How much postpartum bleeding is normal

Pregnant women often experience bleeding problems after giving birth. Whether it is a caesarean section or a natural birth, there will be a certain amount of bleeding, which is a relatively normal situation. However, some pregnant women have different physical conditions, so the amount of bleeding should also be different. Pregnant women need to pay special attention to their body changes after childbirth, especially after the baby has been delivered, they should pay attention to their own maintenance. But how much postpartum bleeding is normal?

Bleeding exceeding 500 mL within 24 hours after delivery is called postpartum hemorrhage, 80% of which occurs within 2 hours after delivery. Late postpartum hemorrhage refers to heavy uterine bleeding that occurs during the postpartum period 24 hours after delivery, and is more common 1 to 2 weeks after delivery. Postpartum hemorrhage is a serious complication of delivery and one of the four major causes of maternal mortality. In recent years, postpartum hemorrhage has been the leading cause of maternal mortality in my country, especially in remote and backward areas. The incidence of postpartum hemorrhage accounts for 2% to 3% of the total number of deliveries. Due to the large subjective factors in measuring and collecting the amount of bleeding, the actual incidence is higher.

Clinical manifestations

Postpartum hemorrhage usually occurs within 2 hours after the delivery of the fetus, and can occur before, after, or both before and after the delivery of the placenta. Vaginal bleeding can be heavy bleeding in a short period of time, or it can be light bleeding that continues for a long time. It is usually overt, but there are also cases of occult bleeding. The main clinical manifestations are vaginal bleeding, hemorrhagic shock, and secondary anemia. If excessive blood loss occurs, disseminated intravascular coagulation may occur. The severity of symptoms varies depending on the amount and rate of blood loss and whether anemia is present. Heavy bleeding in a short period of time can cause shock rapidly. It should be noted that in the early stages of shock, due to the body's compensatory mechanism, the patient's vital signs such as pulse and blood pressure may be within the normal range. However, close monitoring is still required at this time, early identification of risk factors, assessment of bleeding volume and active treatment. In clinical practice, people often only pay attention to the patient when blood loss reaches a certain level and decompensation symptoms such as increased pulse and decreased blood pressure appear, thus losing the best time for treatment. In addition, if the mother already suffers from anemia, shock may occur even if the bleeding is not much, and it is not easy to correct. Therefore, every parturient must be carefully observed and analyzed to avoid delaying the rescue.

Diagnosis

The key to postpartum hemorrhage is the correct measurement and estimation of blood loss. The commonly used methods for estimating blood loss in clinical practice include: volume method; weighing method; area method; shock index, etc. Inaccurate measurement of blood loss will result in loss of the best time to rescue postpartum hemorrhage. Sudden, massive postpartum hemorrhage is easily noticed and diagnosed early, while slow, continuous, small amounts of bleeding (such as long suture time for soft birth canal lacerations) and undetected hematomas are often important reasons for delayed diagnosis and treatment. Based on the relationship between the duration and amount of vaginal bleeding and the delivery of the fetus and placenta, the cause of postpartum hemorrhage can be preliminarily determined. Several reasons are often causal.