What is dangerous bleeding after childbirth. postpartum hemorrhage

Childbirth is always accompanied by blood loss. This is a natural process that usually does not exceed the physiological norm. But sometimes, after childbirth, uterine bleeding develops, which threatens the life of a young mother. This is an emergency situation and it requires prompt and well-coordinated work of a gynecologist, midwife and anesthetist. Why is hypotonic bleeding dangerous? And what if it developed a month or two after discharge from the hospital?

Physiology of blood loss

For each woman entering the maternity hospital, the doctor must calculate the physiologically acceptable blood loss. To do this, mathematically find 0.5% of body weight. For example, for a woman in labor with a weight of 68 kg, this volume will be 340 ml. Blood loss of 0.7-0.8% or more is considered pathological.

In childbirth, the volume of blood lost is calculated most often by collecting it in a special tray. It is placed under the buttocks of the woman in labor, and bloody discharge flows freely into it. In addition, weighing of diapers is used.

Other methods for assessing blood loss are also used, but in practice, the assessment of the clinical condition and hemodynamic parameters is most often used. There are three degrees of severity of the condition:

1 degree - there is weakness, palpitations up to 100 beats per minute. The skin becomes pale, but remains warm. The pressure is low, but not lower than 100 mm Hg. Art. Hemoglobin is not critically reduced, up to 90 g/l.
Grade 2 - weakness increases, severe tachycardia over 100 beats per minute worries. Systolic pressure drops to 80 mm Hg. Art. Pale skin becomes moist. Hemoglobin decreases to 80 g/l.
Grade 3 - a state of shock, the skin is pale and cold. The pulse is palpable with difficulty, it becomes threadlike. The pressure is critically low, urine output stops.

The state of acute blood loss is very dangerous in the postpartum period. This is due to the peculiarities of hemostasis in a pregnant woman.

Dangerous symptoms in the delivery room

After giving birth, the woman remains in the delivery room for 2 hours under the supervision of medical staff. During this period, hypotonic bleeding most often occurs. It is characterized by a sudden onset against the background of apparent well-being and a rapid course: in a short period of time, the puerperal can lose up to a liter of blood. Such a volume can be critical and lead to rapid decompensation, the development of hemorrhagic shock and death.

Therefore, in order to notice adverse signs in time, to have time to respond to them and reduce the time for rendering assistance, the patient does not shift from the chair to the couch or gurney: in the gynecological chair they will provide medical assistance in the event of a critical situation.

How long does bleeding last after childbirth?

It all depends on individual characteristics. It continues directly in the delivery room, when transferred to the ward, and even during the first day it looks like liquid blood. By the second day, it is no longer blood, but lochia, thicker in consistency, containing a mucous component. Over the next four days, the discharge decreases, first becomes dark brown, and then gradually brightens. Lochia continues to stand out for another month.

Signs of bleeding in the early postpartum period are difficult to determine on their own. It is accompanied by weakness, which already worries a woman after childbirth. There may be a feeling of chills, but this is also a non-specific symptom. After muscle tension during the straining period, the puerperal may experience a period of muscle trembling, which is difficult to distinguish from a state of severe blood loss.

While the patient lies motionless, blood can accumulate in the uterine cavity, gradually stretching it. When pressing on the uterus through the abdominal wall, a large amount of blood is released, sometimes with large clots. Gradually, normally, this amount should decrease. But with the development of pathology, this does not happen.

Blood pressure measurement is mandatory. With a significant decrease, as well as an increase in signs of tachycardia, a conclusion is made about significant blood loss.

Why won't the bleeding stop?

The causes of postpartum hemorrhage are to reduce the contractility of the uterus. Several risk factors influence this:

large fruit;
diseases of the blood coagulation system.

Also increase the risk of excessive postpartum blood loss frequent childbirth. If a woman has a break between births that does not exceed two years, and births are more than four, then hypotension must be prevented.

The immediate cause most often becomes a delay in the uterine cavity of parts of the placenta or fetal membranes. To prevent this condition, after the birth of the placenta, the midwife carefully lays it out on the diaper, blots it from the blood, aligns and matches the edges. This allows you to assess whether all parts have separated from the walls of the uterus and come out.

The delay of any parts in the uterine cavity violates its contractility. The vessels to which the placenta was attached do not collapse and bleed. Also important is the release from the placenta of active substances that prevent blood clotting.

Sometimes blood loss in the postpartum period is the result of tight attachment or. In this case, in the first case, the villi are woven into the tissues of the uterus and can be separated manually. And in the second case it is impossible to do it. The only way to save a woman is to have a hysterectomy.

Emergency care for postpartum hemorrhage includes a mandatory manual examination of the uterine cavity. The purpose of this manipulation is as follows:

Determine the presence in the uterine cavity of the remnants of the placenta or membranes.
Determine if the organ has a contractile potential.
Determine if there are ruptures of the uterine wall.
The ability to identify organic abnormalities that can cause bleeding, for example, a myomatous node.

