Uterine Haemorrhage - Symptom & Treatment
Bleeding which occurs immediately after delivery of the baby is known as primary postpartum haemorrhage. A secondary postpartum haemorrhage is one that occurs more than 24 hours after completion of delivery. The lochia, which is bright red blood for the first 2-3 days, then becomes pinkish and later brown, and may become red again as a result of exercise or a return to household chores. Excessive bleeding occasionally occurs and may be the result of infection (when the bleeding is not usually severe and does not generally require any specific treatment other than for the infection itself) or retention of a small piece of placenta, known as a cotyledon. If the bleeding becomes more serious and the woman starts to pass dots, then the presence of a retained cotyledon is always considered.
Subinvolution follows a low-grade infection inside the Uterus so that the Uterus does not involute, or return to its normal size, properly. Because the involution is not satisfactory, there is a tendency to excessive bleeding. When the infection is treated, normal involution ensues and bleeding ceases.
Although the placenta is carefully inspected at delivery, it sometimes happens that small fragments, retained within the uterus, are too small to be detected as missing. Retained products of conception may result in the sudden onset of brisk bleeding often associated with the passage of dots.This usually starts about the 10th day after delivery.
If bleeding suddenly begins, the midwife or doctor must be notified immediately. The treatment follows two principles. Firstly,the administration of ergometrine, syntocinon or syntometrine (which contains both ergometrine and syntocinon), will make the uterus contract and stop bleeding for at least 3-4 hours, and, secondly,admission of the woman to hospital where if there are obvious retained products, a gentle curettage will be performed under general anaesthetic to empty the uterus. If there is doubt as to whether there are retained products of conception within the uterus then an ultrasound scan may be performed. If the uterus is empty an operation will not be necessary and antibiotics may be given. Occasionally, if blood loss has been severe,a transfusion may be given, but once the uterusis empty it will contract and there will be no further haemorrhage.