After childbirth, women are not completely out of the woods as there can be some complications such as postpartum hemorrhage. There are four main reasons for postpartum hemorrhage, which include uterine atony, placental factors, vaginal tears, and coagulation dysfunction. The main clinical manifestation is vaginal bleeding, and excessive bleeding can lead to other complications such as shock and anemia.
1. Increased vaginal bleeding may not be sudden and massive, but may be stable until it causes severe hypotension. Alternatively, it may lead to significant blood loss within a few hours. The clinical manifestations of postpartum hemorrhage vary depending on the cause. Lacerations in the birth canal: Immediate vaginal bleeding with bright red color after delivery may indicate birth canal lacerations. Placental factors: Bleeding that starts several minutes after delivery with a darker color may be due to placental factors. Uterine atony or retained placenta and membranes: Bleeding after placental delivery is mainly caused by uterine atony or retained placenta and membranes. Coagulation dysfunction: If vaginal bleeding is persistent and the blood does not clot, it may be due to postpartum hemorrhage caused by coagulation dysfunction.
2. Large and soft uterus: Within 24 hours after childbirth, the uterus should be globular with its fundus at or below the level of the umbilicus and aligned with the midline of the abdomen. If the uterus is atonic, it may be difficult to palpate or feel very soft. When massaged, the uterus becomes firm, but loses tension when the massage stops.
3. Tachycardia and hypotension: During hemorrhage, the heart rate increases first, followed by a decrease in blood pressure as the bleeding continues. When the pulse rate increases to 100-120 beats per minute and the systolic blood pressure falls below 90-100 mmHg, it usually indicates that the blood loss has reached 25-35% of the total blood volume.