The sequence of actions of a doctor during a manual examination includes the following steps:

The volume of blood loss and the condition of the woman are assessed.
The external genitalia are treated with antiseptics.
Anesthesia and contraction drugs are given (or uterotonics are continued).
The hand is inserted into the vagina and gently into the uterine cavity.
All clots and parts of pathological tissues are gradually removed.
The tone of the uterus is determined. It should be tight.
The hand is removed, the birth canal is assessed for damage, which can also cause bleeding.
The condition of the woman in labor is reassessed. Compensation for blood loss is carried out using solutions of crystalloids and colloids. If necessary, transfusion of blood plasma or uniform elements is performed.

Additional actions to stop hypotonic bleeding after manual examination are the following:

Introduction of additional reduction funds. Usually, a solution of methylergometrine is used for this purpose. It is administered while maintaining the drip of oxytocin.
You can inject oxytocin into the cervix to improve its contractility.
Swabs soaked in ether are inserted into the posterior fornix of the vagina. Bleeding should stop reflexively.
Evaluate blood loss and compensate for it.

The uterus does not always respond to ongoing activities, and its contractility. This condition is called atonic bleeding.

If blood loss continues after manual examination, the following tactics are used:

There are a lot of receptors on the posterior lip of the cervix that are responsible for contractility. Therefore, suturing is used with a thick catgut ligature on this area according to Lositskaya. Bleeding should reflexively stop.
In case of ineffectiveness, clamps are applied to the uterus by passing them through the vagina. This is due to the anatomical location of the uterine artery.

But if in this case the deterioration continues, the only way to help is surgery. During it, it is possible to save the organ if the intervention is carried out in a short time and special intraoperative methods are used.

You can reflexively stop blood loss by tying the vessels according to Tsitsishvili. To do this, they tie up the vessels that pass in the round ligament of the uterus, the own ligaments of the ovary. A more outdated method is electrical stimulation. The last way is . It is resorted to with the ineffectiveness of previous manipulations, and if the loss is more than 1200-1500 ml.

Bleeding in the room...

The postpartum period can be complicated by bleeding a few days after birth. There are symptoms that should alert a woman. The first sign is a decrease in the number of lochia. They become scarce or. This must be reported to the doctor.

Earlier postpartum hemorrhage develops when the cervix is blocked by clots that do not allow the lochia to flow normally. They stagnate in the uterine cavity, leading to its subinvolution. This symptom is clearly visible on ultrasound.

Diagnosis is necessarily carried out in the postpartum period for all women in order to exclude this pathology. On ultrasound, signs of subinvolution are:

expansion of the uterine cavity more than 1 cm;
discrepancy between the size of the organ to the postpartum period;
the presence of homogeneous contents in the cavity.

After a long absence of discharge, sudden bleeding may begin. Therefore, treatment is carried out immediately after diagnosis. To do this, it is necessary to eliminate the remnants from the uterine cavity that prevent it from contracting. By the third day, the neck is already beginning to form, so the procedure cannot be performed only by hand, a surgical instrument is needed.

To remove the remnants of the membranes, clots, use a curette. She is carefully scraped. After the procedure, an intravenous solution of oxytocin or methylergometrine is administered to improve contractility. Be sure to replenish blood loss with special saline solutions.

The duration of the discharge in this case should correspond to those during normal childbirth.

...and on the operating table

In most cases, there are no emergencies during a caesarean section. But sometimes the variant anatomy of the location of organs and vessels can lead to an inadvertent injury to one of them, and, as a result, to internal bleeding, which manifests itself already on the operating table.

Very rarely, its cause is the divergence of the seams in the postoperative period. Then the puerperal has all the symptoms of hemorrhagic shock:

pale skin;
cold sweat appears;
tachycardia is observed;
blood pressure drops sharply.

There may also be symptoms of irritation of the peritoneum by the outflow of blood. The clinical protocol in this case provides for the only way to stop the blood - abdominal surgery, which will allow you to find a bleeding vessel and tie it.

The woman is usually in critical condition. Replenishment of blood loss is possible with blood substitutes, colloid and crystalloid solutions, plasma, uniform elements. Sometimes they collect their own blood poured into the abdominal cavity and return it back to the bloodstream through a vein.

After being discharged home

Bleeding in the late postpartum period occurs after discharge home. Its symptoms are similar to the processes that occur during subinvolution of the uterus. The release of lochia suddenly stops, after a while there is a cramp-like pain in the abdomen. Blood clots come out of the genital tract, causing blood retention in the uterus. After this, profuse bleeding usually begins.

If these symptoms appear, you should urgently seek medical help. Treatment is no longer carried out in the hospital, but in a gynecological hospital. The correct tactic is to. Be sure to prescribe oxytocin drip.

To continue therapy at home, oxytocin tablets are prescribed.

