When does bleeding stop after childbirth? How much blood is in the discharge after childbirth and pathological bleeding. Atony and hypotension of the uterus

Childbirth is a laborious process, which in many cases proceeds with complications. Such postpartum pathology is postpartum hemorrhage. Of course, with uterine bleeding, the life of the mother is in the hands of medical personnel. After all, qualified monitoring of the health indicators of the puerperal, preventive measures, timely provision of appropriate medical care - all this allows you to save the life and health of the woman who has given birth. Why intrauterine bleeding occurs and how to prevent them - these are the main questions that a woman giving birth should know the answers to.

Postpartum hemorrhage: what is it?

One of the frightening obstetric complications that a woman can experience after giving birth is bleeding.

Postpartum hemorrhage is the cause of death of a woman during or after childbirth, ranking third after death from anesthesia and infection.

The severity of the condition of a young mother, faced with such a formidable deterioration in well-being, is determined by the amount of blood lost. Blood loss during and after childbirth is natural in physiological terms. But this is only in the case of blood loss in an acceptable volume (0.3% of body weight). The female body prepares for this already during pregnancy, increasing the volume of circulating blood. Large blood loss (over 500 ml to several liters), no matter how frightening it sounds, can cause the death of the puerperal. Such intense bleeding is provoked by the wounded state of the uterus after childbirth. In women prone to hemorrhage, the process of uterine contraction is disrupted or the process of blood clotting and blood clots does not start.

The outcome of postpartum hemorrhage depends on the following factors:

• the amount of blood lost;
• bleeding rate;
• the effectiveness of the therapy and the speed of its implementation;
• blood clotting disorder.

Causes of complications

It is considered normal if a woman loses blood in an amount of not more than 0.5% of her body weight. By volume, this is about 300 - 400 ml. Blood discharge from the birth canal is explained by physiology. So, at the birth of a child, the placenta separates from the uterine wall. The uterus is injured, which means that blood discharge is inevitable.

If a woman in labor loses more than 400 ml of blood in the postpartum period, this is a deadly pathology that requires immediate elimination of its cause. What is she like?

Atony and hypotension of the uterus

What is hidden behind the medical terms "atony" and "hypotonia of the uterus"?

The uterus - the organ in which pregnancy develops - has in its structure a muscular layer, called the "myometrium". He, like any muscle tissue, tends to be excited (come into a state of tone). When, after childbirth, the tone of the myometrium decreases along with the ability to contract, they speak of uterine hypotension, and when it is completely lost, it is called atony. Vessels injured by childbirth must undergo the process of thrombosis (clotting into clots). If this did not happen, and the uterus has already lost or reduced its tone, blood clots are washed out through the bloodstream from the body of the woman in labor. Severe bleeding develops, when a woman can lose several liters of blood. Needless to say, how dangerous this is for the life of a young mother.

What can cause such a clinical picture:

• fatigue of muscle fibers due to prolonged or, conversely, rapid childbirth;
• the use of drugs that reduce the tone of the uterus;
• loss of the ability of the myometrium to contract normally.

Conditions predisposing to hypotension and atony are:

• young age;
• pathological conditions of the uterus: fibroids and uterine fibroids; malformations; postoperative scars on the uterus; inflammatory processes; a large number of births; excessive stretching of the uterus when carrying a multiple pregnancy, with polyhydramnios;
• pregnancy complications;
• prolonged labor with a large fetus;
• anomalies of the placenta (previa or detachment) and some others.

How can an obstetrician-gynecologist help a woman in labor? The medical measures taken are determined by the type of bleeding and the condition of the woman:

• Hypotonic bleeding: external massage of the uterus through the abdominal wall and the introduction of contracting drugs are performed.
• Atonic bleeding: with blood loss above 1 thousand ml, a complete removal of the uterus is performed, the woman is removed from the state of hemorrhagic shock as a result of profuse blood loss.

Violation of the separation of the placenta

The placenta leaves the uterus at the end of the birth period.
Childbirth has three stages: cervical dilatation, expulsion of the fetus and the postpartum period

When the placenta came out, the early postpartum period begins (it lasts for the first two hours). The placenta is carefully examined by obstetricians: it must completely come out. Otherwise, the placental lobes and fetal membranes remaining in the uterus will not allow the uterus to fully contract, which, in turn, will trigger inflammation and bleeding.

Unfortunately, such bleeding, which suddenly begins a month or more after childbirth, is not uncommon. Of course, the doctor who delivered the baby is to blame. He saw that there was not enough lobule on the placenta, or maybe it was an additional lobule at all (separate from the placenta), and did not take appropriate measures (manual control of the uterine cavity). But, as obstetricians say: "There is no placenta that cannot be folded." That is, the absence of a lobule, especially an additional one, is easy to miss, and the doctor is a person, not an x-ray.

Obstetrician-gynecologist Anna Sozinova

http://zdravotvet.ru/krovotechenie-post-rodov/

Why do parts of the placenta remain in the uterine cavity? There are a number of reasons:

• partial increment of the placenta;
• improper management of the third stage of labor;
• uncoordinated labor activity;
• spasm of the cervix.

Blood diseases

Blood diseases that often cause bleeding include:

• hemophilia: dysfunction of blood coagulation;
• Werlhof's disease: the presence of hemorrhages and bruises on the trunk and limbs against the background of a sharp decrease in the number of platelets in the blood;
• von Willebrand disease: increased permeability and fragility of the vascular wall - and others.

Bleeding associated with these diseases is relatively rare. However, women with such a diagnosis should be carefully monitored by a doctor during pregnancy and comprehensively prepare for childbirth.

Injuries of the birth canal

Bleeding in a woman in labor (usually early) can be triggered by trauma to the birth canal at the birth of a baby.

Tissue damage can be determined in the area:

• vagina;
• cervix;
• uterus.

Tissues are damaged spontaneously, as well as due to improper medical actions. Therefore, typical tissue ruptures can be classified into groups:

• spontaneous ruptures are possible during the expulsion of the fetus (for example, during rapid labor);
• ruptures are associated with medical manipulations during the extraction of the fetus (imposition of obstetric forceps, vacuum escochleator);
• uterine rupture is also provoked by scars on it after previous surgical interventions, curettage and abortion, the use of intrauterine contraceptives, obstetric manipulations (external rotation of the fetus or intrauterine rotation), stimulation of labor, narrow pelvis.

