Recognize the Causes of Post Partum Bleeding That Can Result in Death

Post partum hemorrhage or bleeding after childbirth, is still the main cause of death in pregnant women, especially in developing countries. Some of the accompanying symptoms of post partum hemorrhage include increased heart rate, decreased blood pressure, and pain in the vagina. Post partum hemorrhage is generally due to the opening of blood vessels in the uterus where the placenta attaches to the uterine wall when pregnant. In addition, blood can also come out of a tear in the birth canal that occurs when a woman goes through an episiotomy procedure during labor.

Various Causes of Post Partum Bleeding

Each patient's body has a different reaction when there is bleeding. However, there are some cases that have more severe post partum hemorrhage. The following are things that can cause excessive postpartum hemorrhage (PPH):
  • Post partum hemorrhage that occurs due to a tear or a wide incision episiotomy in the perineum or vagina.
  • Uterine atony is a condition in which uterine muscle tone is lost so that it cannot contract, compress vessels and reduce blood flow. This situation is the main cause of post partum hemorrhage.
  • Placenta previa is a condition when the baby's placenta closes all or part of the cervix that connects with the upper part of the vagina.
  • Thrombin enzyme deficiency can cause bleeding disorders due to failure of blood clots.
  • A ruptured uterus (rupture) can also cause post partum hemorrhage. However, this case is a rare condition.

How to Overcome Post Partum Bleeding and Prevention

The goal of the treatment of post partum hemorrhage is to stop the cause of the bleeding as soon as possible. Here are some ways to deal with post partum hemorrhage:

  • Oxytocin massage and infusion

    • After the placenta comes out, the uterus should continue to contract until the blood vessels close again. But under certain conditions contractions do not occur. This process can usually be assisted by nurses by massaging the stomach, this action is known as massage of the uterine fundus. In addition, the breastfeeding process that releases the natural hormone oxytocin can also help speed up this process. In addition, doctors can administer the synthetic oxytocin hormone through an IV to help contractions.

  • Foley catheter balloon

    • Developing a Foley catheter balloon placed in the uterus, can put pressure on open blood vessels. This action helps temporarily stop bleeding, until other actions can be taken.

  • Removing the placenta

    • Placenta that has not come out yet needs to be removed manually. This procedure will be performed by a trained doctor or midwife. Previously will be given pain medication.

  • Medication to stimulate uterine contractions

    • While continuing to massage, the doctor will give drugs other than oxytocin, to stimulate uterine contractions so as to stop bleeding.
The doctor may also need to examine the remaining placenta in the uterus by inserting a hand into the vagina. In some cases, curettage is necessary to clean the uterus and remove the remaining placenta. In more severe cases, laparotomy (abdominal surgery) may be needed to find the cause of bleeding or even hysterectomy, which is surgical removal of the uterus to stop post partum bleeding. Hysterectomy is the last resort in most cases. After the bleeding stops, the patient may feel very weak. Therefore, patients will get intravenous fluids and blood transfusions. Women who experience post partum hemorrhage may also experience anemia so they need lots of rest and consume enough fluids and nutritious food. Your doctor may prescribe folic acid and iron supplements. To prevent post partum hemorrhage, periodic pregnancy checks can be done. Your obstetrician will do an examination, and consider your risk factors and condition during pregnancy. If you have a rare blood group, bleeding disorders, or a history of post partum hemorrhage, your doctor can prepare an appropriate delivery plan.

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