(PPH, Postpartum Bleeding)
Postpartum hemorrhage is excessive bleeding after the birth of a baby. It is more common with cesarean
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Some women are at greater risk than others. The following may lead to postpartum hemorrhage:
- Uterine atony (uncontrolled relaxation of the uterus)—most common
- Placental abruption
Some of the above causes are also risk factors for postpartum hemorrhage. Once the baby is delivered, the obstetrician will be watching for uterine contraction. Some birthing centers give all delivering mothers pitocin after the baby delivers. Pitocin
The uterus continues to contract after the birth, working to return to its prepregnancy size. This activity helps deliver the placenta. Some birthing centers take a more natural approach and wait to see if there is any problem with bleeding. If the placenta is not delivered, your physician may prescribe uterus massage to help pass clots of blood. Talk to your obstetrician or midwife before the birth so you know what method to expect.
Some bleeding after the birth of a baby is normal. If you experience any of the following symptoms do not assume that you are experiencing postpartum hemorrhage. But contact your physician right away.
- You are soaking more than one sanitary pad per hour for several hours.
- You have heavy, bright-red bleeding four or more days after the delivery.
- Your discharge has a foul smell.
- You are passing blood clots larger than a golf ball.
- This loss of blood is causing you to have heart palpitations, feel faint, lightheaded, and breathless.
Your doctor usually diagnoses postpartum hemorrhage based on the symptoms.
Tests may include the following:
- Estimation of blood loss (this is done by counting or weighing the saturated pads)
- Pulse rate and blood pressure measurement
- Blood test to check for clotting factors and hematocrit (the % of red blood cells in the blood fluid)
Talk with your doctor about the best treatment plan for you. Specific treatment will depend on your overall health, medical history, tolerance for medications and procedures, and your opinion or preference. The goal of treatment is to locate the cause and stop the excessive bleeding as fast as possible. Treatment options include the following:
- Medication—Drugs such as pitocin, methergine, and hemabate can stimulate uterine contractions.
- Manual massage of the uterus—This external pressing down on the pelvic area helps expel clots of blood from the uterus and helps the uterus contract.
- Removal of pieces of the placenta still in the uterus
- Packing the uterus with sterile materials to stop the bleeding
- Tying off bleeding blood vessels
- Laparotomy—This is open surgery on the abdomen to find the cause and stop the bleeding.
- Hysterectomy—This is surgical removal of the uterus. This is a worst-case scenario for severe bleeding that is life-threatening.
- IV fluids, blood/blood products, oxygen—Your physician will replace lost blood and fluids, if necessary. These treatments are used to prevent shock.
- X-ray-guided uterine artery thromboembolism—a technique whereby a radiologist inserts a catheter into the femoral artery (in the groin) and injects substances which close off the bleeding artery
The American College of Obstetricians and Gynecologists
National Institute of Child Health and Human Development
The National Women’s Health Information Center
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
Cunningham G, et al. Williams Obstetrics. 20th ed. New York: Appleton- Lange; 1997.
Postpartum hemorrhage. Children’s Hospital of The King’s Daughters website. Available at: http://WWW.CHKD.ORG/HIGH_RISK_PREGNANCY/POSTPART.ASP. Accessed August 8, 2005.
Postpartum hemorrhage. University of Virginia Health System website. Available at: www.healthsystem.virginia.edu/uvahealth/peds_hrpregnant/postpart.cfm. Accessed August 8, 2005.
Last reviewed April 2008 by
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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