Early and late bleeding after childbirth and cesarean: symptoms, duration, difference from lochia

Bleeding after childbirth is classified as early and late:

• early (primary) - occurred immediately after childbirth or during the first 24 hours;
• later (secondary) - occurred after 24 hours or more.

Video: postpartum hemorrhage

A visual examination of the birth canal, examination of the uterine cavity, and ultrasound diagnostics help the doctor establish the fact of bleeding.

Early bleeding

If the medical parameters of the woman who has given birth during the first two hours are normal (pressure, pulse, skin color, amount of discharge), she is transferred from the delivery room to the postpartum department. There, being in a separate room, the young mother must control her own well-being and, in case of any deviations in the postpartum recovery, call the medical staff.
Every woman who has given birth should understand the importance of self-observation on the first day after childbirth, since bleeding can occur rapidly

Bleeding after childbirth is different in the amount of blood released and the intensity of blood loss. If the uterus does not contract, the bleeding is profuse. At the same time, blood pressure drops, the heartbeat slows down, the woman's skin turns pale. Such massive blood loss is rare, and successful management of bleeding in this case is difficult.

Bleeding may be continuous, or it may come and go alternately. This situation (the release of blood in portions, at the time of relaxation of the uterus) is more common. The body resists, resists blood loss, defense mechanisms have time to work. If assistance is provided on time and qualified, the bleeding can be stopped.

If bleeding does not stop after uterine contraction medicines, uterine massage, surgery may be required. The doctor must act immediately so that the woman does not fall into a state of hemorrhagic shock and so that irreversible pathological processes in the organs do not start.

Late bleeding occurs when the woman is already outside the hospital walls. This is the danger of the situation. Intense bleeding from the birth canal may suddenly appear at the end of the first week after childbirth, as well as in the second, third week. It can be provoked by physical activity, lifting weights

What signs of illness should a young mother pay close attention to?

Table: pathological conditions that cause anxiety in a woman

If one of these symptoms is observed, a young mother should consult a doctor. Any delay is a risk to life.

Difference from lochia

Postpartum hemorrhage cannot be identified with discharge after childbirth (natural or operational) - with lochia. Lochia exit the uterine cavity in response to the healing of its wound surface. This is a natural process due to physiology. When the endometrium lining the uterine cavity is completely restored (by the end of the third week after a natural birth, a few weeks later - after a caesarean section), the discharge stops. The recovery period after childbirth is an average of 8 weeks. During this time, a woman loses 0.5 - 1.5 liters of lochia, which change color (from scarlet to dark red, brown, yellowish, transparent white), consistency.

Bleeding is always profuse blood loss, possibly sudden, blood thinned, scarlet in color. The woman feels dizzy, blood pressure drops, the skin turns pale. This is an indication for urgent hospitalization.

Bleeding after cesarean

Let us dwell separately on cases of bleeding after surgical delivery.

Bleeding after caesarean section occurs 3-5 times more often than during vaginal delivery.

http://www.tinlib.ru/medicina/reabilitacija_posle_operacii_kesareva_sechenija_i_oslozhnennyh_rodov/p6.php#metkadoc2

The main causes of bleeding after cesarean in the early postoperative period are the same that cause bleeding after natural childbirth:

• impaired contractility of the uterus;
• intravascular coagulation syndrome (DIC) develops, which leads to massive bleeding and bleeding from unsutured uterine vessels with incomplete suturing of the incision.

Bleeding associated with the loss of the ability of the uterus to contract may be the result of incorrect actions of the doctor during the operation. Obstetrician-gynecologists try to save the uterus to the last, and often the bleeding intensifies and becomes irreversible. In most cases, amputation of the uterus is inevitable, and it is not advisable to delay this due to high risks (shock due to profuse blood loss, death).

If a woman preparing for a caesarean section is diagnosed with DIC (blood clotting pathology), complex therapeutic measures are taken before and after operative delivery. Medical actions are aimed at the following:

• normalization of blood clotting;
• treatment of the underlying disease or complications of the course of pregnancy that caused the development of DIC;
• control of shock, elimination of septic infection, improvement of microcirculation, restoration of circulating blood volume, elimination of influences that can maintain or aggravate DIC.

Late postoperative bleeding is rare and is caused in most cases by purulent-septic processes.
Incorrectly placed stitches are the main cause of bleeding after a caesarean section. So, for example, not all vessels can be sutured, the sutures on the uterus can disperse. It's the fault of the doctor who performed the operation. According to the indications, it is possible to perform a second operation with the removal of the uterus

Has anyone had postpartum hemorrhage? If someone knows something, please explain why this happens? I had a cesarean, the reason is elementary - breech presentation. I woke up after the second operation. Thank God my baby is ok. After the cesarean, I was taken to the ward and did not immediately notice the bleeding. Noticed after 30-40 minutes. Then they tried to save him for two hours, and then they took him back to the operating room. They say that the uterus did not contract. But they somehow sewed me up after the first operation, which means that I was shrinking ... As a result, I lost 2,200 blood and I will never be able to get pregnant again.

Diagnostics

To understand whether a woman is at risk of postpartum hemorrhage, modern medicine examines pregnant women. In the course of regularly conducted blood tests, the following indicators are established:

• hemoglobin level;
• the number of erythrocytes and platelets in the blood serum;
• time of bleeding and blood clotting;
• the state of the blood coagulation system.

Insufficient contractility of the uterus is diagnosed visually by a qualified doctor even in the third stage of labor.

When a woman has already given birth, an obstetrician-gynecologist examines the placenta, fetal membranes, the birth canal of the puerperal for ruptures, unexposed tissues, and blood clots. Under anesthesia, the uterine cavity can be examined for neoplasms that prevent contractile processes.

On the 2nd - 3rd day after childbirth, an ultrasound of the pelvic organs is performed, which allows you to accurately determine the presence or absence of unexposed fragments of the placenta, fetal membranes in the uterine cavity.

Treatment

The algorithm of actions of medical personnel in the development of postpartum hemorrhage is as follows:

1. Establishing the cause.
2. Taking measures to quickly stop bleeding and prevent large blood loss.
3. Restoration of circulating blood volume and stabilization of blood pressure.

The implementation of these medical actions involves therapeutic procedures (medication, mechanical manipulations) and surgery.

Table: drug treatment

Drug therapy is not limited to the named medicines, it is supplemented by a doctor depending on the specific clinical picture. The patient is infused with donor blood (erythromass, plasma), blood substitutes are used.