The development of bleeding in the late postpartum period - a month or 2 months after birth - is an alarming symptom that may be a sign of a placental polyp. This is a neoplasm that occurs at the site of the remaining placental villi. They are covered with fibrin clots, connective tissue and outwardly initially look like a flat formation. Bleeding is the main symptom of this pathology. Its consequence can be severe anemia, endometritis, sepsis and infertility in the long term.

Diagnosis is based on ultrasound of the pelvic organs. Further tactics include conducting, during which you can finally verify the presence of a pathological formation and remove it. In some cases, they are limited to separate diagnostic curettage, followed by a histological examination of the material obtained.

Prevention is easier than cure

Prevention of bleeding in the postpartum period is the proper management of pregnancy and childbirth. The anamnestic and clinical data of a particular pregnant woman are assessed and a risk group for the development of bleeding is established. These mothers need special attention. Already in childbirth, they are prescribed oxytocin, but not to enhance labor activity, but to reduce the risk of massive blood loss. Prevention measures include examining the child's place, a thorough revision of the birth canal and suturing the existing ones.

Restoration of the menstrual cycle

Sometimes menstruation begins even during breastfeeding.

How to distinguish between menstruation and bleeding after childbirth?

It is necessary to focus on the normal amount of blood lost during menstruation. On average, for all days, it should be no more than 100 ml. In this case, menstrual blood can come out in small mucous clots - rejected endometrium. In the first, second, sometimes third, the intensity of the secretions is slightly greater, but gradually this process should decline.

The duration of menstruation after childbirth may differ from that before pregnancy. Normally, it is 3-7 days. With an extension of this period, as well as with heavy discharge, which does not decrease in accordance with the days of the cycle, you should consult a doctor.

The problem of bleeding in the postpartum period does not lose its relevance, regardless of the level of development of medicine. Sometimes it is impossible to predict how the uterus will contract, how tightly the placenta is attached, and whether it can completely stand out on its own. Therefore, women who decide to experiment with childbirth should also be aware of such a risk to their own lives, in which a few minutes are allotted for medical assistance.

Postpartum recovery is a very complex process that has a serious impact on many systems of the female body. Of course, the pelvic organs and the birth canal take the biggest blow, where tears can form, stitches are applied due to medical intervention, and so on. But blood discharge in women after childbirth is more associated not with these reasons, but with physiological ones. During childbirth, the placenta is separated from the uterus, which provided the child with everything necessary for its development in the womb. In place of the endometrium, to which the placenta was attached, a large wound is formed. The process of its healing should normally last 6-8 weeks and be accompanied by lochia - blood secretions with clots, impurities, placental remnants and bacteria. Therefore, if a woman bleeds immediately after childbirth, this is natural, inevitable and safe for health, except when there is an inflammatory process in the uterus or vagina. In this article, we will consider one of the main issues of the postpartum recovery process - how long does the blood flow after childbirth.

Regardless of how the delivery took place - naturally or by caesarean section - lochia will stand out from the birth canal of a woman who has just given birth, the duration of which will be several weeks. However, their character will constantly change: every day they will decrease in volume, change color and consistency. Based on this, the period of blood discharge after childbirth can be divided into three main periods:

The first few hours after childbirth.

After a woman gives birth, she will need to be in the delivery room for 2-3 hours under the strict supervision of doctors who will monitor her general condition and the nature of the discharge from the uterus. This period is the most dangerous, since there is a high probability of opening massive hypotonic uterine bleeding, which is usually caused by a violation in uterine contractions. It, in fact, does not cause any pain in a woman, but can lead to dizziness and fainting. After all, the first hours after the birth of a child, a newly-made mother already begins very abundant vaginal discharge in strong streams, which can be continuous and uneven - at the slightest pressure on the stomach, a lot of blood can flow out. During the stay of the puerperal in the delivery room, she can lose more than half a liter of blood. For this reason, a woman is strictly forbidden to get up immediately after giving birth. This can be done only after the permission of the doctor, who must first make sure that you do not have tears that can bleed and bruises.

As soon as you get up, and with any other slightest movement, slight bleeding may begin, so do not forget to put an oilcloth or diaper under your feet.

The first few days after childbirth.

The countdown of this period begins from the moment the woman is transferred to the postpartum ward. As a rule, it lasts 2-3 days, exactly as long as during the normal course of postpartum recovery, the puerperal should be in the maternity hospital under the supervision of doctors. During this period, a woman is allowed to independently, but slowly move around the ward and department. The amount of discharge is just as plentiful. You will need not ordinary pads that women use during menstruation, but special postpartum ones. For new mothers who have had a caesarean section, absorbent diapers can be used instead of pads. Every day, the doctor who makes the rounds of the patients will look at the nature of the discharge: if scarlet blood comes out after childbirth without a pungent odor, it means that the healing process of the uterus is proceeding correctly and without complications. The exceptions are those puerperas whose uterus is overstretched. This may be due to the fact that their pregnancy was multiple or the fetus was very large. Among other reasons are difficult births, in which there was curettage of the placenta or other medical intervention. Such women are given oxytocin drips throughout this period, which helps their uterus contract faster.

