Bleeding in the early postpartum period - the allocation of blood from the birth canal in the first 2 hours after delivery . It is normal in the postpartum period, if it does not exceed 0.5% of the womanβs body weight (300-400 ml). Bleeding is associated with the separation of the placenta from the uterine wall. Bleeding in excess of 400 ml in volume is considered dangerous and occurs, as a rule, in the case of hypotension or atony of the uterus, which can be fatal.
| Postpartum hemorrhage | |
|---|---|
| ICD-10 | O 72.1 , O 72.2 , |
Content
Epidemiology
The frequency of bleeding in the early postpartum period is 2-5% of the total number of births. By the time of occurrence, early and late postpartum hemorrhages are distinguished. Postpartum hemorrhage that occurs within 24 hours after childbirth is considered to be early or primary, later than this period it is classified as later or secondary.
Bleeding within 2 hours after birth occurs for the following reasons:
- delay of parts of the placenta in the uterine cavity;
- hereditary or acquired defects of hemostasis ;
- hypotension and atony of the uterus;
- soft birth trauma;
- eversion of the uterus .
Hypotonic and atonic bleeding
Hypotonic (decreased tone of the myometrium ) and atonic (complete loss of tone) uterine bleeding in the early postpartum period occur as a result of a violation of the mechanism of postpartum hemostasis . Decrease or loss of myometrial tone before the completion of the blood clotting process leads to leaching of blood clots by blood flow and the development of bleeding, up to massive, with rapid blood loss of up to several liters. Occurs in 3-4% of the total number of births and is the cause of 36% of maternal deaths [1] .
With hypotonic bleeding, an external massage of the uterus through the abdominal wall and the introduction of contraction drugs are performed, which, as a rule, leads to restoration of tone and stopping of bleeding. With atonic bleeding, such measures are useless, with blood loss above 1000 ml, uterine extirpation is performed. The condition is complicated by the development of hypovolemic (hemorrhagic) shock as a result of extensive blood loss.
See also
- Obstetric bleeding
Literature
- Intensive therapy. National Leadership / Ed. B.R. Gelfand, A.I. Saltanova. - GEOTAR-Media, 2011. - T. 2. - (National guidelines). - ISBN 978-5-9704-1789-8784.