Postpartum hemorrhage symptoms

Heavy bleeding is a frightening thing, because especially during childbirth, the chance of heavy bleeding is the highest. In particular, many mothers exert too much force, which causes capillaries to rupture, which will increase the amount of bleeding. Many mothers will also become comatose or even enter a stage of severe shock due to excessive blood loss. When heavy bleeding occurs, a large amount of blood is often secreted, which is also one of the symptoms that requires special attention.

diagnosis

In addition to diagnosing postpartum hemorrhage based on the amount of bleeding, a clear diagnosis of the cause should also be made so that timely and correct treatment can be given.

1. Be alert to weak uterine contractions. Sometimes, even though the placenta has been expelled and the uterus has relaxed, a large amount of blood accumulates in the uterine cavity, but there is only a small amount of vaginal bleeding, and the mother has symptoms of excessive blood loss. Therefore, in addition to paying close attention to the amount of vaginal bleeding after delivery, you should also pay attention to the contraction of the uterus. The amount of vaginal bleeding visually estimated is much less than the actual amount of blood loss, so it must be collected and measured using a curved tray. If there is uterine atony before delivery and excessive bleeding during and after placental delivery, the diagnosis should not be difficult, but one must be alert to the aforementioned occult postpartum hemorrhage and the possible co-existence of birth canal laceration or placental factors.

2. Soft birth canal lacerations Cervical lacerations are mostly on both sides and may also appear petal-like. If the laceration is severe and affects the cervical blood vessels, it will cause heavy bleeding. Cervical lacerations can occasionally extend to the lower uterine segment. Vaginal lacerations are mostly located on the vaginal side wall, posterior wall and perineum, and are mostly irregular lacerations. If vaginal laceration affects deeper tissues, it may cause severe bleeding due to the rich blood supply. The contractions are good at this time. Vaginal examination can determine the location and severity of the laceration. According to the degree of perineal laceration, it can be divided into three degrees. Grade I refers to tears in the perineal skin and vaginal entrance mucosa that do not reach the muscle layer and generally do not cause much bleeding. Grade II means that the laceration has reached the perineal muscle layer, involving the posterior vaginal wall mucosa, and even tearing the grooves on both sides of the posterior vaginal wall upward. The laceration may be irregular, making the original anatomical tissue difficult to identify and causing heavy bleeding. Grade III means that the external anal sphincter has been ruptured, and even the vaginal rectal septum and part of the anterior rectal wall are lacerated. This condition is serious. But the amount of bleeding may not be large.

3. Placental factors: incomplete placental detachment and retention of the placenta in the uterine cavity after detachment can be clinically seen as weak uterine contractions, failure to deliver the placenta and excessive bleeding. If the placenta is incarcerated, a narrow ring may be found in the lower segment of the uterus. When part of the placenta is adhered to the uterine wall, incomplete detachment is prone to occur, and the retained placenta affects the contraction of the uterus. The blood sinuses at the site of placental detachment open and bleed. The placenta that is completely adhered cannot be detached and expelled on time. The diagnosis can only be made when the placenta is found to be firmly attached to the uterine wall during manual detachment. Partial placenta implantation may cause partial separation of the non-implanted part and cause continuous bleeding, which is often confused with placenta adhesion. When the placenta is removed manually, it is found that the placenta is completely or partially connected to the uterine wall. The diagnosis was confirmed by difficult dissection. Placental retention is often detected during a routine careful examination of the placenta and fetal membranes to ensure their integrity after delivery. If defects are found on the surface of the placenta or defects in the fetal membranes with broken blood vessels at the edges, it means that there are remnants of placental tissue or accessory placenta, and a diagnosis can be made.

4. Coagulation dysfunction: If there is a tendency to bleed before or during pregnancy, or if there is placental detachment or damage to the birth canal, bleeding and coagulation dysfunction may occur.

Causes of bleeding

(1) Excessive mental tension: Some women are too nervous during childbirth, which leads to poor uterine contraction and is the main cause of postpartum hemorrhage. Under normal circumstances, when the placenta is detached from the decidua layer of the uterus, the blood sinuses on the detached surface open and some bleeding is common, but when the placenta is completely detached and discharged from the uterus, the bleeding decreases rapidly. However, if the mother is overly nervous or due to other reasons, the uterus may not contract well and the blood vessels may not close, heavy bleeding may occur. If the mother is overly nervous, the labor process is too long, the labor lasts too long, too many sedatives are used, or the anesthesia is too deep, it can also cause the placenta to contract weakly and heavy bleeding to occur. For example, in cases of polyhydramnios, macrosomia, and multiple pregnancy. Due to excessive expansion of the uterus, the uterine fibers stretch excessively and cannot recover well after delivery; too many and too frequent births cause degeneration of uterine muscle fibers, increased connective tissue, reduced muscle fibers and weak contraction, etc., which is also one of the causes of postpartum hemorrhage.

(2) Retained placenta: Retained placenta is also one of the causes of heavy bleeding, including incomplete placental detachment and placental adhesion, which can also cause heavy bleeding.

(3) Coagulation dysfunction: If the mother suffers from blood disease or severe hepatitis, the consequences are also very serious and must be paid close attention to. When giving birth, you should go to a hospital with the necessary facilities to avoid accidents.

Therefore, mothers must undergo prenatal examinations. Mothers with a history of postpartum hemorrhage, bleeding tendencies such as blood diseases, hepatitis, and multiple curettages should be admitted to the hospital in advance to prepare for delivery, have their blood type checked, and have blood prepared to prevent any accidents during delivery. Postpartum hemorrhage is sometimes difficult to predict in advance and often occurs suddenly, so it is important to take good care of yourself: if bleeding is caused by weak uterine contractions, you should immediately massage the uterus to promote rapid uterine contractions, or compress the abdominal aorta to reduce the amount of bleeding.