Blood loss after childbirth. How long does blood bleed after childbirth?

Bleeding after childbirth- This is the release of blood and tissue debris from the uterus. Usually, approximate periods of this bleeding are distinguished depending on the intensity and color of the blood.

In the first three days bleeding is profuse, often large in volume compared to menstruation. The blood is bright red as it is released from the vessels at the site of the placenta.

The cause of this bleeding is insufficient contractility of the uterus in the first few days after birth. This is normal and should not scare you.

Over the next two weeks the intensity of bleeding is significantly reduced. The discharge changes color from light pink to brown and yellowish-white.

The uterus gradually contracts and by the end of the second week all discharge from it usually stops.

There are often exceptions to this general rule. Let's consider which of them are also a variant of the norm, and which are a sign of a condition requiring medical intervention.

How long does bleeding last in the early postpartum period?

So, discharge from the uterus during the first 2-6 weeks are considered normal. Even in the sixth week there may be an admixture of blood in them.

Sometimes, bleeding after childbirth first stops after a few days, and then resumes.

This is usually typical for overly active mothers who tend to hit the gym in the first week after giving birth. Then just stop loading and the bleeding will stop again.

Variant of the norm The so-called “short period” of bleeding is also considered (it occurs three weeks to a month after birth).

The bleeding is then not profuse and painless. Its duration is no more than one or two days. Such recurrence of bleeding also does not require visiting a doctor.

Now let's talk about pathological (late) postpartum bleeding.

Most often its cause becomes part of the placenta, which remains in the uterus after childbirth and prevents its complete contraction. Then, a week after birth, the bleeding does not decrease, but remains the same profuse and bright in color.

In this case Necessarily get an appointment with a gynecologist as soon as possible and have additional “” examination of the uterine mucosa.

This the procedure scares many women and they try to delay the visit to the doctor, hoping that the bleeding will stop. This position often leads to the development of inflammation in the uterus, increased blood pressure, and pain.

“Cleaning” still cannot be avoided, but additional treatment after it can drag on for months. It goes without saying how this adversely affects breastfeeding and a woman’s future reproductive function.

Another case- continuation of light brown discharge longer than six weeks after birth. This may be caused by an infection.

Often such discharge is accompanied by pain in the lower abdomen and fever. If you don’t delay your visit to the doctor, this condition is easily treated and does not cause adverse consequences.

And of course, most serious case- this is when the bleeding initially stopped completely, and after one or two weeks it resumed in the form of copious discharge from the uterine cavity.

It is impossible to stop such bleeding at home. It really threatens life due to the rapid loss of a large volume of blood. That's why, in this case, you must immediately call an ambulance.

Causes

What affects the intensity and duration of bleeding after childbirth? How long does bleeding last and when does it stop after childbirth? What accompanying conditions should alert a woman and make her more attentive to her health?

Normal phenomenon- this is stopping bleeding due to rapid contraction of the uterus after childbirth. This is facilitated by breastfeeding as a natural stimulator of muscle contraction of the uterus, inherent in nature.

Doctors often prescribe oxytocin injections in the first days after childbirth to artificially speed up this process.

If the uterus remains relaxed after childbirth, bleeding continues and becomes pathological. This happens often due to a traumatic birth, a large baby or.

Other reasons- multiple fibrous nodes in the uterus, improper attachment of the placenta, early placental rejection, exhaustion of the woman before childbirth.

A very rare case abnormal postpartum bleeding - mechanical damage to the uterus during childbirth or undiagnosed clotting problems.

Uterine bleeding a few weeks after birth may be caused by infection.

So, bleeding after childbirth is serious process, requiring close monitoring of the woman and contacting a doctor at the slightest doubt or concern.

Most often, bleeding after childbirth is not a spontaneous phenomenon.

Uterine bleeding after childbirth is a pathological process that is provoked by a number of reasons. Among the factors that cause bleeding directly from the placental site (the place where the placenta is attached to the uterine cavity), the most significant and common are the following:

too much expansion of the uterine cavity;
pathological labor activity;
rapid labor;
protracted labor process;
however, the main etiological factors of such a pathological phenomenon as bleeding after childbirth are hypotension and/or atony of the uterus.

Uterine hypotension is a pathological phenomenon that represents insufficient postpartum contractility of the uterine muscles and its imperfect tone.

Hypotony of the uterus can be a consequence of weak labor forces, rapid labor and labor with excessive force, a functional impairment of the ability of the myometrium to contract, overstretching of the myometrium during high water intake or a large fetus, as well as dystrophic phenomena of the myometrium after previous curettage of the mucous membrane of the uterine cavity, the presence of scar changes ( after undergoing surgery, for example, after enucleation of a myomatous node or cesarean section) and/or inflammatory processes in the uterus (chorioamnionitis), uteroplacental apoplexy, premature abruption of a normally located placenta, abnormalities of placenta attachment (its accretion or tight attachment), uterine tumors (fibroids).

This condition can be treated with the use of specialized medications. However, in some cases, hypotension can transform into atony (characterized by a complete loss of muscle tone of the uterus and its contractility) of the uterus and aggravate the current situation. It is extremely rare that atony can occur without a previous hypotonic state.

Signs characterizing bleeding

Like many other types of bleeding, bleeding after childbirth has a number of characteristic distinctive features.

