What is delivery hemorrhage?

What is a delivery hemorrhage?

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

Nevertheless, it happens that a hemorrhage is noted, one speaks then about a hemorrhage of the delivery, or post-partum hemorrhage. This refers to heavy bleeding (more than 500 ml for vaginal delivery and 1,000 ml for a cesarean section) that can occur in the 24 to 48 hours following delivery.

An adult woman has between 6 and 6.5 liters of blood in her body. During a pregnancy, she has 500 ml of extra blood in "anticipation" of giving birth. 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 threshold of 500 ml of loss is not exceeded, which is why it is considered that beyond 500 ml of loss, it is a hemorrhage that represents a risk for the mother.

These hemorrhages affect about 5 to 10 women out of 100 after childbirth. It is a medical emergency that must be treated quickly. However, delivery hemorrhages are often diagnosed within 2 hours of delivery because the woman is usually monitored in the delivery room during this period.

Blood loss can be measured in some cases by 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 hemorrhage?

As you will have understood, the symptoms of a delivery hemorrhage are first and foremost bleeding at the time of and following childbirth, which can be seen especially vaginally. An accelerated pulse, but also dizziness can be felt because of this blood loss.

What causes this hemorrhage?

There are several possible causes:

• One of the most common is that the placenta has not fully emerged. In theory, the placenta comes out on its own, but sometimes it is not detached, or is not detached properly, or part of it remains in the uterus, which prevents it from closing properly. In this way, the blood vessels do not close and bleed.

• Lack of uterine contractions: the most common cause. As we have seen previously, it is essential that the uterus contracts following childbirth in order to expel the placenta and retract afterwards. However, sometimes the uterus does not contract or does not contract sufficiently (uterine atony), which does not allow the blood vessels to close. Some doctors also believe that an induced labor could be a factor in a delivery hemorrhage, because the uterus contracts less well.

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

• A bleeding disorder. If a woman bleeds a lot and for a long time, it may damage her clotting factors and cause her to bleed more. It can also happen if she does not have enough platelets or has bad clotting factors, but it is not systematic.

• A complication after a cesarean section.

It can also happen that a hemorrhage is due to several of these causes. The amount of blood lost is then more abundant.

Some pregnancies are unfortunately more at risk. These include pregnancies where the uterus has been very tight (women who are pregnant with twins or babies weighing more than 4 kg at term, or who have too much amniotic fluid), women with diabetes or high blood pressure, too fast or very long deliveries, a caesarean delivery, women who have had more than one child or who have already suffered a delivery hemorrhage. Nevertheless, these high-risk pregnancies are usually known in advance and allow doctors to prepare themselves. In the case of high-risk pregnancies, we advise you to choose a type II maternity hospital in order to have special care if necessary.

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