Are you aware of complications related to bleeding after giving birth?

By: - 22nd August 2019
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Childbirth is a challenging experience for any mother. However, the determination and love to see and hold the little one who was inside of them for 9 months drives every mum to take on this difficult but rewarding experience. In our previous articles, we have spent time and effort to educate you on your journey from pregnancy to childbirth. In this article, we will look at certain things you need to be aware of after giving birth to your child.

One crucial aspect that you need to pay attention to is bleeding. Bleeding after childbirth is a natural occurrence. However, you need to be able to identify when the bleeding becomes severe or unnatural. This will help you reach out to a medical professional in due time and receive proper assistance and help.

After childbirth, it takes roughly 6 weeks for your body’s tissues and pelvic organs to become normal again. This period is categorised into three phases:

  • First 24 hours after giving birth.
  • After 24 hours - 7 days.
  • After 7 days - 3 weeks.

During this time, you will have a vaginal discharge, known as Lochia. This discharge has a unique odour but is not an offensive one. If there is an offensive odour, then this could mean that there is an infection. Typically the Lochia discharge will keep on occurring for up to 3 weeks, and as long as there's no sign of infection or offensive odour, this is perfectly normal.

There are three types of Lochia discharge:

  • Lochia rubra
  • Lochia serosa
  • Lochia alba
Lochia rubra

This discharge typically has a reddish colour and will be visible during the first 3 - 5 days after childbirth. It is made up of mainly red blood cells and remaining tissue.

Lochia serosa

This discharge is not as red in colour as the Lochia rubra. It has a pink colour due to the presence of less red blood cells and more white blood cells. It also includes discharges from internal wounds and tissue and mucus. You can expect this discharge to cease after about 5 - 9 days.

Lochia alba

This discharge starts typically after 10 days from childbirth and will continue for 5 more days. It is more of a white colour with a slightly sticky texture and includes white blood cells, other cells and mucus.

Abnormal bleeding after childbirth

Bleeding that occurs after 6 weeks from childbirth is known as postpartum hemorrhage PPH. Excessive postpartum bleeding is the leading cause of mortality in mothers after childbirth. Bleeding of more than 500 ml of blood is also known as Postpartum haemorrhage. This could happen in two stages.

  • Primary haemorrhage that happens within the first 24 hours after childbirth.
  • Secondary haemorrhage that occurs after 24 hours is completed from childbirth.

If you undergo a Caesarean section (C-section), you could bleed close to 750 - 1,000 ml.

However, it is practically impossible to measure the exact amount you bleed after childbirth. Most often, what can be measured is almost half of the bleeding that actually occurs. For example, blood can be mixed with fluids that are absorbed into gauze or other clothes. One more important fact to remember is that the amount of bleeding a woman can bear will also be dependent on her haemoglobin levels. Therefore, the impact of PPH cannot be purely measured just by the volume of blood that was bled.

Even a mother who does not suffer from anaemia can be at life risk if PPH is excessive. Furthermore, continuous bleeding can lead to psychological distress. Therefore, every mum should take all necessary steps to help minimise PPH during the third stage of labour.

Why does PPH occur?
  1. When the womb does not contract in size after childbirth. This is a frequent but dangerous incident.
    Factors that result in this include:
    • The womb being excessively stretched (due to twins, excessive abrasive fluids, the child being abnormally large).
    • Multiple childbirths (where womb muscles have decreased and replaced by fibrous ligaments)
    • Prolonged labour.
    • Using Syntocinon (an oxytocin) to stimulate contractions.
    • General anaesthesia.
    • Placenta previa (placenta lies low in the uterus).
    • Placental abruption (the placenta separates from the inner wall of the uterus before birth).

  2. Placenta not detaching in full after childbirth. When the placenta is attached to the womb this will prevent the womb from contracting in size.
  3. Parts of the placenta remaining.
  4. Tears/ Injuries to the vagina.
  5. Inverted uterus.
  6. Bladder being full of urine. This will prevent the womb from contracting normally.
  7. History of PPH or retained placenta from previous pregnancies.
  8. Womb having tumours such as fibroids.
  9. Mother’s blood haemoglobin levels being less than 10 g/dL. This is known as anaemia.
  10. Uterine eruption
Secondary haemorrhage

This is bleeding that occurs after the completion of the first 24 hours and during the first 6 weeks after childbirth. Typically, secondary haemorrhage starts occurring within day 8 and 14.

Reasons for secondary haemorrhage
  1. Uterine infection.
  2. In this situation, there is likely to be fever or an vaginal discharge with an offensive odour. Mothers who could be at risk of this are:

    • Those who have had caesarean surgery.
    • Those who have had a premature rupture of membrane. If this happens, abrasive fluids will start flowing out of the vagina. This creates a connection between the womb and the external environment which could result in unwanted germs and bacteria entering the womb.
    • Extended labour.
  3. Retained placental fragments or tissue.
  4. Placenta accreta, where the placenta is attached abnormally into the womb walls and remains attached to it.
Complications that occur with PPH
  • Excessive blood haemorrhaging can result in stress and death.
  • The occurrence of anaemia after childbirth.
  • Pituitary glands becoming dysfunctional (very rare). This occurs when blood circulation to the pituitary glands is reduced.
  • Fear resulting in mothers not wanting to become pregnant again.
Prepared in consultation with Dr D M I Dissanayake of Anuradhapura Teaching Hospital.

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