What is delivery hemorrhage?

What is a delivery hemorrhage?

Delivery is the third phase of childbirth: the expulsion of the placenta, amniotic membranes and umbilical cord. Approximately a quarter to half an hour after birth, contractions begin again with low intensity to expel the placenta. This causes moderate bleeding, but the blood vessels close up, in theory, gradually as the uterus retracts.

Occasionally, however, a hemorrhage may occur, known as a delivery hemorrhage, or post-partum hemorrhage. This refers to heavy bleeding (over 500 ml for vaginal deliveries and 1,000 ml for Caesarean sections) that can occur in the 24 to 48 hours following childbirth. 

An adult woman has between 6 and 6.5 liters of blood in her body. During pregnancy, she has 500 ml more blood in "anticipation" of childbirth. It is therefore normal to lose a small amount of blood, due to the increase in blood mass. However, in the majority of cases, the 500 ml loss threshold is not exceeded, which is why any loss in excess of 500 ml is considered a hemorrhage, representing a risk for the mother.

These hemorrhages affect between 5 and 10 out of every 100 women following childbirth. It is a medical emergency that must be treated rapidly. However, delivery haemorrhages are often diagnosed within 2 hours of ldelivery, as the woman is usually kept under surveillance in the delivery room during this period. 

In some cases, blood loss can be measured using a collection bag, which is a pouch placed under the mother's buttocks after delivery, or by weighing the undersheet placed under the mother during delivery (compared to a blank undersheet).

What are the symptoms of delivery haemorrhage?

As you will have gathered, the symptoms of a delivery hemorrhage are primarily bleeding during and after childbirth, particularly vaginal bleeding. The loss of blood can also lead to an accelerated pulse and dizziness.

What causes this haemorrhage?

There are several possible causes:

• One of the most frequent is that the placenta has not fully emerged. In theory, the placenta comes out on its own, but sometimes it doesn't come out, or doesn't come out properly, or part of it remains in the uterus, preventing it from closing properly. As a result, the blood vessels fail to close and bleed. 

• Lack of uterine contractions: the most frequent cause. As we saw earlier, it is essential for the uterus to contract following childbirth, in order to expel the placenta and retract afterwards. Sometimes, however, the uterus does not contract or does not contract sufficiently (uterine atony), preventing the blood vessels from closing. Some doctors also believe that induced labor may be a factor in delivery hemorrhage, as the uterus contracts less well.

• A sore in the genital area. It may not be the uterus that is bleeding, but the cervix or vagina.

• A coagulation disorder. If a woman bleeds a lot for a long time, it may damage her clotting factors and cause her to bleed even more. This can also happen if she doesn't have enough platelets or her coagulation factors are not right, but it's not systematic.

• A complication after a Caesarean section.

Hemorrhage can also be due to more than one of these causes. The amount of blood lost is then more abundant.

Unfortunately, some pregnancies are even more at risk. lThese include spregnancies in which the uterus has been very strained (women pregnant with twins or with babies weighing over 4 kg at term, or who have too much amniotic fluid), women suffering from diabetes or hypertension, too rapid or very long deliveries, caesarean deliveries, women who have had several children or who have already suffered a delivery haemorrhage. Nevertheless, these high-risk pregnancies are generally known in advance, enabling doctors to prepare for them. In the case of high-risk pregnancies, we advise you to choose a type II maternity hospital, so that you can benefit from special care if necessary.

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