Elimination of early bleeding

If in the first hours after childbirth, the bleeding in the woman who has given birth increases (the discharge is more than 500 ml), the medical personnel carry out the following therapeutic actions:

1. Emptying the bladder, possibly through a catheter.
2. The introduction of drugs of contractile properties intravenously (usually, methylergometrine with oxytocin).
3. Cold in the lower abdomen.
4. External massage of the uterine cavity: the doctor places his hand on the bottom of the uterus and compresses - unclenches it, stimulating contraction.
5. Manual massage of the uterus: under general anesthesia, the uterus is compressed with one hand of the doctor until its natural contraction is triggered, while with the other hand, the doctor performs an external massage of the uterus.
6. A swab soaked in ether is inserted into the vagina to reflex contraction of the uterus.
7. Infusion-transfusion therapy with blood components and plasma-substituting drugs.

Table: postpartum complications and treatment measures

The described medical actions are performed under local anesthesia or general anesthesia after a thorough diagnostic examination of the woman.

I had postpartum bleeding ... Then, under anesthesia, they manually cleaned the uterine cavity ... They said that the cause could be endometriosis, infections, or just a combination of circumstances ... My uterus did not contract ... I lay down and said that it was pressing on the rectum, they said it happens , and they took me to the ward, and there I was alone, and I felt like a contraction and an attempt, and as it went, I barely got up, went to the corridor and called for the doctor, and it was pouring from me, I remember that my head was spinning, they took me to intensive care and cleansed the stomach, tk. I managed to eat, but anesthesia with food in the stomach is impossible. When I left, everything hurt and I lay with the terminals for another 3 hours.

https://www.u-mama.ru/forum/waiting-baby/pregnancy-and-childbirth/138962/index.html

Elimination of late bleeding

When parts of the placenta or blood clots remain in the uterine cavity, late postpartum hemorrhage occurs.

What actions are taken by doctors:

• immediate hospitalization of a woman in the gynecology department;
• curettage of the uterine cavity under anesthesia;
• cold on the lower abdomen for 2 hours;
• carrying out infusion therapy, if necessary, transfusion of blood products;
• prescribing antibiotics;
• prescription of reducing drugs, iron preparations and vitamins.

I had bleeding 4-5 hours after giving birth, the doctors said that this often happens with anemia, the uterus did not contract, my head was spinning (almost fainting), and clots, like beef liver, began to stand out. They cleaned it by hand, now everything is fine, the baby is 10 months old.

Julia David'son

https://www.u-mama.ru/forum/waiting-baby/pregnancy-and-childbirth/138962/index.html

Rehabilitation of a woman

After bleeding in the postpartum period, the female body is weak. He needs more time and energy to recover. A woman should find time to rest, eat well. Part of the responsibility for caring for a child is better to entrust to close relatives: their help is now extremely important.

How to strengthen a weakened body? It will help to take vitamin complexes for several months (for example, Centrum, Complivit, Oligovit, etc.), the use of which is possible during lactation.

Large blood loss can cause iron deficiency (anemia). Therefore, after consulting a doctor and taking blood tests (including hemoglobin levels), it is possible to use iron supplements.

Strengthen the vessels, prevent their bleeding will help drugs, the active substance in which is calcium (calcium gluconate, calcium chloride).

Traditional medicine will also act as an assistant to a young mother at the stage of recovery of the body after bleeding.

Photo gallery: fruits and berries that help mothers recover

Juice from the fruits of viburnum, a decoction of the bark of a shrub are used as a hemostatic agent Preparations from lingonberries are an excellent vitamin remedy for bleeding Chokeberry contains vitamins K and P among many useful trace elements that help blood clot Pomegranate fights anemia, improves blood counts

Medicinal herbs have long been used as stimulants of the body's defenses.

Table: medicinal herbs as a general tonic

To restore the body, it is important to drink high-quality mineral water with a high content of calcium, iron (Essentuki, Borjomi and others).

Bleeding is an irreversible condition that is better prevented than cured.

I had postpartum hemorrhage! I already gave birth to the placenta, and they even sewed me up. And when the child was put to the chest while still on the birth chair, I complained of pulling pains in the lower abdomen! They pressed on the stomach, and from there two clots! They immediately put a dropper and did a manual examination! As a result, everything is fine with the child, the blood loss is 800 ml, I can have children!

Yana Smirnova

https://www.u-mama.ru/forum/waiting-baby/pregnancy-and-childbirth/138962/index.html

A woman can protect herself if she adheres to the following recommendations.

Prevention of early bleeding

Even during pregnancy, women at risk (diseases of the circulatory system, gynecological diseases, taking drugs that thin the blood) are under the supervision of doctors and, if possible, are sent to specialized perinatal centers. A woman preparing for childbirth should be aware of existing chronic diseases (diseases of the cardiovascular system, kidneys, liver, respiratory organs), and the doctor conducting the pregnancy should conduct a diagnostic examination of the future woman in labor.

The process of delivery, especially for women with a risk of bleeding, should be with a minimum number of medical interventions, with respect for the woman in labor.

Measures to prevent future bleeding are carried out by medical staff immediately after childbirth.

Table: preventive measures in the early postpartum period

Of course, the success and effectiveness of many preventive measures depends on the competence of the doctor, his professionalism and attentive attitude to each patient.

Prevention of late bleeding

Being already outside the hospital walls, each mother should follow simple recommendations that reduce the risk of late bleeding.

Table: prevention measures in the late period

It is difficult to overestimate the danger of a situation when a woman who has given birth suddenly or predictably opens uterine bleeding. The forces of doctors at this moment are thrown to stop a large blood loss, eliminate the cause of the hemorrhage, and subsequent rehabilitation of the patient. In order for qualified medical care to be provided to the puerperal woman in time, the woman must also be aware of the possibility of such a severe postpartum complication. After all, we are talking about the life or death of a young mother.

After the birth of a child, a young mother must undergo an examination by a gynecologist. The first visit is scheduled two weeks after discharge from the maternity hospital, then two months later. At the reception…

Bleeding after childbirth- This is the release of blood and tissue debris from the uterus. Usually allocate approximate periods of this bleeding, depending on the intensity and color of the blood.

In the first three days bleeding is profuse, often profuse in volume compared to menstruation. The blood is bright red, as it is released from the vessels at the site of attachment of the placenta.