For example, hypotonic bleeding can have 2 variants of its clinical picture:

Option 1 – initially the bleeding can be very profuse with massive blood loss. In this case, the palpable uterus becomes flabby, atonic and poorly responsive to the administration of uterotonic drugs. There is rapidly progressing hypovolemia, possible rapid development of hemorrhagic shock and, possibly, disseminated intravascular coagulation syndrome. Vital organs may also undergo pathological changes that are irreversible.
Option 2 – there is a small amount of initial blood loss. The hypotonic state alternates with temporary restoration of myometrial tone. The uterus is capable of short-term response to conservative measures, the purpose of which is to stop the resulting bleeding (administration of uterotonics). Blood is mainly released from the vagina in portions of 150 to 250 ml. Due to the fact that a woman does not lose blood suddenly, the body is able to adapt to gradually developing hypovolemia: blood pressure numbers remain within normal limits, and slight tachycardia is observed. However, then it is possible that the uterus may stop responding to the administration of drugs and further develop hemorrhagic shock, as well as disseminated intravascular coagulation syndrome.

Atonic bleeding is characterized by its massiveness and consistency. Atonic bleeding after childbirth cannot be stopped by the administration of pharmaceutical drugs.

Duration of postpartum bleeding

Question: “How long does bleeding last after childbirth?” concerns all women who have given birth. Normally, the duration of postpartum bleeding can vary from 6 to 8 weeks. However, this bleeding is a normal physiological phenomenon - the uterus is cleared of accumulated blood clots, such discharge is called lochia. The total amount of this type of discharge does not exceed 1500 ml. If a woman notices bleeding a month after giving birth, she should not worry. There are 2 reasons that can cause this phenomenon.

Firstly, this may be the onset of menstruation, and secondly, the release of remaining blood clots may be slightly delayed. However, if bleeding begins after 2-3 months or more, you should think about the presence of some pathological process localized in the uterine cavity and urgently contact a qualified specialist.

To the question: “How long does bleeding last after childbirth?” the doctor will not be able to give you an answer in a specific figure, because the duration of this phenomenon is strictly individual and depends on the physiological characteristics of each woman’s body.

Treatment

The treatment of postpartum hemorrhage is based on the following set of measures:

diagnosis and elimination of the cause of hypotension or uterine atony;
restoration of the functional ability of the myometrium is carried out by using measures such as: catheterization of the bladder, external massage of the uterus, intravenous administration of drugs that promote uterine contraction (Methylergometrine, Oxytocin), applying an ice-filled bladder to the lower abdomen;
sometimes techniques are used to help reduce blood flow to the uterine cavity: finger pressing of part of the aorta, as well as the application of specialized clamps to the parametrium;
if the above therapeutic measures do not bring the expected effect (the bleeding does not stop and blood loss continues to increase), removal of the uterus is indicated;
An obligatory aspect of treatment is the restoration of circulating blood volume.

This occurs in a small percentage of cases and usually occurs during labor or within 24 hours after. Less commonly, bleeding can occur several (up to 6) weeks after birth.

Heavy bleeding after childbirth can have various causes.

For the most part it is one of the following:

Uterine atony. After birth, the uterus must contract to stop bleeding at the placenta site. For this reason, after giving birth, you will periodically massage your abdomen to stimulate your uterus to contract. With atony, the muscles of the uterus contract weakly. The likelihood of this condition increases slightly if the uterus has been severely distended by a large baby or twins, if you have already had multiple pregnancies, or if the labor was very long. To reduce the chance of atonia, you may be given the medicine oxytocin after the baby is born. For atony, other medications are also used.

Retained placenta. If the placenta does not come out on its own within 30 minutes of the baby's delivery, heavy bleeding may occur. Even if the placenta comes out on its own, the doctor must carefully check its integrity. If a piece remains, bleeding may occur.

Breaks. If the vagina or cervix is torn during childbirth, this may cause bleeding. Tears can be caused by a large baby, the use of forceps or a vacuum, the baby moving too quickly through the birth canal, or a bleeding episiotomy.

Abnormal fastening. In very rare cases, the placenta is attached to the wall of the uterus deeper than necessary. As a result, after birth, her separation is difficult. This may cause severe bleeding.

Inversion of the uterus. In this case, the uterus turns inside out after the baby is born and the placenta is separated. This is more likely if there has been abnormal placement of the placenta.

Uterine rupture. Rarely, the uterus ruptures during pregnancy or childbirth. If this happens, the woman loses blood and the baby's oxygen supply deteriorates.

The risk of bleeding is higher if this has already happened during a previous birth. The risk is also higher if you have placenta previa, where the placenta is low in the uterus and completely or partially blocks the opening of the cervix.

In addition to blood loss, signs of serious postpartum hemorrhage include pale skin, chills, dizziness or fainting, clammy hands, nausea or vomiting, and rapid heartbeat. If there is bleeding, immediate action must be taken.

Every day, about 1,600 women die during childbirth. Of this number, about 500 deaths are due to bleeding. The majority of cases are attributed to atonic bleeding in the postpartum period (PPH), of which approximately 99% occur in developing countries. Deaths are associated with three delays: delay in decision to seek medical care, delay in transport to hospital, and delay in providing medical care. This problem is very acute in developing countries, but doctors in developed countries also encounter it. The UK Maternal Mortality Report states that deaths due to CAT are often associated with treatment given “too late, too little”. Hemorrhage is the fifth or sixth leading cause of maternal mortality in developed countries.

