Postpartum hemorrhage is one of the leading causes of maternal death and disability worldwide. In addition, postpartum bleeding can be prevented with early diagnosis. Gynecology and Obstetrics Specialist Op. Dr. Gönül Çimen wrote about postpartum bleeding.
While 500 ml of bleeding after vaginal delivery and 1000 ml of bleeding after cesarean section is expected, bleeding above these amounts is defined as excessive bleeding. Identifying patients at high risk of bleeding, interventions to prevent bleeding, early diagnosis, and timely and appropriate management play a key role in preventing maternal deaths.
Unstoppable Bleeding May Have Consequences Such as Removal of the Uterus
Postpartum bleeding; It is divided into two: early (those in the first 24 hours) and late (those between 24 hours and 12 weeks). The most common cause of early bleeding is; Uterine atony is the inability of the uterus to contract sufficiently. The vascular openings in the uterus, which cannot contract, remain open and excessive bleeding occurs. Therefore, atonia is a serious emergency that requires rapid intervention. The aim of the intervention is to ensure contraction of the uterus and prevent deterioration of the mother's circulatory system. Some drug treatments are applied for this. Blood products are administered to patients when necessary. If there is a response to the medications, contractions occur and bleeding decreases, the mother is followed up appropriately. However, if bleeding continues despite all the interventions, the mother is taken into surgery and attempts are made to stop the bleeding with various surgical techniques or by removing the uterus. After the operation, the mother is cared for and treated under intensive care conditions until the threat to her life disappears.
There Are Many Risk Factors in Postpartum Bleeding
The risk for atony bleeding is higher. "Identifying pregnant women with high rates of pregnancy and correcting changeable causes are the precautions to be taken," said Dr. Çimen: “Multiple pregnancy, large baby, excess amniotic fluid, giving birth 5 or more times, rapid birth or prolonged labor, mother's history of atony in previous births, maternal overweight, fibroids, before or during birth "Some medications used are risk factors for the development of atonia," he said.
Do� Other causes of post-um bleeding are;
- Abnormalities due to the placement of the placenta,
- Placenta or membrane fragments remaining in the uterus,
- Genital injuries in the duct,
- Uterine rupture and
- Bleeding-coagulation disorders in the mother.
Dr. Çimen : “In placentation anomalies, factors such as the placenta covering the cervix, previous surgery related to the uterus (such as caesarean section, myoma removal), advanced age of the mother, and smoking of the mother are factors. It is also the most common reason for hysterectomy after birth. In this respect, it is important for patients diagnosed during pregnancy to be delivered in appropriate centers. For injuries occurring in the genital tract, the genital area must be examined carefully and repairs must be made in bleeding areas. For this examination, it is important that the woman who has given birth assists the physician and allows the examination. Remaining parts of the placenta or membrane in the uterus also causes abnormal bleeding. We detect this with ultrasound. "We evacuate these remains with surgical intervention in order to both prevent bleeding and eliminate the risk of infection," said Dr. Çimen: “Postpartum hemorrhage is the leading cause of maternal deaths. Because the blood flow in the pregnant uterus increases (600 ml / min), the bleeding that may occur is quite high and will affect the patient's hemodynamics in a short time. "The main reason for the deaths is that the diagnosis is made late and the amount of bleeding cannot be determined objectively," he said and added: "It is important for the person responsible to follow up closely and inform the relevant parties in case of even the slightest suspicion."
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