The first month and a half after childbirth.

When a woman is at home, and this is approximately 7 days after the birth of a child, vaginal discharge will resemble ordinary menstruation with small blood clots that form in the uterus after childbirth and gradually leave it. Every day, the discharge will decrease in volume, and then change its color - bright red will change to yellow. A month after the birth, there should definitely be no more blood, there may be scant spotting yellowish-white discharge, but nothing more. In case of any deviations from this norm, you should immediately contact your gynecologist.

How much blood flows after childbirth - pathological discharge

There are a number of reasons why a woman may have problems after childbirth, related to violations in the process of uterine recovery. The mother can determine these violations on her own. What applies to them:

The amount of blood released a week after birth does not decrease, but remains as plentiful. This symptom indicates that part of the placenta and many blood clots remained in the uterus after childbirth, and this prevents its full reduction. Because of this, the inflammatory process begins, the woman's temperature rises greatly. If you notice such a symptom in yourself, do not delay going to the doctor. In this case, you will be shown an additional cleaning under anesthesia. This procedure sounds scary, but you can’t do without it, otherwise the woman is threatened with blood poisoning or infertility.
Blood after childbirth comes out for longer than 8 weeks, while the woman experiences pain in the lower abdomen, her temperature rises. The reason for this may be an infection introduced after or during childbirth, which must be cured so that there are no more adverse consequences, which include endometritis.
At first, there was no bleeding at all, and two weeks after the birth, blood began to flow. This can happen if you had fibromatous nodes formed on your uterus during or before pregnancy. This complication most often occurs in puerperas who have had a caesarean section.

How to behave to a woman in labor in order to avoid severe bleeding after childbirth

Walk less and lie down longer in the first few days after the baby is born.
Breastfeed your child. Breast milk is not only the best food for a newborn, but also the most effective way to quickly contract the uterus. When feeding, a woman releases the hormone oxytocin, which has a beneficial effect on the uterus.
Go to the toilet as often as possible to empty your bladder. After giving birth, problems may arise with this matter - a woman sometimes stops experiencing the urge to urinate, which is why the bladder fills up and prevents the uterus from contracting normally.
Apply a heating pad with ice water to the lower abdomen - this will affect the vessels that are also involved in the process of uterine contraction. For the same reason, lie on your stomach more often.
Wear a bandage or tie up your stomach with a sheet.

Of course, don't lift any weights. The biggest thing you can hold in your hands is your baby.

Rules for personal hygiene after childbirth

Use only good quality, highly absorbent sanitary napkins and change them at least every 5 hours. If you have abundant discharge, then change the pad depending on the degree of its filling.
Do not use tampons, which can harm an injured birth canal.
Every time you change a pad, wash with normal baby soap, directing the water jet from front to back.
If you have stitches on the perineum, treat them with furatsilin or potassium permanganate.
Don't take a bath. You can only bathe in the shower to reduce the risk of infection in the vagina.

How much blood flows after childbirth - when the menstrual cycle is restored

As soon as the postpartum discharge stops, the woman begins to wonder when her period will come now, because the menstrual cycle has gone astray after pregnancy. There are several options here, but all of them will depend on the individual characteristics of the body of each woman.

As a rule, if a young mother is breastfeeding her child, then her menstrual cycle is restored only after six months. During this time, there may not be any periods at all, since the body of a nursing woman produces the hormone prolactin, which prevents ovulation. In women who have given up breastfeeding, the menstrual cycle returns to normal a couple of months after childbirth.

conclusions

How many days after childbirth will blood flow - this is a question that all women who have just given birth ask. But there is no unequivocal answer to it, since everything in this matter depends on the physiological characteristics of the puerperal. But in any case, no matter how much blood flows after childbirth, it is important that it does not have a rotten smell, and you do not feel pain. If your postpartum recovery process proceeds without complications, then one and a half months after the birth of the baby, any unpleasant discharge from the birth canal will stop and cease to cause you discomfort.

Video "Discharge after childbirth"

This video shows in detail what happens to a woman after childbirth, and what care specialists should indicate to her so that bleeding does not occur.

Such a phenomenon as bleeding is completely normal during the recovery period of the female body after delivery. It ends some time after childbirth and does not require medical intervention. However, in some cases, uterine bleeding after childbirth can signal serious pathological changes that have occurred in a woman's body. And an untimely appeal to a medical institution in this case can cause irreversible consequences. That is why every woman who is preparing for the birth of a child or who has already become a mother should know everything about postpartum hemorrhage: what color are the discharges, what are the volumes of blood released, what sensations accompany bleeding, etc. It is very important to responsibly and scrupulously treat health after birth child in order to avoid the occurrence of various infections and other pathological processes and phenomena.

