How much bleeding after childbirth. Postpartum bleeding and personal hygiene after childbirth After childbirth, how many blood

How to avoid heavy bleeding after childbirth

In some cases, heavy bleeding in the postpartum period can be avoided. To do this, you must follow these simple rules:

• Go to the toilet at least once every 3 hours. You need to do this for several days in a row. Never ignore the urge to urinate. The fact is that a full bladder puts a lot of pressure on the uterus and because of this, it begins to contract poorly, which results in bleeding.
• Breastfeed as often as possible. Ideally, this should be done at the first request of the baby. When breastfeeding occurs, the synthesis of a hormone called oxytocin, which stimulates uterine contractions. Therefore, when the child suckles the breast, the blood goes faster, and there are severe pains in the lower abdomen, which are like pain during contractions.
• Observe the rules of personal hygiene. Thanks to this, it is possible to avoid the development of inflammation in the pelvis.
• Lie only on your stomach. Even while sleeping, try to take this pose. The fact is that in this position, clots come out of the uterus, and its contraction also occurs.
• Apply cold to the abdomen from time to time. This should be done on the first day after natural childbirth. Ice will speed up the contraction of the uterus and strengthen the blood vessels.

Although bleeding in the postpartum period is a natural process, it can lead to profuse blood loss. Every woman in labor should remember this and carefully monitor her health, especially in the first days after the birth of the baby.

Childbirth is always accompanied by blood loss. This is a natural process that usually does not exceed the physiological norm. But sometimes, after childbirth, uterine bleeding develops, which threatens the life of a young mother. This is an emergency situation and it requires prompt and well-coordinated work of a gynecologist, midwife and anesthetist. Why is hypotonic bleeding dangerous? And what if it developed a month or two after discharge from the hospital?

Physiology of blood loss

For each woman entering the maternity hospital, the doctor must calculate the physiologically acceptable blood loss. To do this, mathematically find 0.5% of body weight. For example, for a woman in labor with a weight of 68 kg, this volume will be 340 ml. Blood loss of 0.7-0.8% or more is considered pathological.

In childbirth, the volume of blood lost is calculated most often by collecting it in a special tray. It is placed under the buttocks of the woman in labor, and bloody discharge flows freely into it. In addition, weighing of diapers is used.

Other methods for assessing blood loss are also used, but in practice the assessment is most often used. clinical condition and hemodynamic parameters. There are three degrees of severity of the condition:

• 1 degree - there is weakness, palpitations up to 100 beats per minute. The skin becomes pale, but remains warm. The pressure is low, but not lower than 100 mm Hg. Art. Hemoglobin is not critically reduced, up to 90 g/l.
• Grade 2 - weakness increases, severe tachycardia over 100 beats per minute worries. Systolic pressure drops to 80 mm Hg. Art. Pale skin becomes moist. Hemoglobin decreases to 80 g/l.
• Grade 3 - a state of shock, the skin is pale and cold. The pulse is palpable with difficulty, it becomes threadlike. The pressure is critically low, urine output stops.

The state of acute blood loss is very dangerous in the postpartum period. This is due to the peculiarities of hemostasis in a pregnant woman.

Dangerous symptoms in the delivery room

After giving birth, the woman remains in the delivery room for 2 hours under the supervision of medical staff. During this period, hypotonic bleeding most often occurs. It is characterized by a sudden onset against the background of apparent well-being and a rapid course: in a short period of time, the puerperal can lose up to a liter of blood. Such a volume can be critical and lead to rapid decompensation, the development of hemorrhagic shock and death.

Therefore, in order to notice adverse signs in time, to have time to respond to them and reduce the time for rendering assistance, the patient does not shift from the chair to the couch or gurney: in the gynecological chair they will provide medical assistance in the event of a critical situation.

How long does bleeding last after childbirth?

It all depends on individual characteristics. It continues directly in the delivery room, when transferred to the ward, and even during the first day it looks like liquid blood. By the second day, it is no longer blood, but lochia, thicker in consistency, containing a mucous component. Over the next four days, the discharge decreases, first becomes dark brown, and then gradually brightens. Lochia continues to stand out for another month.

