4 Major Causes of Post Partum Hemorrhage
Hemorrhage remains a major challenge throughout pregnancy and after a child birth. This is because, hemorrhage is one of the main complications of pregnancy associated with maternal death during and after the child birth. A woman is considered to have a hemorrhage when the blood lost is between 500ml to 1000ml and happens within the first 24 hours after giving birth or any other time within the postpartum period, which is 6 weeks. In most cases, post partum hemorrhage occurs within the first 24 hours.
Post partum hemorrhage may be associated with many causes, but there is four main causes that are known to be responsible for most post partum hemorrhages that occurs; Lacerations, Retained Placental Fragments, Uterine Atony and Disseminated Intravascular Coagulation.
It is expected that a woman will experience some sort of small lacerations as normal process of child birth especially during vaginal birth. Large lacerations are considered as a complication and possible cause of post partum hemorrhage. These lacerations occur as a result of delivery that happens very fast or delivery that takes longer time to happen than it is expected. The other cause is due to birth of child who is large for gestation (bigger than expected size during delivery) or during assisted delivery (use of instruments to deliver the child). Laceration is also common to woman who is having a child for the first time (primigravida) unlike woman who had given birth several times.
There are three types of lacerations that are responsible for postpartum hemorrhage; vaginal, cervical and perineal lacerations. Any of the above laceration is suspected when the uterus remains firm but bleeding persists.
Retained Placental Fragments
This occurs when a part of placenta (fragment) is left behind. This fragment prevents the uterus from contracting fully leading to bleeding. If the retained fragments are large enough, bleeding occurs immediate postpartal period and if the fragments are smaller in size, bleeding may not be noticed until after 6 to 10 days postpartal period. To prevent such complication from happening, every placenta should be inspected after a birth to make sure that it is complete.
This is the most frequent cause of post partum hemorrhage. It happens when the uterus relaxes and it does not contract anymore. The uterus is expected to remain in a contracted state after birth to allow the open blood vessels at the placenta site to seal. When uterine atony happens, the uterus does not contract leading to bleeding. Deep anesthesia, induced labor, previous uterine surgeries are some of the factors that can predispose an individual to have a poor uterine tone hence the inability of the uterus to contract.
Disseminated Intravascular Coagulation (DIC)
This a condition that results from deficiency of clotting factors as a result of vascular injury. It is usually associated with premature separation of the placenta, missed miscarriage or fetal death but it can still happen during the post partal period. If there is an extreme bleeding, platelets and fibrin from the circulation rushes to the site of bleeding leaving the rest of the body with little clotting factors. The body is no longer able to clot normally leading to widespread bleeding. This is usually an emergency case that needs immediate intervention.