Features of postpartum hemorrhage

Normal postpartum discharge, lochia, has a number of distinctive features. The main parameters of bleeding after childbirth are the volume and nature of the discharge. Blood loss in the normal state of a newly-made mother should not exceed 0.5% of the total body weight of a woman. Indicators that exceed the norm are considered dangerous, and blood loss of more than 1% of the weight of the woman in labor is considered critical.

Bleeding can occur against the background of a violation of heart contractions, fluctuations in blood pressure, dizziness, deterioration of health, weakness and other not very pleasant symptoms.

How long does bleeding last after childbirth

This phenomenon is caused by the release of the remnants of the placenta, as well as the fetal membranes. These processes take place in several stages. And each of them has its own distinctive features of bleeding after childbirth.

How long it should last normally worries almost all women. The most abundant discharge is observed in the first 2-3 days after delivery. The amount of blood released is greater than that during menstruation. Severe bleeding in the first few days after childbirth is due to a lack of contractile properties of the uterus. Keep in mind that the process may take longer after a caesarean section. This is due to the fact that after this medical manipulation, the uterus contracts much worse, more slowly.

Over the next two weeks, the intensity of bleeding decreases markedly. The color of the highlights also changes. If in the first days after childbirth the blood had a rich bright red color, then at this stage it is light pink, brown or light yellow. Normally, by the end of the second week, the intensity of the discharge should noticeably decrease. From the 3rd week, the discharge is scanty and has a light pink or light yellow color. In young women, the discharge should stop 5-6 weeks after childbirth, in older women, the duration of postpartum bleeding can last up to 8 weeks. If the discharge continues after the specified time, it is recommended to consult a specialist for advice and conduct the necessary medical research.

How to distinguish lochia from bleeding

In order not to miss the moment and avoid unpleasant consequences, every woman should know how to distinguish uterine bleeding from lochia, the release of which in the first time after childbirth is a normal phenomenon, due to the physiological characteristics of the female body.

Uterine bleeding is more profuse than postpartum discharge. This can be seen from the fullness of the sanitary napkin. With the allocation of lochia, it is filled in 2-4 hours, with uterine bleeding - in 30-60 minutes. Normal postpartum discharge is dark red or brown, while abnormal bleeding is characterized by bright red blood.

Lochia has an astringent texture. When bleeding, the discharge is liquid, the blood comes out in jerks. In addition, pathological blood loss is characterized by significant changes in the state of health of the newly-made mother. With uterine bleeding, there is severe nausea, dizziness. Possible loss of consciousness, fainting. In addition, a woman should be alerted to the pain that occurs during bleeding. Normally, they shouldn't be. The presence of such signals the occurrence of pathological phenomena in the body.

The reasons

Normally, the causes of bleeding are insufficiency of the contractile function of the uterus. Its dimensions should come to prenatal indicators. Breastfeeding contributes to the increase in the intensity of uterine contraction.

Bleeding can occur due to traumatic damage to the woman's vagina and external genitalia that occur during the passage of the child through the birth canal.

Signs of normal bleeding

It is worth summarizing and listing the signs of normal postpartum hemorrhage. These include:

profusion of discharge, not exceeding 0.5% of the total body weight of the woman in labor;
in the first days they have a bright red color, subsequently the color of lochia changes to brown, light pink or light yellow;
intensity on the 4-5th day after birth is significantly reduced;
the duration of the discharge is 2-6 weeks, sometimes 8 weeks;
full filling of the sanitary napkin is observed after 2-4 hours;
absence of pain and deterioration of well-being.

It is worth noting that in some cases, in the first few days after childbirth, a woman may experience a worsening condition, namely dizziness. This is due to the individual characteristics of the organism.

When to sound the alarm

Bleeding after childbirth after 2-4 days should decrease. If the intensity of the discharge does not decrease 3-4 days after delivery, and the blood has a bright red color, the woman should suspect something was wrong. She should immediately seek medical advice from a specialist. An alarming sign is the fact that bleeding a month after childbirth is characterized by copious discharge.

The suspicion of the presence of a pathology should be caused by the rapid filling of a sanitary napkin, which becomes unusable in a record short time, 30-60 minutes after the start of use. In addition, in case of pathology, discharge is accompanied by painful sensations, the intensity of which can change periodically, significantly worsening the quality of life of a newly-made mother.

Causes of abnormal bleeding

The causes of blood loss in the early postpartum period are hypotension of the woman's uterus, due to a lack of contractile function (which was mentioned above);

the remainder of the placenta can also provoke bleeding, preventing uterine contraction;
injuries such as uterine, vaginal, and vulvar ruptures;
blood diseases that prevent normal blood clotting.

The causes of bleeding in the late period after childbirth can be:

polyp;
inflammation in the uterine cavity;
bubble drift.