Signs of bleeding in the early postpartum period are difficult to determine on their own. It is accompanied by weakness, which already worries a woman after childbirth. There may be a feeling of chills, but this is also a non-specific symptom. After muscle tension during the straining period, the puerperal may experience a period of muscle trembling, which is difficult to distinguish from a state of severe blood loss.

While the patient lies motionless, blood can accumulate in the uterine cavity, gradually stretching it. When pressing on the uterus through the abdominal wall, a large amount of blood is released, sometimes with large clots. Gradually, normally, this amount should decrease. But with the development of pathology, this does not happen.

Measurement required blood pressure. With a significant decrease, as well as an increase in signs of tachycardia, a conclusion is made about significant blood loss.

Why won't the bleeding stop?

The causes of postpartum hemorrhage are to reduce the contractility of the uterus. Several risk factors influence this:

• large fruit;
• diseases of the blood coagulation system.

Also increase the risk of excessive postpartum blood loss frequent childbirth. If a woman has a break between births that does not exceed two years, and births are more than four, then hypotension must be prevented.

The immediate cause most often becomes a delay in the uterine cavity of parts of the placenta or fetal membranes. To prevent this condition, after the birth of the placenta, the midwife carefully lays it out on the diaper, blots it from the blood, aligns and matches the edges. This allows you to assess whether all parts have separated from the walls of the uterus and come out.

The delay of any parts in the uterine cavity violates its contractility. The vessels to which the placenta was attached do not collapse and bleed. Release from the placenta is also important active substances that prevent blood clotting.

Sometimes blood loss in the postpartum period is the result of tight attachment or. In this case, in the first case, the villi are woven into the tissues of the uterus and can be separated manually. And in the second case it is impossible to do it. The only way to save a woman is to have a hysterectomy.

Emergency care for postpartum hemorrhage includes a mandatory manual examination of the uterine cavity. The purpose of this manipulation is as follows:

1. Determine the presence in the uterine cavity of the remnants of the placenta or membranes.
2. Determine if the organ has a contractile potential.
3. Determine if there are ruptures of the uterine wall.
4. The ability to identify organic abnormalities that can cause bleeding, for example, a myomatous node.

The sequence of actions of a doctor during a manual examination includes the following steps:

1. The volume of blood loss and the condition of the woman are assessed.
2. The external genitalia are treated with antiseptics.
3. Anesthesia and contraction drugs are given (or uterotonics are continued).
4. The hand is inserted into the vagina and gently into the uterine cavity.
5. All clots and parts of pathological tissues are gradually removed.
6. The tone of the uterus is determined. It should be tight.
7. The hand is removed, the birth canal is assessed for damage, which can also cause bleeding.
8. The condition of the woman in labor is reassessed. Compensation for blood loss is carried out using solutions of crystalloids and colloids. If necessary, transfusion of blood plasma or uniform elements is performed.

Additional actions to stop hypotonic bleeding after manual examination are the following:

1. Introduction of additional reduction funds. Usually, a solution of methylergometrine is used for this purpose. It is administered while maintaining the drip of oxytocin.
2. You can inject oxytocin into the cervix to improve its contractility.
3. Swabs soaked in ether are inserted into the posterior fornix of the vagina. Bleeding should stop reflexively.
4. Evaluate blood loss and compensate for it.

The uterus does not always respond to ongoing activities, and its contractility. This condition is called atonic bleeding.

If blood loss continues after manual examination, the following tactics are used:

1. There are a lot of receptors on the posterior lip of the cervix that are responsible for contractility. Therefore, suturing is used with a thick catgut ligature on this area according to Lositskaya. Bleeding should reflexively stop.
2. In case of ineffectiveness, clamps are applied to the uterus by passing them through the vagina. This is due to the anatomical location of the uterine artery.

But if in this case the condition continues to worsen, the only way to help is surgery. During it, it is possible to save the organ if the intervention is carried out in a short time and special intraoperative methods are used.

You can reflexively stop blood loss by tying the vessels according to Tsitsishvili. To do this, they tie up the vessels that pass in the round ligament of the uterus, the own ligaments of the ovary. A more outdated method is electrical stimulation. The last way is . It is resorted to with the ineffectiveness of previous manipulations, and if the loss is more than 1200-1500 ml.

Bleeding in the room...

