Postpartum hemorrhage (PPH) is severe vaginal bleeding after childbirth. It’s a serious condition that can lead to death. Other signs of postpartum hemorrhage are dizziness, feeling faint and blurred vision. PPH can occur after delivery or up to 12 weeks postpartum. Early detection and prompt treatment can lead to a full recovery. Get help right away if you’re experiencing symptoms of PPH.
Postpartum hemorrhage (PPH) is severe bleeding after giving birth. It's a serious and dangerous condition. PPH usually occurs within 24 hours of childbirth, but it can happen up to 12 weeks postpartum. When the bleeding is caught early and treated quickly, it leads to more successful outcomes.
Postpartum hemorrhage is when the total blood loss is greater than 32 fluid ounces after delivery, regardless of whether it’s a vaginal delivery or a Cesarean section, or C-section, or when bleeding is severe enough to cause symptoms of too much blood loss or a significant change in heart rate or blood pressure.
There are two types of PPH. Primary postpartum hemorrhage occurs within the first 24 hours after delivery. Secondary or late postpartum hemorrhage occurs 24 hours to 12 weeks postpartum.
There are a few reasons why postpartum hemorrhage occurs.
Your placenta attaches to the wall of your uterus and provides food and oxygen to your baby during pregnancy. After your baby is delivered, your uterus continues to contract to deliver the placenta. This is called the third stage of labor. Contractions also help to compress the blood vessels where the placenta was attached to your uterine wall. Sometimes, these contractions aren’t strong enough to stop the bleeding (called uterine atony). This is the cause of up to 80% of postpartum hemorrhages.
Postpartum hemorrhage can also happen if parts of the placenta stay attached to your uterine wall or if parts of your reproductive organs are damaged during delivery. You’re at an increased risk for PPH if you have a blood clotting (coagulation) disorder or certain health conditions.
Postpartum hemorrhage can affect anyone after childbirth. There are many risk factors for PPH, but approximately 40% of hemorrhages occur in women without any risk factors. Most postpartum hemorrhage occurs right after the placenta is delivered. PPH may be more likely after a C-section.
Postpartum hemorrhage occurs in about 1% to 10% of pregnancies.
Postpartum hemorrhage is a serious and potentially fatal condition. With PPH, you can lose large amounts of blood very quickly. It causes a sharp decline in blood pressure, which can restrict blood flow to your brain and other organs. This is called shock, and it can lead to death. Postpartum hemorrhage is a medical emergency and needs to be treated right away.
The causes of postpartum hemorrhage are called the four Ts (tone, trauma, tissue and thrombin).
The most common causes of PPH are:
The most common symptom of postpartum hemorrhage is persistent, excessive bleeding after delivery.
Other signs of PPH are:
Be honest with your healthcare providers about how you’re feeling after delivery. In some cases, PPH doesn’t cause symptoms until after you’ve left the hospital. Contact your healthcare provider immediately if you feel any of the symptoms above in the days or weeks after giving birth.
Healthcare providers diagnose postpartum hemorrhage through visual and physical examinations, lab tests and a thorough review of your health history.
They may detect postpartum hemorrhage based on the amount of blood you’ve lost. Measuring the volume of collected blood and weighing the blood-soaked pads or sponges from delivery is one common way to approximate blood loss.
Other methods to diagnose PPH are:
Healthcare providers treat PPH as an emergency in most cases. Stopping the source of the bleeding as fast as possible and replacing blood volume are the goals of treating postpartum hemorrhage.
Some of the treatments used are:
In rare cases, or when other methods fail, your healthcare provider may perform a laparotomy or a hysterectomy. A laparotomy is when your surgeon makes an incision in your abdomen to locate the source of bleeding.
You may be given medications to help induce contractions if uterine atony is the cause of the bleeding. The most common drugs used are oxytocin, methylergonovine or prostaglandins like carboprost or misoprostol.
Excessive blood loss can cause several complications like increased heart rate, rapid breathing and decreased blood flow. These symptoms can restrict blood flow to your liver, brain, heart or kidneys and lead to shock. In some cases, Sheehan’s syndrome (a condition of the pituitary gland) is seen after postpartum hemorrhage.
An overdistended uterus also increases the risk for PPH. This is when your uterus is overstretched from:
Certain factors during labor and delivery can increase your risk for hemorrhage:
Other health conditions that can increase your risk for postpartum hemorrhage are:
The best way for healthcare providers to prevent postpartum hemorrhage is to identify those at high risk for postpartum hemorrhage before delivery. This is dependent on you sharing your complete medical history and symptoms with your healthcare provider. Routinely giving medications like oxytocin at the time of delivery to help your uterus contract is also important. Ensuring adequate iron intake and red blood cell levels during pregnancy can minimize the impact of postpartum hemorrhage should it occur.
Postpartum hemorrhage can lead to death without prompt treatment. Excessive blood loss can lead to shock. Shock is when your organs don’t receive enough blood.
Recovery is different for everyone. Recovering from a postpartum hemorrhage depends on the severity of blood loss and how your healthcare provider treated it. Be sure to take care of yourself in the days following delivery — eating healthy, drinking lots of water and resting as much as possible. Your healthcare provider may recommend an iron supplement to help with anemia.
A note from Cleveland Clinic
Postpartum hemorrhage is a serious condition that requires medical attention as soon as possible. Contact your healthcare provider immediately if you’re experiencing severe bleeding after childbirth. Other signs of postpartum hemorrhage are dizziness, feeling faint and blurred vision. Early detection and prompt treatment can help prevent complications. It’s important to be open with your healthcare provider about your medical history so they can determine if you’re at higher risk for postpartum hemorrhage.
Last reviewed by a Cleveland Clinic medical professional on 01/03/2022.
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