In addition, the causes of discharge in the late postpartum stage may be hereditary contractions of the organ.

In addition, the occurrence of bleeding can be caused by the occurrence of infectious processes in the uterine cavity. The presence of fibrous nodes in the uterus can also provoke bleeding, which is easily confused with the normal discharge of postpartum lochia.

Treatment Methods

Bleeding therapy proceeds in a certain sequence:

the doctor determines the cause of the discharge;
the introduction of reducing funds;
method for identifying the remains of the placenta;
manual examination of the birth canal for injuries sustained during childbirth;
if necessary, the doctor applies clamps to the vaginal vaults, after which he re-introduces drugs that improve the contractile properties of the uterus.

If after all of the above actions the bleeding does not stop, the patient is transferred to the operating unit for surgical procedures.

Treatment of late bleeding begins with the use of antibiotics, hemostatic agents, and reducing drugs. If you suspect the presence of the remains of the placenta, as well as curettage, or hysteroscopy.

Preventive measures

It should be understood that no woman in labor is immune from the occurrence of uterine bleeding, even if the birth was successful and without complications. That is why, in the near future after delivery, the doctors of the obstetric department apply measures that reduce the risk of complications:

excretion of urine with a catheter;
applying cold to the lower abdomen;
women at risk are given reducing agents, such as Oxytocin.

At home, a woman needs to follow some recommendations, namely:

practice natural feeding of the baby;
avoid exhausting physical activity;
avoid sexual intercourse in the first two months after childbirth.

The duration of sexual rest depends on the complexity of childbirth and on the characteristics of the course of the recovery process. It is necessary not only in the presence of bleeding. A month after childbirth is a recovery period when a woman's body needs to be provided with comfort and tranquility.

How to distinguish bleeding from the onset of menstruation

If a woman refuses to breastfeed a newborn and prefers mixtures, menstruation can recover very quickly. In this case, lochia can be confused with the onset of menstruation. As a rule, normal menstruation is restored a couple of weeks after the woman refuses to breastfeed. Menstrual bleeding after childbirth in most new mothers, namely in 70% of women, begins between 6 and 12 weeks. However, in rare cases, the cycle may recover earlier. But such occurrences are extremely rare. That is why it is difficult, almost impossible, to confuse the onset of menstruation with postpartum bleeding.

Conclusion

Postpartum hemorrhage is an extremely important process that occurs immediately after the birth of a child and normally lasts from 4-5 to 6-8 weeks. This phenomenon requires maximum close attention and observation. A woman who has recently become a mother should be aware of the features of normal and pathological secretions in order to be able to distinguish them from each other if necessary. It is very important to carefully and scrupulously monitor your health during this difficult period of recovery of the body. This is necessary in order to avoid unnecessary worries and be ready. The slightest doubt and anxiety should be the reason for contacting a specialist in a medical institution.

Bleeding after childbirth is a normal physiological process. It allows the female body to return to its previous state: the uterus is cleansed of the placenta, lochia and pieces of the placenta. Allocations begin immediately after the birth of the child and last about one and a half months.

But sometimes this process becomes pathological. The main criterion for its evaluation is the nature and volume of blood loss. It is especially important for women in late pregnancy and who have recently given birth to know what bleeding is considered normal and what measures to take to prevent complications.

The question of how long postpartum bleeding lasts arises in almost all new mothers. The duration of this process can be from 2 to 6 weeks and even a little more. The duration depends on several factors: the ability of the uterus to contract, blood clotting, the rate of tissue regeneration, etc. Breastfeeding women recover faster.

It is important to evaluate not only the duration of bleeding, but also the general nature: they should gradually become less abundant. On the first day after childbirth, the discharge is strong, then it becomes less and less and eventually turns into a brownish “daub”. This sequence is the norm.

Causes of bleeding after childbirth

Abundant pathological bleeding in the early postpartum period, lasting about 2 hours after the baby is born, is caused by the following reasons:

Insufficient blood clotting. With such a complication, it flows out in a jet without the formation of clots and lumps (violation of thrombus formation). To prevent the situation, before giving birth, it is necessary to donate blood for a general analysis, cancel all drugs with an anticoagulant effect.
Rapid labor activity. It is accompanied by ruptures of the birth canal: the cervix, vagina, and in rare cases, the uterus are damaged.
An augmented placenta. With this complication, the reverse development of the uterus is difficult, which leads to heavy bleeding.
Insufficient ability of the uterus to contract. Most often this happens when the walls are strongly stretched ( , );
The presence of fibroids and myomas in the uterus.

Causes of postpartum hemorrhage between 2 and 6 are:

The release of particles of the placenta remaining in the uterine cavity.
Exit of blood clots, difficult due to spasmodic contraction of the cervix after operative delivery (caesarean section).
Slow recovery due to inflammation in the pelvic area (high temperature is also noted).