Primary bleeding in the postpartum period

Due to the subjectivity of diagnosis, the frequency of this pathology varies from 2 to 10%. In general, the following trend can be observed: medical personnel underestimate blood loss, while patients overestimate it. For example, if a doctor estimates blood loss to be “greater than 500 ml,” then the actual blood loss is usually about 1000 ml. In addition, it should be remembered that BCC correlates with the patient’s weight. Accordingly, a thin, anemic patient will not tolerate even a small loss of blood.

Physiology of the third stage of labor

Before discussing the causes and treatment tactics of primary CP, it is necessary to consider the physiology of the third stage of labor. This is the shortest period of labor, which, however, poses a great danger for the woman in labor.

During pregnancy, myocytes are greatly stretched; accordingly, the uterus can accommodate an increasing volume. After the birth of the fetus, the uterus continues to contract, which leads to a pronounced shortening of the long fibers. This process is ensured by retraction - a unique property that does not require energy and is characteristic only of the myometrium.

Separation of the placenta occurs due to contraction and retraction of myometrial fibers, which leads to a significant reduction in the surface of the placenta. It detaches from the wall of the uterus, like a postage stamp detaches from the surface of a balloon that has been deflated. After the placenta is separated from its attachment site due to uterine contractions, it migrates to the lower uterine segment and then through the cervix into the vagina.

Clinical signs of placental separation

Placental separation corresponds to three clinical signs.

After the placenta is separated and moved to the lower uterine segment, it is possible to palpate to determine the change in the shape of the uterus - its body becomes narrow and elongated (before the placenta is separated it is wide and flattened). Changes in the shape of the uterine fundus are quite difficult to clinically determine, with the exception of very thin patients. However, the uterus becomes harder due to contractions and is easily displaced.
Bloody discharge accompanies the separation of the placenta from the uterine wall. This sign has less clinical significance, because bleeding may also appear with partial separation of the placenta. Hidden bleeding is possible when blood accumulates between the membranes and is therefore not visualized.
After the placenta is separated and moved to the lower uterine segment and cervix, the visible part of the umbilical cord increases by 8-15 cm. This is the most reliable sign of placental separation.

The mechanism of hemostasis at the placentation site is one of the anatomical and physiological wonders of nature. The myometrial fibers rearrange and intersect with each other, forming a lattice through which the vessels feeding the placental bed pass. When the uterine wall contracts, this structure ensures reliable compression of the blood vessels. This myometrial architecture is sometimes called a living ligature or physiological sutures of the uterus.

Tactics for managing the third stage of labor

After the birth of the fetus, the umbilical cord is clamped and cut, and if necessary, cord blood is collected. Very gently pull the umbilical cord towards you to make sure that there are no loops in the vagina. Then, at the level of the introitus, a clamp is applied to the umbilical cord, this makes it easier to visualize its elongation after separation of the placenta. The fundus of the uterus is palpated with one hand to determine changes characteristic of placental separation or to identify an atonic uterus dilated with blood. It is forbidden to carry out any massaging movements with the hand located on the bottom of the uterus, because this contributes to partial premature separation of the placenta, increased blood loss, the formation of a contraction ring and retention of parts of the placenta. After signs of separation of the placenta appear, it is released by gently pulling the umbilical cord. The second hand is moved lower, directly above the pubic symphysis, and alternately moves the uterus up and down, while the other hand constantly tightens the umbilical cord. It is necessary that there is sufficient distance between the two hands to avoid uterine inversion.

There are two tactics for managing the third stage of labor.

Expectant management involves waiting for the placenta to separate. This usually happens within 10-20 minutes. This tactic is chosen by those who prefer minimal intervention in the birth process. Some experts recommend breastfeeding immediately after birth to stimulate the physiological release of oxytocin. Unfortunately, this tactic does not reduce the likelihood of CAT compared to active medication.
Active tactics include the administration of oxytocin drugs at the end of the second or beginning of the third stage of labor in order to accelerate uterine contractions, facilitating the separation of the placenta. Active labor management tactics have been introduced into practice over the past 50 years. During this period, it was shown that active tactics, compared to expectant management, are characterized by a 50-70% reduction in blood loss, the frequency of administration of therapeutic doses of oxytocin, the frequency of CPT and the need for transfusion of blood products. Evidence-based medicine and accumulated experience have contributed to the fact that such tactics have now become the standard of care. Watchful waiting is followed only at the urgent request of the patient and with her written informed consent.

The choice of drug for active management of the third stage of labor is usually made between inexpensive injectable drugs, oxytocin and ergometrine or their combination (syntometrine). Among these drugs, oxytocin is the cheapest; in addition, it has the lowest percentage of side effects, in particular, it does not cause retention of parts of the placenta. However, this is a short-acting drug (15-30 minutes). Ergometrine is an effective drug, the duration of action of which is longer (60-120 minutes), but it is more likely to have side effects (see below), including a slight increase in the frequency of retained parts of the placenta.

The duration of action of ergometrine or oxytocin is usually sufficient for the specified period. In patients at high risk for atonic CAT (eg, multiple pregnancies), recommended prophylaxis is long-term administration of intravenous oxytocin or, in some cases, prostaglandins.

