Contents
5 questions about the hemorrhage of the deliverance
How to recognize a bleeding from the delivery?
Normally, a quarter of an hour to a maximum of half an hour after the baby is released, the placenta detaches from the uterine wall and then migrates outward. This stage is accompanied by moderate bleeding, quickly stopped by the work of the uterus which constricts the uteroplacental vessels. When a mother, within 24 hours of giving birth, loses more than 500 ml of blood, it is calledhemorrhage from the delivery. This can occur before or after the delivery of the placenta and affects approximately 5 to 10% of childbirth. It is an emergency immediately taken care of by the medical team.
Why can we bleed from the delivery?
In some future mothers, the placenta is inserted too low towards the cervix or adheres abnormally to it. At the time of delivery, its detachment will be incomplete and cause excessive bleeding.
More frequently, the concern comes from the uterus which is not performing its muscular work properly. This is called theuterine atony. When everything is going normally, the bleeding from the vessels of the placenta after delivery is stopped by the contraction of the uterus which allows them to be compressed. If the uterus remains soft, bleeding persists. Sometimes a small piece of the placenta can remain in the uterine cavity and prevent it from contracting completely, increasing blood loss.
Bleeding during delivery: are there mothers at risk?
Certain situations can favor this complication. In particular those where the uterus has been too distended. This is the case of pregnant women who are expecting jumeaux, a big baby, or who have too much amniotic fluid. Women who suffer from hypertension or diabetes during pregnancy are also more at risk. Likewise those who have given birth several times or have already undergone a bleeding from the delivery in previous pregnancies. The very long deliveries are also implicated.
How is the delivery hemorrhage treated?
Several solutions exist. First, if the placenta is not expelled, the gynecologist will perform an obstetric maneuver called “ artificial deliverance “. It consists, under epidural or under general anesthesia, in going to search manually the placenta.
If any placental debris is left inside the uterus, the doctor will remove it directly by performing a “uterine revision”. To allow the uterus to regain its tone, a gentle and continuous massage can be effective. More frequently, drugs given through the veins allow the uterus to contract very quickly.
Exceptionally, when all these methods fail, the gynecologist is sometimes forced to consider a surgical operation or to call on a radiologist for a very specific procedure.
In addition to these methods, if you have lost too much blood, you will be taken care of by the anesthesiologist who will decide whether or not to give you a transfusion.
Can we avoid the bleeding of deliverance?
All new mothers are kept in the delivery room for a few hours to check the correct retraction of the uterus and to assess the extent of postpartum bleeding.
A increased vigilance at the time of delivery is required in mothers at risk, and to prevent any complications, the gynecologist or midwife performs a ” directed delivery “. This involves injecting oxytocin (a substance that contracts the uterus) intravenously, very precisely when the baby’s front shoulder emerges. This allows very rapid expulsion of the placenta after the birth of the child.
During pregnancy, mothers who have already had hemorrhage from the delivery will receive iron supplementation in the third trimester to reduce the risk of anemia.