The postpartum period can be complicated by bleeding a few days after birth. There are symptoms that should alert a woman. The first sign is a decrease in the number of lochia. They become scarce or. This must be reported to the doctor.

Earlier postpartum hemorrhage develops when the cervix is ​​blocked by clots that do not allow the lochia to flow normally. They stagnate in the uterine cavity, leading to its subinvolution. This symptom is clearly visible on ultrasound.

Diagnosis is necessarily carried out in the postpartum period for all women in order to exclude this pathology. On ultrasound, signs of subinvolution are:

• expansion of the uterine cavity more than 1 cm;
• discrepancy between the size of the organ to the postpartum period;
• the presence of homogeneous contents in the cavity.

After a long absence of discharge, sudden bleeding may begin. Therefore, treatment is carried out immediately after diagnosis. To do this, it is necessary to eliminate the remnants from the uterine cavity that prevent it from contracting. By the third day, the neck is already beginning to form, so the procedure cannot be performed only by hand, a surgical instrument is needed.

To remove the remnants of the membranes, clots, use a curette. She is carefully scraped. After the procedure, an intravenous solution of oxytocin or methylergometrine is administered to improve contractility. Be sure to replenish blood loss with special saline solutions.

The duration of the discharge in this case should correspond to those during normal childbirth.

...and on the operating table

In most cases, there are no emergencies during a caesarean section. But sometimes the variant anatomy of the location of organs and vessels can lead to an inadvertent injury to one of them, and, as a result, to internal bleeding which will appear already on the operating table.

Very rarely, its cause is the divergence of the seams in the postoperative period. Then the puerperal has all the symptoms of hemorrhagic shock:

• pale skin;
• cold sweat appears;
• tachycardia is observed;
• blood pressure drops sharply.

There may also be symptoms of irritation of the peritoneum by the outflow of blood. The clinical protocol in this case provides for the only way to stop the blood - abdominal operation, which will allow you to find a bleeding vessel and bandage it.

The woman is usually in critical condition. Replenishment of blood loss is possible with blood substitutes, colloid and crystalloid solutions, plasma, uniform elements. Sometimes they collect their own blood poured into the abdominal cavity and return it back to the bloodstream through a vein.

After being discharged home

Bleeding in the late postpartum period occurs after discharge home. Its symptoms are similar to the processes that occur during subinvolution of the uterus. The release of lochia suddenly stops, after a while there is a cramp-like pain in the abdomen. Blood clots come out of the genital tract, causing blood retention in the uterus. After this, profuse bleeding usually begins.

If you experience these symptoms, you should seek immediate medical attention medical care. Treatment is no longer carried out in the hospital, but in a gynecological hospital. The correct tactic is to. Be sure to prescribe oxytocin drip.

To continue therapy at home, oxytocin tablets are prescribed.

The development of bleeding in the late postpartum period - a month or 2 months after birth - is an alarming symptom that may be a sign of a placental polyp. This is a neoplasm that occurs at the site of the remaining placental villi. They are covered with fibrin clots, connective tissue and outwardly initially look like a flat formation. Bleeding is the main symptom of this pathology. Its consequence can be severe anemia, endometritis, sepsis and infertility in the long term.

Diagnosis is based on ultrasound of the pelvic organs. Further tactics include conducting, during which you can finally verify the presence of a pathological formation and remove it. In some cases, they are limited to separate diagnostic curettage, followed by histological examination received material.

Prevention is easier than cure

Prevention of bleeding in the postpartum period is the proper management of pregnancy and childbirth. The anamnestic and clinical data of a particular pregnant woman are assessed and a risk group for the development of bleeding is established. These mothers need special attention. Already in childbirth, they are prescribed oxytocin, but not to enhance labor activity, but to reduce the risk of massive blood loss. Prevention measures include examining the child's place, a thorough revision of the birth canal and suturing the existing ones.

Restoration of the menstrual cycle

Sometimes menstruation begins even during breastfeeding.

How to distinguish between menstruation and bleeding after childbirth?

It is necessary to focus on the normal amount of blood lost during menstruation. On average, for all days, it should be no more than 100 ml. In this case, menstrual blood can come out in small mucous clots - rejected endometrium. In the first, second, sometimes third, the intensity of the secretions is slightly greater, but gradually this process should decline.