The cause of this bleeding is insufficient contractility of the uterus in the first few days after childbirth. This is normal and should not scare you.

Over the next two weeks the intensity of bleeding is significantly reduced. The discharge changes color from light pink to brown and yellowish white.

The uterus gradually contracts and by the end of the second week, all discharge from it usually stops.

There are often exceptions to this general rule. Consider which of them are also a variant of the norm, and which ones are a sign of a condition that requires the intervention of a doctor.

How long does bleeding last in the early postpartum period?

So, discharge from the uterus during the first 2-6 weeks are considered normal. Even in the sixth week they may have an admixture of blood.

Sometimes, bleeding after childbirth first stops after a few days, and then resumes.

This is usually typical for too active mothers who, already in the first week after giving birth, tend to go to the gym. Then just enough to stop the load and the bleeding will stop again.

Variant of the norm the so-called "small period" of bleeding is also considered (it occurs three weeks to a month after childbirth).

Bleeding is then not profuse and painless. Its duration is not more than one or two days. Such a repetition of bleeding also does not require a visit to the doctor.

Now let's talk about pathological (late) postpartum hemorrhage.

Most often its cause becomes part of the placenta, which remains in the uterus after childbirth and prevents its complete reduction. Then, a week after the birth, the bleeding does not decrease, but remains as plentiful and bright in color.

In this case necessarily get an appointment with a gynecologist as soon as possible and conduct an additional "" uterine mucosa.

This the procedure scares many women and they try to delay the visit to the doctor, hoping that the bleeding will stop after all. This position often leads to the development of inflammation in the uterus, increase, pain.

"Purges" still cannot be avoided, but additional treatment after it can drag on for months. It is not necessary to say how this adversely affects breastfeeding and the further reproductive function of a woman.

Another case- continuation of not abundant brown discharge longer than six weeks postpartum. This may be caused by an infection.

Often such discharge is accompanied by pain in the lower abdomen and fever. If you do not delay the visit to the doctor, This condition is easily treated and does not cause adverse effects..

And of course, the most serious case- this is when the bleeding at first stopped completely, and after one to two weeks it resumed in the form of copious discharge from the uterine cavity.

It is impossible to stop such bleeding at home. It is a real life threat due to the rapid loss of a large volume of blood. That's why, in this case, you must immediately call an ambulance.

The reasons

What affects the intensity and duration of bleeding after childbirth? How long does it take and when does the bleeding end after childbirth? What concomitant conditions should alert a woman and make her more attentive to her health?

Normal phenomenon- this is a stop of bleeding due to the rapid contraction of the uterus after childbirth. This is facilitated by breastfeeding as a natural stimulator of the muscular contraction of the uterus, laid down by nature.

Doctors often prescribe oxytocin injections in the first days after childbirth in order to artificially speed up this process.

If the uterus remains in a relaxed state after childbirth, bleeding continues and becomes pathological. Often this happens due to traumatic childbirth, a large child or.

Other reasons- multiple fibrous nodes in the uterus, improper attachment of the placenta, early rejection of the placenta, exhaustion of the woman before childbirth.

Very rare case pathological postpartum hemorrhage - mechanical damage to the uterus during childbirth or undiagnosed clotting problems.

Uterine bleeding a few weeks after giving birth may be due to infection.

So, bleeding after childbirth is serious process, requiring close observation of a woman and a visit to a doctor at the slightest doubt and anxiety.

Most often, bleeding after childbirth is not a spontaneous spontaneous phenomenon.

Uterine bleeding after childbirth is a pathological process that is provoked by a number of reasons. Among the factors that cause bleeding directly from the placental site (place of attachment of the placenta to the uterine cavity), the most significant and common are the following:

• too much expansion of the uterine cavity;
• pathological labor activity;
• rapid childbirth;
• protracted birth process;
• however, the main etiological factors of such a pathological phenomenon as bleeding after childbirth are hypotension and / or atony of the uterus.

Hypotension of the uterus is a pathological phenomenon, which is an insufficient postpartum contractility of the muscles of the uterus and its imperfect tone.

Hypotension of the uterus can be the result of weakness of the labor forces, rapid labor and labor activity with excessive force, functional impairment of the ability of the myometrium to contract, overstretching of the myometrium with polyhydramnios or a large fetus, as well as dystrophic phenomena of the myometrium after the previous curettage of the mucous membrane of the uterine cavity, the presence of cicatricial changes ( after undergoing surgery, for example, after enucleation of the myomatous node or caesarean section) and / or inflammatory processes in the uterus (chorioamnionitis), uteroplacental apoplexy, premature detachment of a normally located placenta, anomalies of placental attachment (its increment or dense attachment), uterine tumors (myoma).

This condition can be stopped by the use of specialized drugs. However, in some cases, hypotension can transform into atony (characterized by a complete loss of uterine muscle tone and its contractility) of the uterus and aggravate the current situation. Extremely rarely, atony can occur without a previous hypotonic state.

Signs characterizing bleeding

Like many other types of bleeding, bleeding after childbirth has a number of characteristic distinguishing features.

For example, hypotonic bleeding can have 2 variants of its clinical picture:

• Option 1 - initially bleeding can be very profuse with massive blood loss. In this case, the palpable uterus becomes flabby, atonic, and poorly responsive to the administration of uterotonic drugs. There is a rapidly progressive hypovolemia, possibly the rapid development of hemorrhagic shock and, possibly, DIC. Vital organs can also undergo pathological changes that are irreversible.
• Option 2 - there is a small amount of initial blood loss. The hypotonic state alternates with a temporary restoration of myometrial tone. The uterus is able to respond briefly to conservative measures, the purpose of which is to stop the resulting bleeding directed (the introduction of uterotonics). Blood is mainly discharged from the vagina in portions of 150 to 250 ml. Due to the fact that a woman does not lose blood abruptly, the body is able to adapt to gradually developing hypovolemia: blood pressure numbers remain within the normal range, there is a slight tachycardia. However, then it is possible to stop the response of the uterus to the introduction of drugs and the further development of hemorrhagic shock, as well as DIC.

Atonic bleeding is characterized by its massiveness and constancy. Atonic bleeding after childbirth cannot be stopped by the administration of pharmaceutical drugs.

duration of postpartum hemorrhage

Q: How long does bleeding last after childbirth? worries all women who have given birth. Normally, the duration of postpartum hemorrhage can vary from 6 to 8 weeks. However, this bleeding is a normal physiological phenomenon - the uterus is cleared of accumulated blood clots, such discharge is called lochia. The total amount of such secretions does not exceed 1500 ml. If a woman notices bleeding a month after giving birth, she should not worry. There are 2 reasons that can cause this phenomenon.