Oxytocin drugs

You should be aware of the characteristics and possible side effects of the available oxytocin drugs, each of which has specific indications for use in different clinical situations.

Oxytocin

Oxytocin is the cheapest and safest uterotonic drug. It acts quite quickly, causing strong and rhythmic contractions of the uterus within 15-30 minutes. Oxytocin acts mainly on the upper uterine segment, and also has a short-term relaxing effect on vascular smooth muscle, which can cause slight hypotension due to a decrease in total peripheral resistance.

Ergometrine

Ergometrine is the first uterotonic drug for intramuscular administration, which has been used for more than 70 years. It causes prolonged contractions (60-120 minutes), acting on the upper and lower uterine segments. Ergometrine affects all smooth muscles, affecting the vascular bed. Peripheral vasoconstriction, which normally has no clinical significance, can cause a significant increase in blood pressure in patients with hypertensive disorders and preeclampsia. Ergometrine is contraindicated in such patients. At the same time, the drug spasms the coronary arteries, which in rare cases causes myocardial infarction in patients with predisposing factors. Therapy for endomerin-associated vasospasm consists of prescribing nitroglycerin.

Due to the duration of the effect, ergometrine can cause strangulation of the separated placenta in the lower uterine segment. When prescribing ergometrine, manual removal of the placenta is sometimes additionally required (1: 200 births).

Nausea and/or vomiting is observed in 20-25% of patients. Ergometrine is prescribed intramuscularly. Given the pronounced vasopressor effect, the drug is not recommended to be administered intravenously (except in emergency cases, in which it is possible to administer a 0.2 mg bolus slowly). The initial dose cannot be increased to 0.5 mg, because at the same time, side effects are extremely pronounced, and there is no expected increase in the uterotonic effect.

Syntomethrin

Syntometrine is a combination drug, one ampoule of which contains 5 units of oxytocin and 0.5 mg of ergometrine. When administered intramuscularly, oxytocin begins to act after 2-3 minutes, ergometrine - after 4-5 minutes. The side effects of syntometrine are a combination of the side effects of both substances in its composition. The slight vasodilating effect of oxytocin slightly reduces the vasoconstriction of ergometrine. This combination combines the advantages of the short-acting oxytocin and the longer-term uterotonic effect of ergometrine. Thus, the drug allows uterotonic therapy to be carried out within 2 hours after birth without the need for intravenous administration of a maintenance dose of oxytocin.

15-methyl PGF 2α

15-methyl PGF 2α, or carboprost, is a methylated derivative of PGF 2α.

This is the most expensive uterotonic drug for parenteral administration. Its undoubted advantage is a pronounced uterotonic effect with less influence on smooth muscles and the occurrence of such adverse reactions as nausea, vomiting, diarrhea, vasospasm and bronchospasm. In this regard, the methylated derivative began to be used more often than the original substance. Other side effects, usually of little clinical significance, include chills, fever, and hot flashes. The duration of action is up to 6 hours, and given the cost of the drug and its side effects, it is not recommended for routine prevention of CPT. However, if long-term uterotonic therapy is required, the drug can be used quite widely.

The dosage of the drug is 0.25 mg, the method of administration is intramuscularly into the myometrium or intravenously 0.25 mg of the substance in 500 ml of physiological solution. The fastest effect is achieved with the intramyometrial route of administration. 15-methyl PGF 2α can be prescribed to patients with hypertensive disorders and asthma, although these are relative contraindications. This drug is a good second-line drug, prescribed when the effect of oxytocin or ergometrine is insufficient in cases where a long-term uterotonic effect is required.

Misoprostol

The PGE 1 analog misoprostol is a cheap uterotonic drug and the only drug of this series that can be prescribed non-parenterally. In these cases, misoprostol is prescribed “off-label”, i.e. for indications not listed in official registration forms, but used by obstetricians and gynecologists for CPT in most countries. The drug has a long shelf life and is stable over a wide temperature range, which distinguishes it from oxytocin and ergometrine, which must be stored in the dark at a temperature of 0-8 °C. Depending on the clinical situation, misoprostol can be administered orally, sublingually, vaginally or rectally. Side effects include chills, mild pyrexia, and diarrhea (develop gradually). Studies have shown that misoprostol is more effective than placebo in preventing CAT, but is less effective than parenterally administered uterotonics. Nevertheless, the previously mentioned properties make misoprostol an extremely convenient drug for use in developing countries, given the limited availability of obstetric services. Prophylactically, the drug is prescribed in a dose of 400-600 mcg orally or sublingually, in case of bleeding - 800-1000 mcg rectally. The duration of action is about 2 hours.

Carbetocin

It is usually prescribed in a dose of 100 mcg intramuscularly or intravenously. Side effects are similar to those of oxytocin: hot flashes and mild hypotension. The most important property of the drug is its long-term uterotonic effect, comparable to that of oxytocin, without the need for prolonged intravenous infusion. The drug is more expensive than oxytocin, but cheaper than 15-methyl PGF 2α.