The duration of menstruation after childbirth may differ from that before pregnancy. Normally, it is 3-7 days. With an extension of this period, as well as with heavy discharge, which does not decrease in accordance with the days of the cycle, you should consult a doctor.

The problem of bleeding in the postpartum period does not lose its relevance, regardless of the level of development of medicine. Sometimes it is impossible to predict how the uterus will contract, how tightly the placenta is attached, and whether it will be able to fully stand out on its own. Therefore, women who decide to experiment with childbirth should also be aware of such a risk to their own lives, in which a few minutes are allotted for medical assistance.

Having given birth to a child, a woman feels joy and relief. Now she can fully feel like a mother. But there may be some troubles that can overshadow this period. It's about postpartum hemorrhage. In most cases, everything is not as scary as it seems, because many understand this term even meager discharge which are running normally. However, a deviation from physiological parameters can pose a serious danger, which requires close attention from the woman in labor.

General information

The postpartum period begins from the moment the placenta leaves the uterus - the placenta with membranes - and lasts for 6 weeks. During this time, involutive (reverse) changes occur in the reproductive system and organs that have undergone changes during pregnancy. In other words, female body gradually returns to its original state.

Immediately after childbirth, the inner surface of the uterus is an almost continuous wound surface. But due to the contraction of muscle fibers, its size is minimized. The uterus decreases in volume, descending lower and lower into the cavity of the small pelvis and on the 10th day is already behind the pubic joint. This contributes breast-feeding during which the hormone oxytocin is produced.

At the end of 2-3 weeks, the cervical canal also closes. But the mucous membrane - the endometrium - requires a longer recovery. The basal epithelium grows by 10 days after birth, and the complete formation of the functional layer will occur only by the end of the entire period.

Normal changes

It is very important for women to know how long bleeding after childbirth lasts and how heavy it can be. Physiological secretions that are observed during this period are called lochia. In the first 2–3 days, they are quite abundant and consist mainly of blood with clots. In general, the volume of blood loss in the afterbirth and early postpartum periods should not exceed 0.5% of the woman's body weight. This is considered the norm and is not able to have a negative effect on the body.

But already at the end of the first week, the discharge becomes more scarce, acquiring a brownish tint. Only under the influence of certain factors, such as exercise stress, sexual intercourse or straining, there is an increase in lochia. Over time, they transform into sanious or yellowish, completely disappearing at 6 weeks. But if the spotting is prolonged, becomes abundant or resumes after a break, then you should definitely consult a doctor. And the specialist will already determine what is the reason and give appropriate recommendations.

Physiological secretions are especially abundant during the first 3 days, and then they decrease and become less bloody.

Pathological processes

Postpartum hemorrhage is a serious obstetric pathology that is fraught with a real danger to a woman's life. It can occur in different periods, which is reflected in the existing classification:

• Early - within the first 2 hours.
• Later - for the remaining 6 weeks after birth.

When a woman loses more blood than expected, it is necessary to figure out what this is connected with and what measures to take. But this must be done in the shortest possible time.

Causes

The appearance of bleeding after childbirth is a rather formidable sign, indicating deviations during the physiological period or certain disorders in the woman's body. The causes of this pathology are:

• Violation of the separation of the placenta and placenta (tight attachment, increment, retention or pinching of individual particles in the uterus).
• Reduced uterine contractility (hypo- or atony).
• Disorders in the coagulation system (coagulopathy).
• Traumatic injuries of the genital tract.

It should be said that most of these conditions have their own predisposing factors and provoking aspects. They must be taken into account when carrying out diagnostic measures. For example, hypo- or atony of the uterus often occurs in women with concomitant phenomena and problems:

• Polyhydramnios, large fetus, multiple pregnancy (distension of the uterus).
• Tumor processes (myomas, polyps).
• Late toxicosis.
• Anomalies in the development of the uterus (saddle-shaped, bicornuate).
• Placental complications (previa, true increment, detachment).
• Neurohormonal disorders and endocrinopathies.
• Weakness of labor activity.
• Operational interventions.
• Inadequate drug therapy (with the appointment of uterotonics, antispasmodics, tocolytics).

