After pregnancy and once the baby is born, vaginal bleeding is a normal consequence as the body gets rid of all of the supporting tissue left in the uterus. Called lochia, this discharge is perfectly natural and nothing to be concerned about. However, in a small percentage of women, abnormal bleeding occurs and medical care may be required to stem the flow of blood. Abnormal loss of blood from the uterus after birth is called postpartum hemorrhage.
Signs and Symptoms
Sometimes it is hard to distinguish postpartum bleeding from normal lochia. If the blood remains bright red more than seven days after birth, this could be a sign of a problem. Postpartum women who experience chills or fever may also have postpartum hemorrhaging. In normal lochia, the discharge should not smell bad and should not soak a sanitary napkin in under an hour, so these may also indicate abnormal bleeding. If the bleeding tapers off but then returns with any of these signs, it could indicate late postpartum hemorrhage. Abnormal bleeding after pregnancy does not only occur right after birth, but can appear any time up to a month after delivery, according to the Merck Manuals Online Medical Library.
Abnormal bleeding occurs when the blood vessels that supported the placenta during pregnancy do not close off properly after birth. This can happen if the uterus does not contract correctly shortly after delivery. Some things that may lead to postpartum hemorrhage include stretching of the uterus from too much amniotic fluid, prolonged labor or certain pain medications used during labor and delivery.
The main complication from abnormal bleeding after pregnancy is blood loss, which can be fatal if left unchecked. Other complications stemming from extreme blood loss may include low blood pressure and anemia. Even after postpartum hemorrhaging is stopped, it can start up again, so further blood loss is possible.
If abnormal bleeding happens immediately after delivery, the doctor or midwife will try massaging the uterus to get it to contract and may administer a synthetic version of oxytocin, a hormone that promotes uterine contraction. In extreme cases, a blood transfusion could be necessary. If bleeding cannot be stopped by stimulating uterine contractions, doctors can compress the arteries supplying the uterus. Doctors might also check the uterus for tears, cuts or any pieces of placenta that might have been retained if no other cause for abnormal bleeding can be found.
Monitoring of the mother and baby during pregnancy and birth can help reduce the risk of abnormal bleeding after delivery. Doctors can look for potential problems via ultrasound and physical examination and prepare for possible complications in advance. In some cases, it isn't possible to predict or prevent postpartum hemorrhaging, so women are typically monitored for at least an hour after birth to watch for signs of abnormal bleeding.