Firstly, it may be the onset of menstruation, and secondly, a slightly belated release of the remaining blood clots. However, if the bleeding began after 2-3 or more months, you should think about the presence of any pathological process localized in the uterine cavity, and urgently contact a qualified specialist.

To the question: "how much bleeding after childbirth?" the doctor will not be able to give you an answer in a specific figure, because the duration of this phenomenon is strictly individual and depends on the physiological characteristics of the body of each woman.

Treatment

The treatment of postpartum hemorrhage is based on the following set of measures:

• diagnosis and elimination of the cause of hypotension or atony of the uterus;
• restoration of the functional ability of the myometrium is carried out by applying such measures as: bladder catheterization, external uterine massage, intravenous administration of drugs that promote uterine contraction (Metilergometrin, Oxytocin), applying a bladder filled with ice to the lower abdomen;
• sometimes techniques are used that help reduce blood flow to the uterine cavity: finger pressure of a part of the aorta, as well as the imposition of specialized clamps on the parameters;
• if the above therapeutic measures did not bring the expected effect (bleeding does not stop and blood loss continues to increase), hysterectomy is indicated;
• an obligatory aspect of treatment is the restoration of circulating blood volume.

Update: October 2018

Uterine bleeding after childbirth - such a "term" of the puerperal is called any bloody discharge from the genital tract after the completion of childbirth. And many of the women who have given birth begin to panic, not knowing how long the bleeding after childbirth should last, what is its intensity and how to distinguish the norm from the pathology.

In order to avoid such situations, the obstetrician, on the eve of discharge from the maternity hospital, conducts a conversation with the woman, explaining all the features of the postpartum period, its duration, and appoints an appearance at the antenatal clinic (usually after 10 days).

Features of the postpartum period

How long does the so-called bleeding last after childbirth, that is, the discharge of blood

Normally, intense bleeding continues no more than 2 - 3 days. This is a natural process and such discharge is called lochia.

As you know, after the birth of the fetus, there is a separation or, roughly speaking, separation of the child's place (placenta) from the inner lining of the uterus. In this case, a sufficiently large wound surface is formed, which takes time to heal. Lochia is nothing more than a wound secret, which is represented by discharge from the wound surface.

On the first day after delivery, the lochia consists of blood and pieces of the decidua. Then, as the uterus contracts and returns to its normal “pre-pregnancy” size, blood plasma and tissue fluid, as well as particles of the decidual membrane that continue to fall off, mucus with leukocytes, join the secretion of the discharge. Therefore, after a couple of days, the discharge after childbirth becomes bloody-serous, and then serous. Their color also changes, from bright red to brown, and finally yellowish.

Along with the color of the secretions, their intensity also changes (decreases). The discharge process ends by 5-6 weeks. If the discharge is prolonged, or becomes bloody and more intense, you should consult a doctor.

Changes in the uterus and cervix

The cervix and the uterus itself are also undergoing a stage of changes. In the postpartum period, which on average lasts about 6 to 8 weeks, that is, up to 42 days, the uterus decreases (shrinks) in size, and its “internal wound” heals. In addition, the cervix is ​​​​formed.

The most pronounced stage of reverse development or involution of the uterus occurs in the first 14 days after birth. By the end of the first postpartum day, the bottom of the uterus is palpated at the site of the navel, and then, subject to its normal contraction, the uterus drops by 2 cm or 1 transverse finger every day.

As the height of the uterine fundus decreases, other uterine sizes also decrease. The uterus becomes flatter and narrower in diameter. By about 10 days after delivery, the bottom of the uterus descends beyond the pubic bones and is no longer palpable through the anterior abdominal wall. When conducting a gynecological examination, you can determine the size of the uterus from 9 to 10 weeks of pregnancy.

In parallel, the cervix is ​​​​formed. The cervical canal gradually narrows. After 3 days, it passes for 1 finger. First, the internal pharynx is closed, and then the external one. Completely the internal pharynx closes by the 10th day, while the external one by the 16th - 20th day.

What is postpartum hemorrhage

Postpartum hemorrhage includes intense blood loss up to 0.5% or more of the body weight of the puerperal and is directly related to childbirth.

• If bleeding occurs after childbirth after 2 hours or more (in the next 42 days), it is called late.
• If intense blood loss is recorded immediately after birth or within two hours, it is called early.

Postpartum hemorrhage is considered a formidable obstetric complication, and can lead to the death of the puerperal.

The severity of bleeding is determined by the volume of blood loss. In a healthy woman in labor, the estimated volume of blood loss during childbirth does not exceed 0.5% of body weight, while with preeclampsia, anemia or coagulopathy, it decreases to 0.3%. If in the early postpartum period a woman has lost more blood than expected, then they talk about early postpartum hemorrhage, which requires immediate action, sometimes up to surgery.

Causes of postpartum hemorrhage

The causes of heavy bleeding, both in the early and late postpartum period are diverse:

Atony or hypotension of the uterus

This is one of the leading factors that contributes to the occurrence of bleeding. Hypotension of the uterus is its condition, in which both the tone and its contractility are reduced. With uterine atony, the tone and contractile activity are sharply reduced or completely absent, and the uterus is in a "paralyzed" state. Atony, fortunately, is extremely rare, but it is dangerous for massive bleeding that is not amenable to conservative treatment. Bleeding associated with impaired uterine tone develops in the early postpartum period. One of the following factors contributes to the decrease and loss of uterine tone:

• excessive overstretching of the uterus, which is observed with polyhydramnios, multiple pregnancy or a large fetus;
• pronounced fatigue of muscle fibers, which is facilitated by prolonged labor, irrational use of contracting, rapid or rapid labor;
• loss of the ability of the myometrium to contract normally with its cicatricial, inflammatory or degenerative changes.

The following factors predispose to the development of hypo- or atony:

• young age;
• pathological conditions of the uterus:
  • myoma nodes;
  • malformations;
  • postoperative nodes on the uterus;
  • structural-dystrophic changes (inflammation, a large number of births);
  • overstretching of the uterus during gestation (polyhydramnios, multiple pregnancy)
• pregnancy complications;
• anomalies of tribal forces;
• abnormalities of the placenta (previa or abruption);
• preeclampsia, chronic extragenital diseases;
• DIC of any origin (hemorrhagic shock, anaphylactic shock, amniotic fluid embolism.

