Hemorrhage refers to internal or external bleeding from open or ruptured blood vessels. Suffering from a hemorrhage during pregnancy, labor or after delivery creates a serious threat to the mother’s health and needs to be immediately brought under control.
There are 3 types of hemorrhage depending on when they occur—antepartum, intrapartum and postpartum.
1. Antepartum Or Prepartum Hemorrhage
Antepartum is identified as bleeding during pregnancy after the 28th week of pregnancy till the term.
Causes
There are two main reasons for experiencing hemorrhage at this gestational age—separation of the placenta from the uterine wall (placental abruption) and when the placenta positions over the cervix (also called placenta praevia). It has been observed in about 5.9 to 6.5 per 1000 single births, however, in the majority of the cases, the reason remains unknown.1
Management
You will be admitted to the hospital and kept under observation. Your baby’s health will be continuously monitored using ultrasound scans and cardiotocograph, which will track their heart rate.
If there is too much bleeding, you will be provided with an intravenous (IV) drip and advised for complete bed rest. If there is an increase in the bleeding, pain in the abdomen or you feel contractions, inform the doctor or nurse immediately. Your baby may have to be delivered before the term.
2. Intrapartum Hemorrhage
When excessive bleeding happens while the mother is in labor, it is referred to as intrapartum hemorrhage. Intrapartum hemorrhage is less common to experience as it can be identified using an ultrasound scan before the onset of labor or delivery. It is classified according to its occurrence—either before or after the delivery.
Causes
The condition of hemorrhage can be preexisting as antepartum hemorrhage due to previously existing complications like placenta previa, uterine rupture, or lesions in the genital tract. It occurs in 4-7% of all pregnancies.2
Management
If the mother experiences heavy bleeding during childbirth, she may require a blood transfusion and will also receive intravenous saline and other fluids. Her blood pressure will be monitored constantly.
In critical cases, the baby is delivered using a c-section to prevent any risks to the baby. However, if there is little bleeding, the mother could go for a vaginal birth, which will be monitored for the bleeding while keeping in check the baby’s heart rate and the progress of the labor.
3. Postpartum Hemorrhage
Postpartum hemorrhage occurs when the mother experiences excessive bleeding after the baby is born. The bleeding happens from the point where the placenta was attached to the uterine wall.
Causes
Your uterus contracts after the delivery to close the blood vessels that were attached to the placenta. The inability of the uterus to contract properly causes them to bleed. Bleeding also occurs if fragments of the placenta are left inside the uterus after the birth. Tears created during assisted birth could also cause bleeding.
Management
Apart from receiving an intravenous, you will be given medication to promote uterus contraction and prevent hemorrhage. The nurse or doctor will externally give a massage to the uterus to aid the contractions. The blood loss will be determined and a blood transfusion will be done if the need arises.
It isn’t unusual for women to lose blood during delivery. Women could lose as much as 15% of their blood volume during delivery without developing anemia or dropping their blood count. Most of the blood present in the mother’s womb is absorbed back into the body after the birth.
A mother’s blood volume increases by 50% during pregnancy. Their bodies are well-prepared and able to cope with blood loss—normally, it isn’t a cause of worry.
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