Causes of coagulopathic bleeding can be common diseases hemostasis systems or hemorrhagic diathesis, which include hemophilia, von Willebrand disease, hypofibrinogenemia and others. But much more important are secondary conditions, in particular, DIC (disseminated intravascular coagulation). It develops under various conditions:

• Premature detachment of the placenta.
• Gestosis (severe preeclampsia, eclampsia).
• Frozen pregnancy.
• Amniotic fluid embolism.
• Massive blood loss.
• Transfusion of a large volume of blood.
• extragenital diseases ( diabetes, heart defects, renal and hepatic pathology, oncology).

Given the diversity probable causes each case requires individual consideration. To understand what processes have become the source of bleeding, an appropriate examination is necessary. And only a doctor can carry out a full diagnosis, so the only way to solve the problem lies through the consultation of a specialist.

The causes of postpartum hemorrhage can be various conditions - associated with obstetric complications, gynecological or extragenital pathology.

Symptoms

Bleeding in the early stages, i.e., in the first 2 hours after childbirth, can occur for almost any of the reasons mentioned above. But most often we are talking about placental (afterbirth) anomalies, uterine hypo- or atony. There may be signs of coagulopathy, but this is less common. In the first case, there is a delay in the placenta in the uterus - it does not come out for half an hour - or appears with a defect on the surface (signs of an additional lobule). The doctor checks for special symptoms that indicate the separation of the placenta:

• Schroeder - the uterus becomes narrower and lengthens, deviating to the side.
• Alfeld - lengthening the outer edge of the umbilical cord.
• Kyustner-Chukalov - when pressed over the pubis, the umbilical cord is not retracted.

If they are negative, then the placenta is still attached to the uterus and auxiliary techniques are required to remove it and, accordingly, stop the bleeding. With hypotension, the uterus may initially contract normally and then relax, leading to a gradual increase in symptoms.

There are also reverse cases, when massive blood loss occurs immediately. On palpation, the uterus is soft to the touch, enlarged - the bottom is located above the navel line. She does not respond to external stimuli: massage or the introduction of uterotonics. Abundant bleeding leads to an increase in general symptoms:

• Dizziness.
• Weakness.
• Pallor.
• Pressure drop.
• Pulse increase.

Uncontrolled bleeding leads to hemorrhagic shock and DIC. And the latter is characterized by microcirculatory and ischemic disorders due to numerous thromboses of small vessels. But in the future, hypocoagulation develops due to the depletion of the reserves of the coagulation system. In turn, this is manifested by the following symptoms:

• Hemorrhages in the skin and mucous membranes.
• Bleeding from various parts of the body: uterus, surgical wounds, teeth, kidneys, lungs, gastrointestinal tract.
• Local necrosis of the skin and mucous membranes.
• Multiple organ failure.
• Anemia and intravascular hemolysis.
• Euphoria, disorientation, impaired consciousness.

This is a very serious condition that poses a threat to the life of the puerperal. Severe and neglected cases, unfortunately, end unfavorably. But with early emergency measures, the prognosis is much better.

Another situation in which blood may appear after childbirth is the rupture of a woman's genital tract. They are observed quite often, especially with a large fetus, post-term pregnancy, rapid labor and the use of assistive devices (obstetric forceps). Bleeding can become protracted and noticeable already in the early period. Tears often spread to neighboring tissues: from the vagina to the perineum, from the cervix to the uterus. When damaged urinary tract blood will come out of the urethra (hematuria).

Clinical symptoms in postpartum hemorrhage can vary significantly, which facilitates the diagnosis. But common signs also exist.

Additional diagnostics

To accurately determine the cause of spotting after the birth of a child, the doctor will prescribe additional studies. Depending on the situation, they are carried out in a planned or urgent manner. As a rule, the following diagnostic procedures are necessary:

• deployed general analysis blood (erythrocytes, platelets, hemoglobin, hematocrit, color index, ESR).
• Coagulogram (fibrinogen, prothrombin index, plasma clotting and recalcification time, fibrinolytic activity).
• Ultrasound of the uterus.
• Hysteroscopy.
• Colposcopy.

It is necessary to establish the cause of bleeding as early as possible, in which the results of additional studies help. Focusing on them, the doctor will prescribe a therapeutic correction to the woman to eliminate the source of the pathology and its consequences. And by what methods this will be done - conservative or surgical - depends on the severity and origin of bleeding. But in any case, you can hope for a full recovery of health.