What is the cause of bleeding three months after delivery?

Expectant mothers have a problem, that is, bleeding three months after delivery. They are often first-time mothers and are helpless about postpartum bleeding. Some people are shy and do not talk about this with their family members in time, thinking it is a normal phenomenon. What is the cause of bleeding three months after delivery? In fact, there are many reasons. Let's take a look at them together.

The causes of postpartum hemorrhage are uterine atony, soft birth canal laceration, placental factors and coagulation dysfunction. The four major causes can exist together or they can be cause and effect to each other.

1. Uterine atony

It is the most common cause of postpartum hemorrhage, accounting for 70%. The anatomical distribution of uterine muscle fibers is inner circular, outer longitudinal, and medial interweaving. Under normal circumstances, after the fetus is delivered, the contraction of the uterine muscle fibers running in different directions effectively compresses the blood vessels between the muscle bundles. If the uterine muscle fibers become weak in contraction, that is, uterine atony, they lose their effective compression effect on the blood vessels and postpartum hemorrhage occurs. Common factors include: 1. Systemic factors: The mother is extremely nervous due to excessive fear of childbirth, especially the lack of confidence in vaginal delivery, which can cause uncoordinated or weak uterine contractions. In this case, sedatives and anesthetics may be needed after delivery, which will increase postpartum uterine atony and cause postpartum hemorrhage; ② Obstetric factors: Prolonged labor causes extreme fatigue and systemic exhaustion of the mother, or too rapid labor can cause uterine atony; excessive amniotic fluid, macrosomia and multiple pregnancies cause excessive stretching of uterine muscle fibers, poor postpartum muscle fiber contraction ability, and multiple deliveries cause damage to uterine muscle fibers, all of which can cause uterine atony. Preeclampsia (severe), severe anemia, intrauterine infection and other obstetric complications and comorbidities cause uterine muscle fiber edema and lead to uterine atony; ③ Uterine factors: uterine muscle fiber hypoplasia, such as uterine malformation or uterine fibroids.

2. Placental factors

It accounts for about 20% of the causes of postpartum hemorrhage. Depending on the situation of placental separation, retained placenta, placenta adhesion and partial retention of placenta and/or fetal membranes can affect uterine contractions and cause postpartum hemorrhage. Retained placenta: If the placenta has not been expelled within 30 minutes after the fetus is delivered, it is called retained placenta. It may be due to improper use of uterotonic agents or rough massage of the uterus, which stimulates spasmodic uterine contractions and forms a contraction ring at the junction of the upper and lower segments of the uterus or at the external os of the cervix, which embeds the detached placenta in the uterine cavity and causes placental retention. Weak uterine contractions or compression of the lower segment of the uterus due to a full bladder can also cause the placenta to be retained in the uterine cavity even though it has been detached. If retained placenta hinders normal uterine contraction, it will cause postpartum hemorrhage, and blood clots will accumulate in the uterine cavity, which will cause the uterine cavity to enlarge and lead to uterine contraction weakness. If not treated in time, it will form a vicious circle and lead to serious consequences. The cause of placental adhesion is mainly related to improper operation. If the uterus is massaged too early or too hard after the fetus is delivered, the normal contraction and reduction of the uterus will be interfered with, resulting in partial detachment of the placenta, opening of the blood sinuses on the detachment surface and excessive bleeding. It may also be due to multiple previous curettage or intrauterine operations that damage the endometrium and easily cause placental adhesion or implantation.

3. Soft birth canal laceration

Soft birth canal lacerations include perineum, vagina, cervix, and lower uterine segment lacerations. Common factors: poor elasticity of vulvar tissue, inflammatory changes of the vulva and vagina; premature delivery, excessive labor force, macrosomia; vaginal surgery; careless examination of the soft birth canal, missing bleeding points. Incomplete suture and hemostasis, etc.

4. Coagulation disorders

Common causes include coagulation disorders caused by placental abruption, amniotic fluid embolism, stillbirth and acute fatty liver of pregnancy. A few are caused by primary blood diseases such as thrombocytopenia, leukemia, aplastic anemia or severe viral hepatitis.

5. Uterine inversion

It is rare and is mostly caused by improper management of the third stage of labor, such as excessive pressure on the uterine fundus or forceful traction on the umbilical cord.

Through the above introduction, I believe mothers all know the causes of bleeding three months after delivery. In fact, postpartum bleeding is caused by the presence of lochia, but bleeding three months after delivery may be an abnormal phenomenon. If there is heavy bleeding, it may also lead to anemia, so mothers must pay attention.