Causes of primary bleeding in the postpartum period

Uterine atony

The causes of atony are any process or phenomenon that impairs the ability of the uterus to contract and retract and occurs in the majority (80-85%) of cases of CP. Atony can also develop in patients without predisposing factors. A number of clinical situations contribute to disruption of contraction and retraction:

high parity;
prolonged first or second stage of labor, especially in the presence of chorioamnionitis. An “exhausted” infected uterus is susceptible to atony and often does not respond to the administration of uterotonics;
rapid birth. This situation is the clinical opposite of the previous one, but is also characterized by an increase in the frequency of CAT;
overdistension of the uterus: multiple pregnancy, macrosomia, polyhydramnios;
retention of parts of the placenta;
the presence of blood clots in the uterine cavity. After the birth of the placenta, you need to massage the fundus of the uterus, and if there are signs of atony, administer oxytocin within 2-3 hours. Otherwise, even slight bleeding from the placental site contributes to the accumulation of blood clots in the uterine cavity. This process can disrupt contraction and retraction, which, in turn, starts a pathological circle;
the use of tocolytics, such as nitroglycerin or terbutaline, deep anesthesia, especially fluorinated hydrocarbons;
anatomical features of the uterus, including malformations and uterine fibroids;
placenta previa: implantation of the placenta in the area of the lower uterine segment, which has a reduced ability to contract and retract;
incorrect tactics for managing the third stage of labor, especially premature massage: the fundus of the uterus and traction on the umbilical cord, which leads to untimely partial separation of the placenta and increased blood loss.

Birth canal injuries

This is the second most common cause, occurring in 10-15% of cases.

Clinically distinguished:

ruptures of the perineum, vagina and cervix;
episiotomy;
uterine ruptures;
hematomas of the vulvovaginal and broad ligament of the uterus.

Other reasons

Other causes of primary CPP are uterine inversion and disorders of the hemostatic system.

Prevention of primary bleeding in the postpartum period

All patients with risk factors for the development of primary CPT should be delivered in a hospital equipped with appropriate anesthesiological, obstetric and transfusiological services, and be under the supervision of medical personnel. It is necessary to properly manage the third stage of labor:

administer oxytocin at birth of the anterior shoulder or as soon as possible;
exclude unnecessary manipulations with the uterus and/or traction on the umbilical cord until clear signs of placental separation appear;
assess the integrity of the placenta after birth;
carry out a thorough massage of the uterus to remove all clots from the uterine cavity;
maintain uterine tone by administering oxytocin for 2 hours, and with a high risk of developing CAT - for a longer period;
Constantly monitor the woman in labor for 2-3 hours after birth, including emptying the bladder.

Tactics for managing primary bleeding in the postpartum period

This section is devoted to management tactics in cases of uterine atony. The basis of therapy for uterine atony is the rapid normalization of physiological hemostasis, namely contraction and retraction. During preparation and administration of the drug, it is necessary to thoroughly massage the uterus.

Uterotonic drugs

It should be remembered that the administration of oxytocin has a negative effect on its receptors. Thus, if labor activation with oxytocin was performed in the first or second stage of labor, its receptors will be less sensitive. During physiological childbirth, the release of oxytocin in the third period does not increase, but there is an increase in the concentration of endogenous prostaglandins. The myometrium contains different receptors for each of the uterotonic drugs, so if one is ineffective, you should immediately switch to another. It is recommended to adhere to the following sequence of prescribing uterotonics:

intravenously 5 units of oxytocin, then 40 units in 500 ml of crystalloids, the rate of administration should be sufficient to ensure good contraction;
if ineffective - ergometrine 0.2 mg intravenously (it is necessary to determine in advance the absence of contraindications);
Oxytocin and ergometrine can be re-administered in the same doses. If oxytocin and ergometrine are ineffective, they immediately proceed to the administration of prostaglandins;
0.25 mg of 15-methyl P1T2a can be administered intramuscularly, but the preferred route of administration is into the myometrium. If necessary, up to 4 doses can be administered. An alternative is intravenous administration of 0.25 mg in 500 ml of crystalloid;
in the presence of bleeding, oral and vaginal methods of administering misoprostol are unsuitable, the latter due to the fact that the drug is simply washed away by blood secretions. The preferred route of administration is rectal, dose - 1000 mcg. Since the drug is inexpensive and easy to use, many specialists prescribe it immediately if there is no effect from oxytocin;
treatment of hypovolemia must be carried out with intravenous administration of colloids, crystalloids, and blood products.

If drug treatment is ineffective, various surgical methods are used, including uterine tamponade, compression sutures on the uterus, ligation and embolization of pelvic vessels, and hysterectomy.

During preparation for any of the surgical interventions, you can perform bimanual compression of the uterus, or massage the uterus on your fist. The hand inserted into the anterior vaginal fornix is clenched into a fist, with the second hand the fundus of the uterus is shifted towards the first hand. Due to the hand inserted into the vagina, the uterus rises slightly, the vessels are slightly pinched and bleeding decreases. You should perform rotating movements with your hands, which can stimulate uterine contractions.

In difficult cases, while waiting for preparation for surgery, external compression of the aorta can be applied. With both hands, the fundus of the uterus is shifted upward, then one hand is placed on the area of the lower uterine segment, and the other presses the fundus of the uterus to the aorta. If the uterus is atonic, then the effectiveness of the procedure is low, because The aorta is pressed with a loose object. An alternative method involves pressing the aorta with a fist placed above the navel.

Secondary bleeding in the postpartum period

Secondary CAT is defined as abnormal blood discharge from the genital tract that occurs between 24 hours and 6 weeks. after childbirth. This type of bleeding is less common than primary bleeding - in about 1% of births. Most often, secondary checkpoints occur within 3 weeks. after childbirth.

