How to reduce the risk of delivery hemorrhage?

Comment diminuer les risques d'hémorragie de la délivrance ?

What is a delivery hemorrhage?

Delivery is the third stage of labor: the expulsion of the placenta, amniotic membranes and umbilical cord. If you want to know more about this topic, we have discussed the symptoms and causes in this article: Delivery hemorrhage, what is it?

How to prevent delivery hemorrhage?

To avoid a delivery hemorrhage, several measures are sometimes taken as a preventive measure. In fact, the National Collegium of French Gynecologists and Obstetricians (CNGOF) indicates that in the majority of postpartum hemorrhages, no risk factors have been previously found. For this reason, measures to prevent this hemorrhage are available to all women. This begins with an anesthesia consultation to establish the minimum measures necessary in case of hemorrhage.

However, women who are "at risk" as we have seen before, are particularly monitored. Women who have already had a delivery hemorrhage will receive an iron supplement in the third trimester to reduce the risk of anemia.

Moreover, as we explained previously, after delivery, the woman is put under surveillance for 2 hours in the delivery room in order to verify, in particular, the good retraction of the uterus. During this time, her heart rate, blood pressure and uterine tone are checked to make sure she is not hemorrhaging. If anything abnormal is found during this time, a blood sample is taken from the patient's finger to instantly check her hemoglobin level. If a hemorrhage is found, the health care team will look for the cause of the bleeding. A multidisciplinary team is then deployed.

In addition, certain techniques are available, particularly in Great Britain, to improve management in the case of severe bleeding. This is an intra-uterine balloon that allows for internal hemostasis. This would make it possible to avoid certain transfers to qualified maternity hospitals. In the next few years, it is possible to envisage widespread use in France.

Treatment after a delivery hemorrhage?

First of all, if there is the slightest doubt about a possible hemorrhage after delivery, the health care team begins by performing, with the patient's agreement, a uterine revision, also called artificial delivery. This procedure verifies that the placenta has been expelled and that there is nothing left in the uterine cavity. It consists of hand movements in the uterus, under epidural or general anesthesia, to extract any remnants of the placenta.

If, on the other hand, the cause is uterine atony, that is to say, as we have seen above, that the uterus does not recontract or does not recontract sufficiently, a massage will be performed to stimulate it because it is essential to have contractions again to stop the bleeding. If this is the case, you can also use a menstrual panty made of organic cotton to absorb the bleeding. It may also be possible to deliver oxytocin through the vein to help the uterus contract to more or less its original size. For most delivery hemorrhages, treatment stops here. If this is still not enough, prostaglandin, a stronger drug, can be given to increase the contractions.

However, if it is not the uterus that is bleeding (or not only), but the vagina or the cervix, a check will be made using valves to see inside the vagina. If a tear is found, it will be necessary to sew it up to stop the bleeding.

If the woman has bled a lot and for a long time, does not have enough platelets or does not have good coagulation factors, a coagulation test will be done to check the coagulation status and the iron level.

In addition, if the mother is below a critical level, she will be placed in intensive care and, in very rare cases, a blood transfusion will be considered.

Finally, if nothing has worked and the bleeding is still present, the woman will undergo surgery to stop the bleeding, which consists of an embolization of the uterine arteries or a ligation of the arteries. It may also be possible to consider a padding which consists of sewing the uterus on itself to compact it and prevent it from bleeding. As a last resort, a hysterectomy is performed, which is the removal of the uterus.

However, just because you had a delivery hemorrhage during a previous pregnancy does not mean that you will necessarily have another one during your next pregnancy, depending on the reasons for the bleeding. Nevertheless, it will be recommended to the patient to give birth in a level II maternity hospital, but also to take an iron supplement during the third trimester of the pregnancy.

To protect you throughout your cycle, our menstrual panties are ideal.

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Les informations issues des articles présents sur le site sont des informations générales. Bien qu’elles aient été relues par des professionnels de santé, ces informations ne sont pas exemptes d’erreurs, ne constituent pas des conseils de santé ou des consultations et n’ont pas vocation à fournir un diagnostic ou proposer un traitement. Ces informations ne peuvent, en aucun cas, se substituer à un avis médical et ne peuvent pas remplacer une consultation auprès d’un professionnel de santé. Pour toute question, nous vous invitons à consulter votre médecin.