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Postpartum Hemorrhage

Medically reviewed by Last updated on Jun 6, 2022.

What is postpartum hemorrhage (PPH)?

PPH is the loss of large amounts of blood after delivery. Most common is early PPH. It happens within 24 hours of delivery. The risk for PPH is greatest within the first hour after delivery. Delayed or late PPH happens 25 hours to 6 weeks after delivery. PPH can be life-threatening no matter when it happens.

What are the causes of early PPH?

  • Uterine atony means your uterus does not contract after delivery. Atony may be caused by your uterus being stretched too much. It may also be caused if you have had more than 4 vaginal deliveries, long labor, medicines, or fibroids. If parts of the placenta stay in your uterus, it can also cause atony.
  • Uterine inversion is your uterus turning inside out.
  • Blood clotting disorders include idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), and von Willebrand disease.
  • Cuts, bruising, and blood clots of your cervix, vagina, or perineum can happen when tears occur during the delivery. Tears may happen with or without use of instruments such as forceps, or when an episiotomy is done. A large baby can also cause cuts, bruising, and blood clots to happen.

What are the signs and symptoms of PPH?

  • Heavy bleeding (using more than 1 pad in 1 hour)
  • Fast breathing, fast heartbeat
  • Cool, clammy skin
  • Decrease in how much you urinate
  • Being lightheaded or dizzy

How is PPH diagnosed and treated?

Your healthcare provider will diagnose PPH by your symptoms. He or she will also do a pelvic exam. You may also need to have an ultrasound to check your uterus. Treatment may include any of the following:

  • Medicines to help your uterus contract and help control bleeding
  • IV fluids, blood and blood products transfusions
  • A balloon inserted into your uterus, filled with saline to put pressure on uterine walls to control bleeding
  • Surgery to stop bleeding or remove placenta left in your uterus
  • Uterine artery embolization to block major blood flow to your uterus
  • Removal of your uterus (hysterectomy)

Call your local emergency number (911 in the US) if:

  • You have heavy bleeding (using more than 1 pad in 1 hour).
  • You are dizzy or lightheaded.
  • You have fast breathing and a fast heartbeat.
  • Your skin is cool and clammy.

When should I call my doctor?

  • You urinate little or not at all.
  • You have a fever or chills.
  • You have bad smelling vaginal discharge.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

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