Post Delivery Bleeding

Overview

Post-delivery bleeding is also known as postpartum hemorrhage. In a normal condition, an average blood loss in vaginal bleeding will be less than 500mL and less than 1000mL for C-section. However, in postpartum hemorrhage, it will be a massive blood loss. There are two types of post-delivery bleeding which are primary and secondary. Secondary post-delivery bleeding is excessive bleeding after 24hours up until 6 weeks postpartum while primary post-delivery bleeding is within the first 2 hours. There are several causes for primary post-delivery bleeding. The common causes are known as the 4T's which are a tone (uterine atony), trauma (genital tract trauma), thrombin (Coagulation disorder such as DIVC secondary to post-delivery bleeding) and tissue (retained placental tissue). On the other hand, causes for secondary post-delivery bleeding are retained product of conception, endometritis, shedding of dead tissue after obstructed labor and breakdown of the uterine wound. The management includes uterine massage, IV ergometrine, Bakri balloon intervention, bimanual compression, and aortic compression.