Heavy bleeding after childbirth (postpartum haemorrhage)
Heavy bleeding after childbirth is also known as postpartum haemorrhage (PPH), and is an emergency complication of childbirth.
Postpartum haemorrhage is defined as a loss of 500ml or more blood from the genital tract in the first 24 hours after giving birth.
Minor postpartum haemorrhage is classed as 500ml to 1000ml of blood loss, or major over one litre (1000ml).
Major postpartum haemorrhage is defined as moderate when there's one to two litres of blood loss. Over two litres, it is classed as severe.
Secondary postpartum haemorrhage is abnormal or excessive bleeding between 24 hours and 12 weeks after giving birth.
Postpartum haemorrhage is relatively rare and affects around 3.7 in 1,000 births. It can lead to anaemia and is a leading cause of maternal death.
Postpartum haemorrhage risk factors
A woman's risk of excessive bleeding after delivery will be assessed before the birth. If the risk is thought to be high, the woman will be advised to have a hospital obstetric unit delivery.
The risk factors before delivery include:
- Previous retained placenta or postpartum haemorrhage
- Low maternal haemoglobin level at the start of labour
- Increased body mass index
- Four or more previous babies
- Low-lying placenta
- Being 35 years or older
Risk factors in labour include:
- Induced birth
- Prolonged labour
- Rapid labour (precipitate labour)
- C-section or operative birth
Postpartum haemorrhage prevention
To help prevent postpartum haemorrhage, an injection of syntocinon will be offered to stimulate contractions, which helps to push the placenta out.
Postpartum haemorrhage treatment
Immediate treatment will be given for postpartum haemorrhage, including an assessment by a specialist obstetrician. Treatment includes:
- Uterine massage
- IV fluids (drip)
- Oxytocin, (which makes the muscles of the uterus contract to reduce bleeding)
If blood loss is very severe, a blood transfusion may be necessary. In some circumstances a hysterectomy may be required.