Causes

Retained parts of the placenta occur in approximately 30% of cases.
Endo(myo)metritis often accompanies retained parts of the placenta. Patients usually had a history of primary CPT.
Extremely rare causes, which, however, must be excluded, are trophoblastic disease, chronic uterine inversion, the formation of a false aneurysm or arteriovenous malformation at the site of a uterine scar after cesarean section.

Lead tactics

If the bleeding has already stopped at the time of examination, the uterus is painless on palpation, its size corresponds to the norm for the given postpartum period, and there are no symptoms of sepsis, expectant management is recommended. To exclude retention of parts of the placenta, an ultrasound is performed.

If the bleeding is profuse, there are signs of sepsis or subinvolution of the uterus, the development of a secondary intrauterine infection due to retained parts of the placenta should be suspected. Such patients undergo a uterine examination under anesthesia. Ultrasound can clarify the clinical picture, but it is not always accurate, so in this situation

First of all, one should be guided by the clinical picture. In such cases, it is necessary to carry out infusion therapy with crystalloids, determine individual blood compatibility, and also prescribe broad-spectrum antibiotics that cover gram-positive, gram-negative and anaerobic flora. In some cases, the bleeding is so massive that it is necessary to prescribe blood products.

It is necessary to examine the soft birth canal under local anesthesia for the presence of ruptures or hematomas. As a rule, the cervical canal allows one finger to pass through. Fingers are inserted into the uterine cavity and its walls are carefully examined. Sometimes it is possible to palpate an area of placental tissue, which is removed with fenestrated forceps, after which careful vacuum aspiration or curettage is performed.

The removed tissue is sent for histological examination to exclude trophoblastic disease; If symptoms of sepsis are present, samples can be used for microbiological testing and antibiotic susceptibility testing.

The uterus after childbirth is very soft, which makes it more likely to perforate. When curettage, you must be extremely careful if the birth was performed by cesarean section. You should not scrape the area of the suspected uterine scar. Curettage of the uterus can cause massive bleeding, because... Formed blood clots and organized areas of placental tissue are removed, some of which, as a rule, have pathological invasion of placentation. Uterotonic drugs for such bleeding are usually ineffective. Surgical treatment such as uterine tamponade, great vessel embolization, or hysterectomy should be considered.

Treatment of heavy bleeding after childbirth

Doctors may take various measures to stop bleeding, including uterine massage. You may be given IV fluids and oxytocin. Oxytocin is a hormone that stimulates uterine contractions. Other treatments may include medications to stimulate uterine contractions, surgery, and blood transfusions. Treatment depends on the cause and severity of the problem. Even in the most severe cases, removal of the uterus is not inevitable.

Any woman who has given birth should not be afraid of postpartum lochia. This process is planned by nature itself, and the young mother’s body is ready for this. But what if the spotting turns into bleeding? How long does it take to bleed after childbirth? When should you see a doctor?

Lochia

Lochia is literally blood after childbirth. How long does this process take? It all depends on the woman’s state of health: for some, lochia lasts for several days, while others suffer for two months.

Lochia is a bloody discharge mixed with bacteria, as well as remnants of the endometrium of the uterus. In the first two to three days after birth, it is difficult to distinguish them from normal bleeding or menstruation, since there is too much blood in them. But then they change their bright red color to serous and become less abundant.

Lochia can be released constantly and in equal volumes, or it can be released intermittently, but in large quantities. In the latter case, the discharge is more abundant, mixed with blood clots.

Of course, such a phenomenon can frighten a young mother, but there are significant and completely natural reasons for the appearance of lochia.

Why should there be blood after childbirth?

The release of blood after childbirth is a normal physiological process.

During pregnancy, the placenta is attached to the wall of the uterus and communicates with it through small blood vessels. During childbirth, the placenta separates from the walls of the uterus, exposing blood vessels that begin to bleed. Young mothers have a completely natural question: how long does blood flow after childbirth?

Ideally, immediately after the birth of a child, a woman should begin postpartum contractions, during which the uterus contracts and compresses the blood vessels, thereby helping to stop the bleeding. If we draw an analogy, a person does the same thing when his finger bleeds: he simply presses the wound with his second hand. Minor blood loss after childbirth is a planned process, especially considering that while carrying a baby, the mother’s blood volume doubles. But if a woman bleeds without interruption, then it is urgent to look for the cause and begin treatment.

How long does it take to bleed after childbirth?

If we talk about such a phenomenon as lochia, then they should not bother a young mother for more than two months. This is the maximum period during which blood can be released after childbirth.

How long does the process of severe blood loss take? The first three days of discharge are even more abundant than during menstruation. Moreover, the blood comes out bright red because the uterine vessels are bleeding. As mentioned above, the reason for this is insufficient contraction of the uterus after childbirth, which is why the bleeding stops for several days.

As the walls of the uterus heal and the internal genital organs are restored, the discharge begins to change color from bright red to pink, and then light yellow. This period lasts approximately two weeks.

If no complications occur, then a healthy woman can count on the fact that after two weeks she will no longer be bothered by such discharge.

Deviations from the norm

We figured out how long a healthy woman bleeds after childbirth. But what if, after two weeks, spotting still continues to bother the young mother?

In some cases, doctors admit that the healing of the uterus can take six weeks, so even two months of the recovery period are considered normal.

