Obstetrical hemorrhage
Refers to heavy bleeding during pregnancy, labor, or the puerperium. Bleeding may be vaginal
and external, or, less commonly but more dangerously, internal, into the abdominal cavity. Typically
bleeding is related to the pregnancy itself, but some forms of bleeding are caused by other events.
Obstetrical hemorrhage is a major cause of maternal mortal
Early pregnancy bleeding
The most common bleeding event is the loss of a pregnancy, a miscarriage, medically also called
an abortion. Bleeding from an early miscarriage may be similar to that of a heavy menstruation, but later
on, a pregnancy loss may be accompanied by excessive or prolonged bleeding. A physician may propose
to perform a D&C for treatment. An ectopic pregnancy may lead to bleeding, internally, that could be
fatal if untreated.
Late pregnancy bleeding
The primary consideration is the presence of a placenta previa, a condition that usually needs to
be resolved by delivering the baby via cesarean section. Also a placental abruption can lead to obstetrical
hemorrhage, some times concealed.
After delivery
Hemorrhage after delivery, or postpartum hemorrhage, is the loss of greater than 500 ml of blood
following vaginal delivery, or 1000 ml of blood following cesarean section. It is the most common cause
of perinatal maternal death in the developed world and is a major cause of maternal morbidity
worldwide.[1]
Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta, and coagulopathy,
commonly referred to as the "four Ts,”.
Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding. Retained
placental tissue and infection may contribute to uterine atony.
• Trauma: trauma from the delivery may tear tissue and vessels leading to significant postpartum
bleeding.
• Tissue: retention of tissue from the placenta or fetus may lead to bleeding.
• Thrombin: a bleeding disorder occurs when there a failure of clotting, such as with diseases
known as coagulopathies.
Management
The success of modern obstetrics is based on the ability to recognize risk patients for obstetrical hemorrhage and their appropriate
management. In developing countries, deaths from obstetrical hemorrhage are very high. It has been recognized that to reduce
morbidity and death, it is necessary to prevent obstetric hemorrhage and reduce the impact of hemorrhage when it does occur
through early diagnosis and timely, appropriate management. Three simple technologies have been used to prevent and manage
post-partum hemorrhage. These are: use of misoprostol prophylactically immediately after childbirth, which reduces risk of post-
partum hemorrhage by 50%,[2] a blood drape that collects and measures blood loss, allowing for early recognition of
hemorrhage,[3] and the non-pneumatic anti-shock garment which can be used to stabilize and resuscitate a woman, and keep her
alive while she is being transported for further treatment or waiting at a facility for care.[4]
