What is late postpartum hemorrhage?

Late postpartum hemorrhage refers to bleeding that occurs more than 24 hours after a woman gives birth. The amount of late postpartum bleeding is generally more than 500 ml and is relatively common. Some women may still experience bleeding about five weeks after giving birth. The occurrence of late postpartum hemorrhage is closely related to postpartum health care and physical constitution. The incidence of this phenomenon is about 0.17%.

The causes of late postpartum hemorrhage are very complex and are introduced below.

Improper handling during cesarean section resulting in uterine incision rupture is one of the important causes of late postpartum hemorrhage. In recent years, due to the increase in pregnancy pathology and social factors, the high level of attention paid to the fetus and the influence of maternal fear of pain, the cesarean section rate has gradually increased, and postoperative complications have also increased. There is a certain relationship between the level of the surgeon during cesarean section and the rate of late postpartum hemorrhage.

Improper selection of uterine incision: The incision should be made in the lower part of the uterus as much as possible, avoiding being too high or too low. If the incision is too high and located at the junction of the uterine body and the lower segment, the thickness of the tissues above and below the cutting edge will be uneven, and the alignment or misalignment may cause poor healing of the uterine incision. If the incision is too low and close to the cervix, the cervix has more connective tissue and poor blood supply, which may also cause poor healing of the uterine incision and easily cause the incision to tear when the fetal head is delivered.

Improper incision method: Using a scalpel or scissors to cut or cut the entire way during the incision will cause the arcuate blood vessels in the uterine wall to rupture, causing excessive bleeding and affecting healing.

Improper suturing: stitches that are too close together or sutures that are too many and too tight may affect local blood circulation and cause poor wound healing. In addition, the endometrium is everted and sewn into the myometrium during suturing, which is also one of the reasons that affect the healing of uterine incision.

It should be noted that late postpartum hemorrhage can lead to severe hemorrhagic shock. Late postpartum hemorrhage must be taken seriously. Go to the hospital for examination and diagnosis in time. Generally speaking, late postpartum bleeding is accompanied by lower abdominal pain and geothermal fever. Some women experience pain or even pus and blood formation at the incision site after delivery, and bleeding is more likely to occur at this time.