Features of postpartum hemorrhage

Symptoms of postpartum hemorrhage can be described in two ways: the volume and nature of the discharge. It is also possible a violation of the heart rhythm, changes in arterial and venous pressure, deterioration in general well-being.

A blood loss of 0.5% or less of a woman's body weight is considered physiologically acceptable. If this figure is greater, then pathological postpartum hemorrhage is diagnosed. Massive blood loss is called its release in the amount of 0.5 to 1% of the weight of the woman in labor. This can lower blood pressure, cause weakness and dizziness.

When the rate exceeds 1%, critical blood loss develops. It can be accompanied by hemorrhagic shock and DIC (coagulability disorder). These complications lead to irreversible changes in the organs.

Abundant postpartum bleeding develops with a decrease or absence of uterine tone. The more pronounced atony, the worse it lends itself to therapeutic measures. Drugs that cause contraction of the myometrium, eliminate bleeding only for a while. The condition is accompanied by arterial hypotension, tachycardia, pale skin, dizziness.

Diagnostic procedures

The diagnostic process begins during pregnancy. In modern obstetric and gynecological practice, the assessment of the risk of postpartum hemorrhage is based on monitoring data on changes in the level of hemoglobin, erythrocytes, and platelets in the blood at different gestation periods. Coagulability indicators (coagulogram) are taken into account.

Hypotension and atony of the muscles of the uterus is diagnosed in the third period of labor. These conditions are indicated by flabbiness and weak contractions of the myometrium, an increase in the time of the subsequent stage.

Diagnosis of bleeding after childbirth includes a thorough examination of the integrity of the discharged placenta, fetal membranes, examination of the birth canal to identify possible injuries. If necessary, the woman is put under general anesthesia and the doctor manually examines the uterine cavity to determine if there are tears, placental remains, blood clots, malformations, or tumors that may interfere with the contraction of the myometrium.

With bleeding in the late postpartum period, diagnosis is carried out using ultrasound. On the 2nd or 3rd day after the birth of the child, the state of the pelvic organs is examined. The procedure allows you to identify the remains of the placenta and membranes in the uterus.

Normal bleeding after childbirth

Normal bleeding in the postpartum period is caused by the release of the remnants of the placenta and the fetal membranes of their uterus. This process is divided into several periods, each of which is characterized by certain signs: the color and intensity of the discharge.

The first three days after the birth of a child, bleeding is profuse, the volume is greater than during menstruation. Color - bright red. Blood comes out of those vessels that were at the site of attachment of the placenta. This condition develops due to insufficient contractility of the uterus in the first days after childbirth. It is considered normal and does not require medical intervention. Postpartum hemorrhage after a caesarean section may be longer because the dissected uterus shrinks worse.

Over the next two weeks, the intensity of the discharge noticeably decreases. They become light pink, brown or yellowish white. Gradually, the uterus contracts, and by the end of the second week, the bleeding completely disappears. This is considered the norm.

In some cases, there is bleeding in the late birth period. It can be both normal and pathological, requiring medical intervention. If in the period from 2 to 6 weeks after the birth of a child there is a slight discharge from the uterus with blood impurities, then you should not worry. This symptom may be present all the time or come and go for a few days. Such an intermittent regimen is typical for women who quickly returned to sports training or other physical activities.

Sometimes bleeding disappears by the end of the second week, and then appears for several days in the interval from 3 to 6 weeks after delivery. Allocations are minor and painless are a variant of the norm.

Pathological bleeding after childbirth

A deviation from the norm, requiring the help of a doctor, is late bleeding with the following features:

duration more than 6 weeks;
meager discharge with ichor is replaced by scarlet blood;
the general condition of the woman becomes worse;
bleeding is accompanied by pain in the lower abdomen;
there are signs of intoxication (fever, dizziness, nausea, etc.);
the discharge acquires a brown or yellow-green color and an unpleasant odor.

With an intense flow of blood, especially if it is scarlet, you should immediately call an ambulance. Pain, fever, discoloration of the discharge indicate the development of complications: infectious diseases, etc. Such conditions require the earliest possible diagnosis and treatment.

Treatment Methods

Acute postpartum hemorrhage requires first of all establishing its cause, as well as prompt termination. The treatment uses an integrated approach and often drug therapy has to be combined with invasive methods.

To stimulate uterine contractions, a catheter is inserted into the urethra to empty the bladder, and ice is applied to the lower abdomen. Sometimes gentle external massaging of the uterus is performed. If all these procedures do not bring results, then uterotonic drugs are administered intravenously, for example, Methylergometrine and Oxytocin, and injections with prostaglandins are injected into the cervix.

Replenishment of the volume of circulating blood and elimination of the consequences of its loss is carried out with the help of infusion-transfusion therapy. Plasma replacement drugs and blood components (primarily erythrocytes) are injected into a vein.