Violation of the separation of the placenta

After the period of expulsion of the fetus, the third or subsequent period of labor occurs, during which the placenta separates from the uterine wall and is released outside. As soon as the placenta is born, the early postpartum period begins (recall that it lasts 2 hours). This period most requires the attention of both the puerperal and the medical staff. After the birth of the placenta, it is examined for integrity, if any lobule remains in the uterus, it can provoke a massive loss of blood, as a rule, such bleeding begins a month after childbirth, against the background of the woman’s complete health.

Case Study: They called me to surgery at night, a young woman with a one-month-old baby was admitted, who became ill. While the child was being operated on, the woman started bleeding, and so intense that the nurses on duty themselves, without a doctor (the surgeon was at the operation), called the gynecologist. From a conversation with the patient, I found out that the birth took place a month ago, and during this time her discharge was normal, corresponded to the postpartum period, and she felt good. She came to the antenatal clinic, as expected, after 10 days and a month later, and (according to the patient) she was nervous about the child, and heavy bleeding happened. At gynecological examination: the uterus is soft, enlarged up to 9-10 weeks of pregnancy, sensitive to palpation. Appendages without features. From the cervical canal, passing freely one finger, copious bloody discharge with pieces of placental tissue. The woman had to be urgently scraped, during the procedure a lobule of the placenta was removed. After curettage of the uterus, the patient received infusion therapy, antibiotics and iron preparations (in the blood, of course, significantly reduced hemoglobin). Discharged in a satisfactory condition.

What I want to note. Unfortunately, such bleeding, which suddenly begins a month or more after childbirth, is not uncommon. Of course, the doctor who delivered the baby is to blame. He saw that there was not enough lobule on the placenta, or maybe it was an additional lobule at all (separate from the placenta), and did not take appropriate measures (manual control of the uterine cavity). But, as obstetricians say: "There is no placenta that cannot be folded." That is, the absence of a lobule, especially an additional one, is easy to miss, and the doctor is a person, not an x-ray. In good maternity hospitals, upon discharge, the puerperal undergoes a mandatory ultrasound of the uterus, but, sadly, not everywhere there is an ultrasound machine. And sooner or later, bleeding in this patient would have begun anyway, only in such a situation it was “spurred on” by severe stress.

Injuries of the birth canal

Not the last role in the occurrence of postpartum hemorrhage (as a rule, in the first 2 hours) is played by obstetric traumatism. In the event of abundant blood discharge from the genital tract, the obstetrician, first of all, must exclude damage to the birth canal. Broken integrity can be in:

• vagina;
• cervix;
• uterus.

Sometimes cervical ruptures occur so long (3-4 degrees) that they pass to the vaginal vaults and the lower segment of the uterus. Ruptures can occur both spontaneously, during the expulsion of the fetus (for example, rapid labor), and due to medical manipulations used to extract the fetus (imposition of obstetric forceps, vacuum escochleator).

Bleeding after caesarean section may be due to poor suturing technique (eg, missed unsutured vessel and uterine suture dehiscence). In addition, in the postoperative period, it can be provoked by the appointment of antiplatelet agents (blood thinners) and anticoagulants (reduce blood clotting).

Predisposing factors contribute to uterine rupture:

• scars on the uterus after previous surgical interventions;
• curettage and abortion;
• use of intrauterine contraceptives;
• obstetric manipulations (external rotation of the fetus or intrauterine rotation);
• stimulation of childbirth;
• narrow pelvis.

Blood diseases

Various blood diseases associated with a violation of its coagulability should also be considered as a factor in possible bleeding. These include:

• hemophilia;
• von Willebrand's disease;
• hypofibrinogenemia and others.

Also, the development of bleeding in liver diseases is not excluded (as you know, many coagulation factors are synthesized in it).

Clinical picture

Early postpartum bleeding, as already noted, is associated with a violation of the tone and contractility of the uterus, so a woman remains under the supervision of medical staff in the delivery room for 2 hours after childbirth. Every woman who has just become a mother should remember that during these 2 hours she cannot sleep. Severe bleeding can open suddenly, and it is likely that there will not be a doctor or midwife next to the puerperal. Hypo- and atonic bleeding can occur in two ways:

• Bleeding immediately becomes massive, "pouring like a faucet." The uterus is very relaxed and flabby, its boundaries are not defined. There is no effect from external massage, manual control of the uterus and contraction drugs. In view of the high risk of complications (DIC and hemorrhagic shock), the puerperal is operated on immediately.
• Bleeding is undulating. The uterus sometimes relaxes, then contracts, so the blood is released in portions of 150 - 300 ml. The positive effect of reducing drugs and external massage of the uterus. But at a certain point, the bleeding intensifies, and the woman's condition deteriorates sharply, the above complications join.

But how to determine the pathology if the woman is already at home? First of all, it is worth remembering that the total volume of lochia for the entire recovery period (6-8 weeks) is 0.5-1.5 liters. Any deviations indicate a pathology and require immediate medical attention:

Unpleasant smell of secretions

Purulent and sharp "aroma" of discharge, and even with an admixture of blood or bloody after 4 days after childbirth, indicates the development of inflammation in the uterus or endometritis. In addition to discharge, fever and the appearance of pain in the lower abdomen may alert.

Profuse bleeding

The appearance of such secretions, especially after the lochia has become grayish or yellow, should alert the woman. Bleeding can be instantaneous, or recur periodically, and blood clots may or may not be present in the discharge. The blood itself can change color - from bright scarlet to dark. The general condition of the mother also suffers. Her pulse and breathing quicken, weakness and dizziness appear, a woman can constantly freeze. Similar signs indicate the remnants of the placenta in the uterus.

Heavy bleeding

If bleeding has begun, and quite massive, it is urgent to call an ambulance. It is not difficult for a young mother to determine the intensity of bleeding on her own - several pads need to be changed per hour. You should not go to the doctor in such a state on your own, as there is a high risk of losing consciousness on the street.

Cessation of secretions

Such an option as the sudden disappearance of secretions is not excluded, which is also not the norm and requires medical assistance.

Bleeding after childbirth lasts (normally) no more than 7 days and is similar to heavy menstruation. If the period of bleeding is prolonged, this should alert the young mother.

