Heavy Bleeding After Childbirth: Immediate Treatment Can Save Lives – Dr Muhammad Izzat

If I experience heavy bleeding after childbirth, what will I go through?

When heavy bleeding after birth (postpartum haemorrhage) occurs in a hospital, the midwife at the scene will enable the ‘red alert’ to call the medical officers i.e. the doctors to attend the patient and provide immediate treatment. It can happen quickly and may cause worry to you and your partner, especially when out of the blue, there are many medical personnel with you in the maternity room. The doctors and the midwives will calm you by explaining the current situation.

In most cases, the bleeding will stop with these few simple steps:

  • Massaging the uterus at the bottom of your belly button (umbilicus) to stimulate uterine contraction
  • Repetition of Syntocinoninjection, if you have received a shot previously, to assist in uterine contraction
  • A rubber tube is inserted into the bladder to empty the bladder, and to assist uterine contraction
  • Abranulaneedle will be inserted into the two sides of your hands, and a blood sample will be withdrawn. A drip will be initiated.
  • The placenta which had been removed will be examined to ensure it is in its full form and there are no bits of placenta left inside the womb. If there are bits of the placenta left behind, it must be removed and this procedure will be performed in the operating theatre with anaesthetic given in advance.
  • Vagina and perineum tears during childbirth are examined. If there is bleeding, stitches will be performed to stop the bleeding.

Your blood pressure, temperature, and pulse will be checked regularly, and you should be monitored in the maternity room for a while until the situation is stable and there is no bleeding. At this point, breastfeeding can be continued.

If you experience postpartum haemorrhageat the district hospital that does not have an obstetrician, you will be immediately transferred to another hospital equipped with an obstetrician.

 

Although major steps have been taken, what if I experience continuous postpartum haemorrhage?

If continuous bleeding occurs and you have lost more than 1 litre of blood, an obstetrician will be called to treat you.

When you have lost a lot of blood, you will start to experience dizziness, nausea, palpitations and may even lose consciousness. Oxygen through a face mask and additional drip will be given pending arrival of the blood supply for transfusion.

Additional drugs will be given to stop the bleeding.

If bleeding still persists, you will be immediately taken to the operating theatre, so the obstetrician can determine the cause of the bleeding (haemorrhage). You will be given an anaesthetic beforehand. However, your husband is not allowed to enter the operation theatre. He may stay with the baby or wait outside the operating theatre, so the doctor can advise your latest situation to your husband.

There are several important procedures that may be performed by the doctor to control the bleeding:

  • A ‘balloon’ will be inserted into the uterus to put pressure on the wall of the uterus to stop bleeding. The balloon will be released in the next day.
  • Surgical laparotomy will be performed to ascertain the overall condition of the uterus and identify the cause of bleeding
  • If all the steps that have been taken fail to stop the bleeding, the last option would be the uterus removal.
  • There are some hospitals that provide uterine artery embolization facilities, where a form of chemical is injected into the blood veins of the uterus to obstruct the blood flow to the uterus, hence, it will reduce bleeding.

After bleeding is controlled and stop, you will be transferred to the maternal intensive care ward where you will be closely monitored until you are stable to be transferred to the normal postnatal ward.

 

I have experienced postpartum haemorrhageduring my previous pregnancy, is there any possibility that this will repeat during my next pregnancy?

If you experienced postpartum haemorrhageduring a previous pregnancy, you are at higher  risk for to experience it during your next pregnancy. 1 in 10 women will experience a recurrence of this problem. Therefore, you are advised to give birth in a hospital with an obstetrician to ensure that immediate steps can be taken should you develop postpartum haemorrhageagain.

When you are pregnant, you are advised to take iron supplements to reduce the risk of a shortage of red blood cells (anaemia).

Choosing to give birth by a caesarean surgery will not reduce your risk of postpartum haemorrhage.

This article is a sequel to the https://www.mmgazette.com/tumpah-darah-selepas-bersalin-nyawa-ibu-menjadi-taruhan-dr-muhammad-izzat/ and was written by Dr Muhammad Izzat bin Abdul Razak. He is currently serving at a hospital in Kuala Lumpur as a registrar of obstetrics and gynaecology.

 

Reference:

  • Heavy bleeding after birth (postpartum haemorrhage) Information For You, by Royal College of Obstetricians & Gynaecologists United Kingdom. Published in June 2013 (next review in 2016)

This article was translated by Nurul Aini Ahmad from https://www.mmgazette.com/tumpah-darah-selepas-bersalin-rawatan-segera-usaha-selamatkan-nyawa-dr-muhammad-izzat/

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