If, during examination with the help of mirrors, ruptures of the birth canal and perineum are revealed, then a local anesthetic is applied, and the doctor sews up the damage. Manual examination and manual cleansing of the uterus is indicated for violations of the integrity of the placenta and hypotonic processes in the myometrium. The procedure takes place under general anesthesia.

If a uterine rupture is detected during a manual examination, then an emergency laparotomy, suturing or complete removal of the uterus is necessary. Surgical intervention is also required for placenta accreta and in cases where the bleeding is massive and cannot be stopped. Similar procedures are carried out with simultaneous resuscitation actions: blood loss is compensated, hemodynamics and blood pressure are stabilized.

Preventive actions

Prevention of postpartum hemorrhage helps to reduce its duration and intensity, as well as to avoid complications.

It involves the implementation of the following recommendations:

go to the toilet regularly: a full bladder and intestines put pressure on the uterus and prevent it from contracting;
take all possible measures to prevent infection of the uterine cavity: observe the rules of intimate hygiene, do not swim in open water, refrain from sexual intercourse and taking baths;
within one and a half months not to go in for sports and other intensive physical activity;
develop the habit of sleeping lying on your stomach, so the uterus contracts and clears faster;
breastfeed the baby;
avoid overheating: do not visit baths, saunas, do not be outside on a hot day.

Bleeding after the birth of a child is a normal physiological process that still needs to be controlled. It is important to pay attention to the duration, intensity and nature of the discharge. If complications are suspected, it is worth getting an appointment with a doctor as soon as possible, and if intense scarlet bleeding appears, call an ambulance.

Useful video about the postpartum period

Bleeding after childbirth is a pathology that should not be ignored by the woman who has given birth and her doctors. There are approximate norms for blood loss in the postpartum period, which should also be monitored upon discharge from the maternity hospital, if necessary.

Normally, during childbirth, a woman loses 250 grams of blood. This can be compared to three heavy menses. Bleeding in the postpartum period continues. Within 2-3 days, a woman can still change an average of 1 sanitary pad per hour. Then the discharge should decrease. Excessive uterine bleeding after childbirth may be a reason for infusion of donor blood. Fortunately, such a need arises infrequently.

Every day the uterus contracts more and more, returns to its non-pregnant size, the discharge gradually turns into spotting. And they can remain so sparse for up to 6-8 weeks. This is exactly the time period for bleeding after childbirth is normal for a woman.

It is bad when the discharge increases sharply in intensity. This can happen 10-15 days after discharge from the hospital. This is an occasion to urgently visit a gynecologist. Of course, it will no longer be possible to return to the maternity hospital, but diagnostics can also be carried out on an outpatient basis. If heavy bleeding begins a week after childbirth, the doctor should first of all conduct a gynecological examination of the patient, probe her uterus in order to determine its approximate size, consistency, find out if it is painful, see if the cervix is closed. Be sure to talk with the patient, here the important point is the presence of elevated body temperature. If such a woman is worried, then you need to find out exactly how she measures the temperature, in what place. In the armpit, measurements may be uninformative, since lactation is established at this time, and small lactostasis, stagnation of breast milk in the milk ducts, can lead to a local increase in temperature. It would be more correct to measure the temperature, for example, in the elbow bend.
And if there is an increase in temperature not associated with the chest, bleeding, pain - this is most often an indication for hospitalization in a gynecological hospital. On ultrasound, the doctor also examines the uterus. The main goal is to determine the causes of bleeding after childbirth, whether particles of the placenta remain in the uterus, whether a placental polyp has formed. Despite the fact that after the birth of the placenta it is always examined for integrity and, in which case, the uterus is audited (“cleansing”), such cases often occur. Especially often this diagnosis is confirmed when heavy bleeding begins a month after childbirth.

If everything is more or less in order according to the results of the ultrasound, the woman takes blood and urine tests. This is done in order to determine if there is an inflammatory process. And if so, then antibiotics are prescribed. The most sparing, so that you can not turn off breastfeeding.

Often the long duration of postpartum hemorrhage is explained by the subinvolution of the uterus, its poorly contractile ability. Doctors call such a uterus “lazy”. The main treatment in this case is the appointment of oxytocin to provoke uterine contractions and hemostatic drugs. For example, Vikasola. If necessary, in parallel with this antibiotic.

After childbirth, the duration of bleeding is normal up to 8 weeks, but on average, discharge is observed during the first 5-6. But sometimes after that, spotting reappears. Could it really be early menstruation when a woman is breastfeeding on demand? Yes, it often happens that bleeding occurs 2 months after childbirth. In this case, the woman should take a closer look at the secretions, their smell and abundance. Normally, a woman loses about 50 grams of blood during menstruation. With abundant - up to 80-100 grams. But if a woman is forced to change pads every two hours, this is the main criterion for distinguishing menstruation from bleeding after childbirth, and an unpleasant smell of discharge can indicate a bacterial infection. In addition, the presence of large clots is considered a bad symptom, this also indicates a large blood loss and requires a doctor's consultation.