Treatment

After the birth of the placenta, a number of measures are taken to prevent the occurrence of early postpartum hemorrhage:

The mother remains in the delivery room

The presence of a woman in the delivery room in the next 2 hours after the end of labor is necessary to take emergency measures in case of possible bleeding. During this period of time, the medical staff monitors the woman, who evaluates blood pressure and pulse, skin color and the amount of blood released. As already mentioned, the allowable blood loss during childbirth should not exceed 0.5% of the woman's weight (up to 400 ml on average). Otherwise, blood loss is regarded as early postpartum hemorrhage, and measures are taken to stop it.

Bladder emptying

Immediately after the completion of labor, urine is removed by a catheter, which is necessary to release the filled bladder and prevent its pressure on the uterus. Otherwise, a full urea will put pressure on the uterus, which will prevent it from contracting normally and can cause bleeding.

Inspection of the placenta

After the birth of a child's place without fail, the obstetrician, together with the midwife, examines it and decides on the integrity of the placenta, the presence / absence of additional lobules, their separation and retention in the uterine cavity. If the integrity of the placenta is in doubt, a manual examination of the uterus is performed (under anesthesia). During the examination of the uterus, the doctor performs:

• excludes trauma of the uterus (rupture);
• removes the remains of the placenta, membranes and blood clots;
• conducts a manual (with caution) massage of the uterus on the fist.

The introduction of uterotonics

As soon as the placenta was born, intravenously, less often intramuscularly, uterine contracting drugs (oxytocin, methylergometrine) are administered. These drugs prevent uterine atony and increase its contractility.

Inspection of the birth canal

In the recent past, inspection of the birth canal after childbirth was carried out only in nulliparous women. To date, this manipulation is carried out for all puerperas, regardless of the number of births. During the examination, the integrity of the cervix and vagina, soft tissues of the perineum and clitoris is established. If ruptures are found, they are sutured (under local anesthesia).

Measures for the development of early postpartum hemorrhage

In case of increased bloody discharge in the first 2 hours after the end of childbirth (500 ml or more), doctors take the following measures:

• Emptying the bladder (if this has not been done before).
• The introduction of uterotonics intravenously in high dosage.
• Cold in the lower abdomen.
• External massage of the uterine cavity

Having established a hand on the bottom of the uterus, gently squeeze and unclench it until the uterus is completely contracted. The procedure for a woman is not very pleasant, but quite tolerable.

• Manual uterine massage

It is carried out, as indicated above, under general anesthesia. A hand is inserted into the uterus and, after examining its walls, the hand is clenched into a fist. With the other hand, the uterus is massaged from the outside.

• Tamponade of the posterior fornix of the vagina

A tampon impregnated with ether is inserted into the posterior vaginal fornix, which causes a reflex contraction of the uterus.

If all of the above measures did not have a positive effect, and the bleeding increased and reached 1 liter or more, the issue of surgical intervention is decided. At the same time, intravenous administration of solutions, blood and plasma preparations is carried out to replenish blood loss. Of the operations used:

• amputation or extirpation of the uterus (depending on the situation);
• ligation of the arteries of the uterus;
• ligation of the ovarian arteries;
• ligation of the iliac artery.

Stopping late postpartum hemorrhage

Late postpartum hemorrhage, as already mentioned, occurs due to retention of parts of the placenta and membranes, less often blood clots in the uterine cavity. The assistance scheme is as follows:

• immediate hospitalization of a woman in the gynecology department;
• preparation for curettage of the uterine cavity (conducting infusion therapy, introducing contractions);
• emptying (curettage) of the uterine cavity and removal of the remnants of the fetal egg and clots (under anesthesia);
• for 2 hours on the lower abdomen;
• further infusion therapy, if necessary, transfusion of blood products;
• prescribing antibiotics;
• the appointment of uterotonics, iron preparations and vitamins.

What can a woman do

To prevent bleeding in the late postpartum period, a young mother is advised to follow simple instructions:

Monitor your bladder

You should urinate regularly, avoiding overflow of the bladder, especially on the first day after childbirth. While the woman is in the hospital, visit the toilet every 3 hours, even if there is no desire. At home, also do not forget about the timely emptying of the bladder.

Baby feeding on demand

Frequent attachment of the baby to the breast not only establishes and strengthens the physical and psychological contact between mother and baby. Irritation of the nipples causes the release of exogenous (own) oxytocin, which stimulates the contraction of the uterus, and also increases the discharge (emptying of the uterus).

Lie on your stomach

In a horizontal position on the stomach, it not only enhances the contractility of the uterus, but also the outflow of secretions from it.

Cold in the lower abdomen

If possible, a young mother should apply an ice pack to the lower abdomen (preferably up to 4 times a day). Cold stimulates the contractile activity of the uterus and reduces the open uterine vessels on its inner shell.

Having given birth to a child, a woman feels joy and relief. Now she can fully feel like a mother. But there may be some troubles that can overshadow this period. It's about postpartum hemorrhage. In most cases, everything is not as scary as it seems, because many people understand this term even as a meager discharge that is normal. However, a deviation from physiological parameters can pose a serious danger, which requires close attention from the woman in labor.

General information

The postpartum period begins from the moment the placenta leaves the uterus - the placenta with membranes - and lasts for 6 weeks. During this time, involutive (reverse) changes occur in the reproductive system and organs that have undergone changes during pregnancy. In other words, the female body gradually returns to its original state.

Immediately after childbirth, the inner surface of the uterus is an almost continuous wound surface. But due to the contraction of muscle fibers, its size is minimized. The uterus decreases in volume, descending lower and lower into the cavity of the small pelvis and on the 10th day is already behind the pubic joint. This is facilitated by breastfeeding, during which the hormone oxytocin is produced.

At the end of 2-3 weeks, the cervical canal also closes. But the mucous membrane - the endometrium - requires a longer recovery. The basal epithelium grows by 10 days after birth, and the complete formation of the functional layer will occur only by the end of the entire period.

Normal changes

It is very important for women to know how long bleeding after childbirth lasts and how heavy it can be. Physiological secretions that are observed during this period are called lochia. In the first 2–3 days, they are quite abundant and consist mainly of blood with clots. In general, the volume of blood loss in the afterbirth and early postpartum periods should not exceed 0.5% of the woman's body weight. This is considered the norm and is not able to have a negative effect on the body.

