient’s condition is stable, the doctor will try to control the bleeding according to the cause.

The following are several methods that doctors will use to treat postpartum bleeding:

1. Massaging the uterus.
   If bleeding occurs because the uterine muscles are weak, the doctor will massage the patient’s uterus to stimulate contractions, so that the bleeding can stop. Doctors can also give oxytocin to trigger uterine contractions. Oxytocin can be administered rectally, intravenously, or injected directly into the muscle.
2. Pressing the blood vessels with a special balloon.
   If the bleeding is caused by a laceration, the doctor can insert gauze or a balloon which is then inflated in the uterus. The goal is to compress the blood vessels where the bleeding occurs, so that the blood can stop coming out.
3. Removing the remaining placental tissue with a curette.
   For cases of bleeding that occur due to placental tissue remaining in the uterus (placental retention), the doctor can perform a curettage to remove the tissue.
4. Prescribe antibiotics.
   In cases of postpartum bleeding due to infection, treatment will be done by administering antibiotics.

If the bleeding has not stopped, the doctor can perform surgery. In some cases, embolization or blood vessel blockage surgery can be performed to stop the bleeding. If necessary, surgical removal of the uterus or hysterectomy may be recommended, although this procedure is rarely performed.

After the bleeding stops, the patient needs to be hospitalized for full monitoring until his condition is declared stable. If necessary, the patient will be treated in the ICU. Monitoring includes measuring pulse, blood pressure, respiratory rate, body temperature and amount of urine excreted, as well as checking a complete blood count. This monitoring is not only carried out after the bleeding has stopped, but from the start periodically while the doctor is trying to stop the bleeding.

Complications of Postpartum Bleeding

Postpartum bleeding can cause several serious complications, namely:

1. Hypovolemic shock (inability of the heart to supply sufficient blood to the body due to a lack of blood volume).
2. Disseminated intravascular coagulation (DIC), namely widespread blood clots throughout the body.
3. Acute renal failure.
4. Acute respiratory distress syndrome (acute respiratory distress syndrome).
5. Failure to function of various body organs, can be due to shock or DIC.
6. Death.

Prevention of Postpartum Bleeding

Postpartum bleeding can be normal, but it can also be abnormal. Considering that abnormal bleeding can be caused by many things, it is difficult to completely prevent this condition from occurring. The best thing you can do is to regularly check your pregnancy with a gynecologist or midwife. That way, the doctor can find out whether the mother is at risk of experiencing abnormal bleeding, so that the doctor can provide and prepare treatment before, during and after the birth process.