If the bleeding stops, but after a long period it starts again, it is necessary to reduce physical activity, since it is increased activity that contributes to this condition.

If the bleeding that recurs three weeks after birth is not too severe, then there is no need to sound the alarm. But if there is as much blood coming out as in the first days after birth, then this is a signal that you need to immediately go to the doctor.

Causes of prolonged bleeding after childbirth

How long does it take to bleed after childbirth if the exposed vessels after detachment of the placenta cause bleeding? Three days are enough for the contracting uterus to cope with the task on its own. If this does not happen, then the cause of the pathology may lie in the following:

The uterus contracts too sluggishly after childbirth or there are no postpartum contractions at all.
Remains of the placenta in the uterus. They can provoke sluggish contraction of the organ, as well as constant discharge.
Ruptures of the tissues of the genital organs. During childbirth, there are complications when the woman in labor tears the tissue of the vagina, perineum, or even the cervix. Sometimes they are cut deliberately so as not to damage the baby’s skull, and also to avoid lacerations, which take longer and harder to heal. Usually doctors carefully stitch everything up, but if a gap in any place was not noticed or the seam is damaged, then it continues to bleed for a long time, which even poses a threat to life.

How to behave

Knowing how many days the blood bleeds after childbirth is just as useful for a young mother as it is to understand how to behave during lochia. To promote rapid healing of the uterus, and not interfere with your own recovery, you must follow the following rules.

Avoid tampons. All blood clots must come out of the vagina and in no case stagnate. To feel comfortable, it is better to get night pads that can absorb large volumes of liquid. You should forget about tampons, as they can provoke the development of infections of the internal genital organs.
Constantly empty your bladder. In the first days after childbirth, this organ loses its sensitivity. It is better not to wait for the urge to urinate, but to visit the toilet in advance. Otherwise, an overfilled bladder will put pressure on the uterus and once again provoke bleeding.
It is necessary to urgently consult a doctor if profuse lochia is observed for more than four days (the pad is completely saturated in one hour), especially if they also contain large blood clots.

Medical treatment of postpartum hemorrhage

Knowing how long the blood flows after childbirth, a woman can draw at least approximate conclusions (whether her lochia corresponds to the norm or not). If there is cause for concern, the young mother should immediately go to see a gynecologist. What treatment will she be offered?

If the cause of long-term lochia is the remains of the placenta in the uterus, then the young mother will have to “cleanse”. You should not shy away from this procedure, since this is fraught with the formation of purulent processes in the uterus, which after some time will lead to infertility. After the “cleansing”, the woman is prescribed a series of antibiotics that will prevent the development of infection.

If the examination shows that there are no serious abnormalities, but it turns out that the young mother too quickly began to lead an active lifestyle, go to the gym, and so on, then it will be enough to reduce physical activity and the lochia will stop. Having assessed the overall picture, the gynecologist may advise the mother to breastfeed the baby more often, since this process provokes uterine contractions and, as a result, stops bleeding.

If undetected tears are found in the vaginal cavity or cervix, they are sutured.

Rehabilitation

We found out how long blood should flow after childbirth and how to control this process. Let's talk about what prohibitions we will have to face if complications do occur and a “cleaning” is done.

At a minimum, you will have to forget about hot baths, steam baths and saunas, going to the gym and any other physical activity. Naturally, you will have to give up sexual relations for some time.

How long after childbirth does the blood stop flowing - their obstetricians-gynecologists should inform future mothers in detail about this. If this does not happen, it is better to inquire yourself in order to avoid unnecessary complications in the future.

Blood discharge after childbirth is a mandatory and completely normal process.

In this way, lochia and the remains of the placenta are removed from the body.

Bloody discharge after childbirth: how long can it last normally and what to do if it is abundant and does not end for a long time?

Is this a cause for concern?

Blood after childbirth: how long does it last and why does this happen?

Postpartum discharge is a natural physiological process in which the body rejects the uterine mucosa. Discharge occurs regardless of how the child was born (naturally or by cesarean). The birth of a child involves the separation of all membranes. The uterus after this is one large bleeding wound.

Restoration of the uterine mucosa begins immediately after the completion of labor. This process is taken over by the uterine glands. In the first days after childbirth, the discharge consists of blood (80%) and secretions of the uterine glands. Gradually, the amount of blood in the discharge decreases.

Lochia occurs in both the early and late postpartum periods. The early period is considered to be the first two hours after birth. The next 6-8 weeks are late.

Blood after childbirth: how long does it flow and what does the duration depend on?

The normal duration of postpartum bleeding is about 6 weeks. During this time, the woman loses about one and a half liters of blood. You should not be afraid of such a figure, because a woman’s body is ready for this in advance. When pregnancy occurs, significantly more blood begins to circulate in the female body than in an ordinary person.

The duration of bleeding depends on many factors. Breastfeeding significantly reduces this period. A woman’s body initially has a connection between breastfeeding and uterine contractions. Accordingly, the faster the uterus returns to its normal state, the faster the discharge will end.

The duration of the discharge is also affected by the process of delivery. For those women who gave birth naturally, blood runs out faster after childbirth. After a caesarean section, the uterus takes a little longer to recover. This is due to the fact that an incision was made on it, which was subsequently sewn up.