But already at the end of the first week, the discharge becomes more scarce, acquiring a brownish tint. Only under the influence of certain factors, such as physical activity, sexual intercourse or straining, there is an increase in lochia. Over time, they transform into sanious or yellowish, completely disappearing at 6 weeks. But if the spotting is prolonged, becomes abundant or resumes after a break, then you should definitely consult a doctor. And the specialist will already determine what is the reason and give appropriate recommendations.

Physiological secretions are especially abundant during the first 3 days, and then they decrease and become less bloody.

Pathological processes

Postpartum hemorrhage is a serious obstetric pathology that is fraught with a real danger to a woman's life. It can occur in different periods, which is reflected in the existing classification:

• Early - within the first 2 hours.
• Later - for the remaining 6 weeks after birth.

When a woman loses more blood than expected, it is necessary to figure out what this is connected with and what measures to take. But this must be done in the shortest possible time.

The reasons

The appearance of bleeding after childbirth is a rather formidable sign, indicating deviations during the physiological period or certain disorders in the woman's body. The causes of this pathology are:

• Violation of the separation of the placenta and placenta (tight attachment, increment, retention or pinching of individual particles in the uterus).
• Reduced uterine contractility (hypo- or atony).
• Disorders in the coagulation system (coagulopathy).
• Traumatic injuries of the genital tract.

It should be said that most of these conditions have their own predisposing factors and provoking aspects. They must be taken into account when carrying out diagnostic measures. For example, hypo- or atony of the uterus often occurs in women with concomitant phenomena and problems:

• Polyhydramnios, large fetus, multiple pregnancy (distension of the uterus).
• Tumor processes (myomas, polyps).
• Late toxicosis.
• Anomalies in the development of the uterus (saddle-shaped, bicornuate).
• Placental complications (previa, true increment, detachment).
• Neurohormonal disorders and endocrinopathies.
• Weakness of labor activity.
• Operational interventions.
• Inadequate drug therapy (with the appointment of uterotonics, antispasmodics, tocolytics).

The causes of coagulopathic bleeding can be general diseases of the hemostasis system or hemorrhagic diathesis, which include hemophilia, von Willebrand's disease, hypofibrinogenemia, and others. But much more important are secondary conditions, in particular, DIC (disseminated intravascular coagulation). It develops under various conditions:

• Premature detachment of the placenta.
• Gestosis (severe preeclampsia, eclampsia).
• Frozen pregnancy.
• Amniotic fluid embolism.
• Massive blood loss.
• Transfusion of a large volume of blood.
• Extragenital diseases (diabetes mellitus, heart defects, renal and hepatic pathology, oncology).

Given the variety of probable causes, each case requires individual consideration. To understand what processes have become the source of bleeding, an appropriate examination is necessary. And only a doctor can carry out a full diagnosis, so the only way to solve the problem lies through the consultation of a specialist.

The causes of postpartum hemorrhage can be various conditions - associated with obstetric complications, gynecological or extragenital pathology.

Symptoms

Bleeding in the early stages, i.e., in the first 2 hours after childbirth, can occur for almost any of the reasons mentioned above. But most often we are talking about placental (afterbirth) anomalies, uterine hypo- or atony. There may be signs of coagulopathy, but this is less common. In the first case, there is a delay in the placenta in the uterus - it does not come out for half an hour - or appears with a defect on the surface (signs of an additional lobule). The doctor checks for special symptoms that indicate the separation of the placenta:

• Schroeder - the uterus becomes narrower and lengthens, deviating to the side.
• Alfeld - lengthening the outer edge of the umbilical cord.
• Kyustner-Chukalov - when pressed over the pubis, the umbilical cord is not retracted.

If they are negative, then the placenta is still attached to the uterus and auxiliary techniques are required to remove it and, accordingly, stop the bleeding. With hypotension, the uterus may initially contract normally and then relax, leading to a gradual increase in symptoms.

There are also reverse cases, when massive blood loss occurs immediately. On palpation, the uterus is soft to the touch, enlarged - the bottom is located above the navel line. She does not respond to external stimuli: massage or the introduction of uterotonics. Abundant bleeding leads to an increase in general symptoms:

• Dizziness.
• Weakness.
• Pallor.
• Pressure drop.
• Pulse increase.

Uncontrolled bleeding leads to hemorrhagic shock and DIC. And the latter is characterized by microcirculatory and ischemic disorders due to numerous thromboses of small vessels. But in the future, hypocoagulation develops due to the depletion of the reserves of the coagulation system. In turn, this is manifested by the following symptoms:

• Hemorrhages in the skin and mucous membranes.
• Bleeding from various parts of the body: uterus, surgical wounds, teeth, kidneys, lungs, gastrointestinal tract.
• Local necrosis of the skin and mucous membranes.
• Multiple organ failure.
• Anemia and intravascular hemolysis.
• Euphoria, disorientation, impaired consciousness.

This is a very serious condition that poses a threat to the life of the puerperal. Severe and neglected cases, unfortunately, end unfavorably. But with early emergency measures, the prognosis is much better.

Another situation in which blood may appear after childbirth is the rupture of a woman's genital tract. They are observed quite often, especially with a large fetus, post-term pregnancy, rapid labor and the use of assistive devices (obstetric forceps). Bleeding can become protracted and noticeable already in the early period. Tears often spread to neighboring tissues: from the vagina to the perineum, from the cervix to the uterus. If the urinary tract is damaged, blood will leak from the urethra (hematuria).

Clinical symptoms in postpartum hemorrhage can vary significantly, which facilitates the diagnosis. But common signs also exist.

Additional diagnostics

To accurately determine the cause of spotting after the birth of a child, the doctor will prescribe additional studies. Depending on the situation, they are carried out in a planned or urgent manner. As a rule, the following diagnostic procedures are necessary:

• Detailed complete blood count (erythrocytes, platelets, hemoglobin, hematocrit, color index, ESR).
• Coagulogram (fibrinogen, prothrombin index, plasma clotting and recalcification time, fibrinolytic activity).
• Ultrasound of the uterus.
• Hysteroscopy.
• Colposcopy.

It is necessary to establish the cause of bleeding as early as possible, in which the results of additional studies help. Focusing on them, the doctor will prescribe a therapeutic correction to the woman to eliminate the source of the pathology and its consequences. And by what methods this will be done - conservative or surgical - depends on the severity and origin of bleeding. But in any case, you can hope for a full recovery of health.