In the minutes or hours following the birth of the child, blood losses may occur that require the intervention of the medical team. But what is the cause of this eventuality? And how to manage it?
THE’post partum bleeding It is an obstetric emergency, as well as a complication of childbirth, which manifests itself with a blood loss in the hours following birth.
We can talk about hemorrhage after childbirth When the blood loss exceeds, in case of vaginal delivery, the 500 ml and, in the event of a cesarean cut, the 1,000 ml.
But how frequent this emergency is? And how do you intervene? Let’s see better what it consists of and, more specifically, What is important to know.
How frequent is Post Partum bleeding?
THE Signals of a post partum hemorrhage They therefore include blood losses that can manifest themselves in the minutes or hours following the birth of the child. There are different classifications of this phenomenon, which are mainly based on the quantity of loss and the appearance times. In particular, it stands out in:
- Primary. The symptoms of this post -birth bleeding provide, as already mentioned, a blood loss over 500 ml after a vaginal birth and over 1,000 ml after a cesarean cut in the first 24 hours after childbirth.
- Secondary. In this case, the blood loss arises more late, i.e. between 24 hours and 12 weeks after childbirth.
From a statistical point of view, the Post partum hemorrhage of a primary type.
However, the frequency of postpartum hemorrhage varies significantly in the different geographical areas of the world: it is in fact more widespread in low -income countries, although a present and very current problem remains even in the richest ones.
To date we know that the frequency of the primary post-actum hemorrhage is around 5-15% of the parties.
But what are the Causes of postpartum hemorrhage? They can be different and are divided, by practicality, according to the rule of the four T.
- Uterine tone. The cause is attributable to the so -called “uterine atony”, that is, to the failure to contraction the uterus necessary in the post -birth to create a hemostatic block and prevent blood loss. Post birth bleeding from uterine atony is the condition that occurs in most cases, i.e. about 70% of post partum bleeding.
- Trauma. When the cause of the hemorrhage is linked to a laceration.
- Tissue. In this case, some portions of placenta, membranes or clots remain within the uterine cavity creating difficulties regarding the hemostasis.
- Trombin. These are the rarer cases, which do not normally reach 1% and occur when there are congenital or acquired coagulation anomalies.
How to understand if you have a post -birth emorrhage?
In general, what is extremely important in the management and treatment of postpartum hemorrhage is the early diagnosis. Observing and estimating with as precision as possible and in the shortest possible time the quantity of blood loss has in fact a not negligible value on the maternal consequences of hemorrhage.
With a view to a birth that is assisted in hospital (or home, but still in the presence of a prepared obstetric team), it will be the task of the health personnel to monitor the maternal and neonatal adaptation and, at the same time, also the Woman blood lossto take action possibly in the event that this is not normal.
In some cases the signs of bleeding after childbirth are not immediately present or clearly identifiable, in others, although the loss is abundant, there are no symptoms of dismissal perceivable by the woman. Among the most frequent symptoms of postpartum bleeding we find those attributable to hemodynamic failure. The most common are:
- lowering of blood pressure;
- tachycardia;
- sweating;
- tremors or agitation;
- pallor;
- oliguria or anuria (i.e. decrease and disappeared of urine production);
- hunger for air;
- collapse.
These symptoms they don’t always appearand it is more likely to detect them (especially the most serious and intense) if the blood loss is of large quantities or if it takes place in a very short time.
As for the Duration of the post partum hemorrhage It is necessary to specify that there is no precise time, since different facts come into play: the resolution of the emergency depends in fact on the speed of diagnosis and intervention, on the identification of the cause and the patient’s response to medical and pharmacological treatments that are implemented.
What to do if you have a post -birth emorrhage?
When an ‘occurspost partum bleeding The treatment depends on the cause of the loss itself. For example, in the case of uterine atony we proceed to the administration of uterotonic drugs (which act on the musculature of the uterus) such as synthetic oxytocin or the methylergometrine (if necessary). If, on the other hand, there is one laceration that bleeding copiously it will be necessary to quickly proceed with the suture or make hemostasis of the area involved.
In any case, it is always indicated to circulate liquids, or the physiological solution or the lactate ringer (a solution that contains a combination of active ingredients, namely sodium chloride, potassium chloride, dihydrate chloride and sodium chloride lactate), in order to compensate for blood loss and maintain the volume of the bloodstream.
For several years, in order to contrast the bleeding that occurs more frequently, namely the hemorrhage from uterine atony, the proposal of numerous birth points is to inject oxytocin synthetic as prophylaxis to all women at the time of childbirth. Specifically 10 IU (international units) of synthetic oxytocin intramuscularly.
At the basis of this intervention there is the idea of limiting blood loss and, at the same time, inducing uterine contractility and accelerating the times of the secondform (the last phase of childbirth, which consists in the expulsion of the placenta and other fetal annexes).
Up to here we have mainly talked about primary hemorrhage, which is the one that occurs in most cases. But it is also important to know What to do for post -birth bleeding secondary, although it is less frequent. For example, if an abnormal blood loss is presented in the days or weeks following birth, do you have to worry? First of all we have to understand what is meant by loss of abnormal blood.
In fact, it should be specified that in the weeks that follow the birth is more than normal to have some Losses of physiological bloodcalled “locchazioni” or more simply “lochi”. These are nothing more than the release by the uterus of the residues of pregnancy. The period of the locchions, which can last four to five weeks, must be imagined as a time necessary for the uterine cavity to “clean up” from the blood, mucus and the cell residues of pregnancy.
The locchions are generally very abundant and bright red in color For the first three-seven days, to follow they will gradually become more scarce and pink/brown in color, and then lighten further until they show up, in the last few days, as whitish losses.
Generally, in the period of the location there are no menstrual pain or other particular sensationswith the exception of the early hours or of the very first days (Massimo Tre-Quottro) in which the so-called “can present themselvesuterine bites“(We talk about it in this article).
Having made this premise, that is, clarified what is normal in terms of postponement losses and sensations related to pain, we can establish that, if after childbirth, in a period in which the locks were decreasing or changing appearance, a blood loss appears very abundant bright red or a large clot associated or not with pain, it is important go to the hospital for a check.
