Postpartum hemorrhage

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According to data from the WHO (World Health Organization) more than half a million women die every year due to complications that arise during pregnancy or childbirth. Among these complications, postpartum hemorrhage is the main cause of maternal mortality, responsible for more than 35% of the total of those deaths per year and occurs mainly in developing countries.

Below you have an index with all the points that we will discuss in this article.

Index

Postpartum hemorrhage

Postpartum hemorrhage is defined as the loss of 500 ml of blood or more during a vaginal delivery or within 24 hours after the expulsive period. There is also who adds to that definition the loss of 1000 ml after a cesarean section.

Hemorrhage after childbirth

This type of complication is almost exclusively linked to humans, as it is rare in other mammals, including non-human primates

Recent studies by a biologist and an anthropologist from the University of Illinois at Chicago, focus on the fixation of the placenta on the wall of the uterus and on different types of mammals to get to better understand the causes of this complication.

It is believed that the effects that this fixation causes in the maternal vessels are greater in the human species than in other mammals.

These studies are aimed at discovering new treatments to be able to not only treat but also prevent this type of hemorrhage.

Risks

We found different risk factors that can be associated with this complication depending on the type of cause, for example uterine atony which is the most common cause of postpartum hemorrhage has several factors that predispose it as a twin pregnancy, macrosomies, prolonged expulsive period, arrest secondary dilatation, administration of drugs (Mg sulfate, tocolytics, oxytocin ...).

Placental retention is more frequent if the woman has a history of caesarean section, a uterine curettage, poor delivery and delivery, abnormal adherence of the placenta.



Causes

Uterine causes

  • Uterine attunement: inability of the uterus to contract. It is the most frequent cause that causes this type of hemorrhages.
  • Placental remnants: when portions of the placenta or fetus that remain attached marrying hemorrhages. It is the most frequent cause of late postpartum hemorrhage.
  • Abnormal placentation: when the placenta invades beyond the endometrium reaching the muscular wall or other neighboring organs such as the bladder.
  • Uterine inversion: inversion of the uterus inside its own cavity, descending through the vagina until it protrudes through the vulva. It occurs immediately after the birth and seriously endangers the life of the mother. It can be a complete or incomplete investment depending on its degree of investment and depending on the acute or chronic duration.
  • Uterine rupture: The most common cause of uterine rupture is the existence of a scar on the wall of the uterus, but in rare cases there may be a tear of the uterus during pregnancy or the dilation phase.

Non-uterine causes

  • Bruising, accumulation of blood inside the uterine cavity.
  • Injuries of the uterine tract, traumatisms or tears in the birth canal.
  • Coagulation problems, coagulation failures that can cause constant bleeding.
Coagulation problems

Types

Late postpartum hemorrhage

Hemorrhage that occurs after the first 24 hours and up to 6 weeks after delivery.


obstetrician in (Spain)

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