Spotting will take a little longer in women who are exposed to constant stress and heavy physical activity during the postpartum period. This is also why young mothers are advised to rest more after childbirth and try not to worry.

What other factors influence the duration of discharge from the birth canal:

● multiple pregnancy (in this case the uterus greatly increases in size, which means the contraction process will take longer);

● impaired blood clotting;

● trauma during childbirth, internal sutures;

● large child;

● elements of the placenta that may remain in the birth canal (in this case, the inflammatory process begins);

● contractile feature of the uterus;

● the existence of fibroids or myomas.

Blood after childbirth: how long does it flow and what are the rules of personal hygiene during this period?

While there is bleeding, there is a high risk of developing an infectious disease. To avoid this, you must adhere to certain rules of personal hygiene. In the postpartum period, they will differ somewhat from the generally accepted and well-known ones:

● special attention should be paid to sanitary pads; it is better to choose those designed specifically for postpartum discharge;

● when the discharge becomes less abundant, you can start using regular menstrual pads, but you should also be careful when choosing them: they must have a high degree of absorption;

● change gaskets more often; despite the fact that the product package says that they can retain moisture for up to 8 hours, you should not fall for advertising, ideally the gasket should be changed every 3-4 hours;

● It is strictly forbidden to use tampons for postpartum discharge, no matter what you are guided by and no matter what manufacturer you choose;

● it is advisable to wash yourself after each gasket change;

● this can be done using baby soap; it is also important to follow the flow of water: it should be directed from front to back;

● if the doctor has indicated the need for home treatment of sutures, then this should be done using antiseptics - furatsilin or potassium permanganate;

Bloody discharge after childbirth: how many days can it last normally and when should you sound the alarm?

Normal postpartum discharge

The first few days after birth, the discharge will be as heavy as possible. Approximately 400 ml of blood should be released daily. Most often it is not homogeneous, but with mucus or clots. There is no need to be afraid, this is a completely natural process. That's how it should be. These days the discharge is bright red.

After 3 days the color will gradually change to brown. The closer to the end of the postpartum period (8 weeks), the less discharge there will be. Gradually they will look like menstruation, then they will become light and turn into regular mucus.

When to sound the alarm

If a woman notices in the maternity hospital that the discharge has become more intense or less frequent, thicker or, conversely, more watery, she must immediately tell the doctor about it.

Also, postpartum discharge should be monitored after discharge from the hospital. Despite the fact that each woman’s recovery process after childbirth is individual, there are general points that should be a reason to contact a gynecologist.

What should every young mother be wary of?

Quickly stop discharge. If lochia stops occurring earlier than 5 weeks after birth, this is a serious cause for concern. Every woman should know that the functional layer of the endometrium is completely restored no earlier than 40 days after delivery. If the discharge stops very soon after the baby is born, this does not indicate the body’s good ability to recover. Most likely this is due to complications. They are often infectious in nature. However, it could also be cervical spasm. It traps lochia in its cavity, preventing it from coming out. This situation requires an immediate solution, as it leads to serious consequences.

Red color of discharge. 5 days after birth, lochia takes on its color. It can be individual for each woman. But if the discharge remains bright red, as in the first days after childbirth, you urgently need to tell your doctor about it. This may indicate problems such as hematopoiesis or blood clotting problems.

Change in lochia color. If at first the discharge changed its color from red to brown, and after some time, it turned back to red, this also indicates problems. In most cases, this is due to intrauterine bleeding, which urgently needs to be eliminated. Timely consultation with a doctor will help avoid serious consequences. A repeated change in the color of the blood after childbirth may indicate the existence of a polyp or rupture of soft tissue in the birth canal.

Odor appears. If after some time the discharge begins to have an odor (no matter what), this means that an infection has entered the uterine cavity. It can cause endometritis. By consulting a doctor in time and diagnosing the disease, a young mother can avoid such an unpleasant procedure as curettage. It is carried out when other methods of treatment (taking drugs that suppress the development of microorganisms and forcibly increasing uterine contractions) have been ineffective.

Bloody discharge after childbirth: how many days can it normally last and when does menstruation begin?

It is impossible to answer the question 100%: when will your period come? Each female body is individual. Typically, if a mother stops breastfeeding towards the end of the postpartum period, her eggs will soon begin to mature.

For those who continue to breastfeed, menstruation may begin six months after birth, not earlier. At first the cycle will be irregular. Menstruation can be both scanty and abundant, both short (up to 1-2 days) and long (up to 7-8 days). There is no need to be afraid of this, everything is within normal limits. For some mothers, menstruation does not appear until the end of lactation. This option is also considered the norm. This is due to the postpartum production of the hormone prolactin. It stimulates the production of milk to feed the baby and helps suppress the formation of hormones in the ovary (ovulation simply does not occur).

The postpartum period is no less important than pregnancy and childbirth. At this time, you also need to be careful about your health and condition. At the slightest deviation from the norm, you must visit a doctor. Don't be afraid to talk about any changes in your bleeding that worry you. Even if your gynecologist is a man, remember that first of all he is a doctor who is interested in your speedy recovery after childbirth. If something worries you while still in the maternity hospital, be sure to consult with him. Many problems are easy to solve at the stage of their formation, and not in a neglected form.

After being discharged home, do not neglect the rules of personal hygiene and doctor’s recommendations. Remember, your baby needs a healthy and cheerful mother!