1. Postpartum bleeding What is the definition of
Postpartum bleeding refers to the vaginal blood loss exceeding 500mL within 24 hours after the fetus is delivered, and during cesarean section, the bleeding exceeds 1000mL.
Jiang Feng: 80% of postpartum bleeding occurs within 2 hours after delivery. The large amount of uterine bleeding occurs during the puerperal period is more common in 1 to 2 weeks after delivery. After the fetus is delivered, the amount of bleeding is large enough for 1,000mL within 24 hours. We call severe postpartum bleeding.
After conservative treatment such as uterine contractions, continuous uterine massage, or compression, conservative treatment measures cannot stop bleeding. It is called surgical interventional treatment of , or even uterine removal and other interventions. This severe postpartum bleeding is also called refractory postpartum bleeding. 24 hours after delivery, vaginal bleeding exceeds 500mL. This postpartum bleeding is called late postpartum bleeding . Postpartum bleeding is a serious complication during delivery and is also one of the four major causes of maternal death.
In my country, postpartum bleeding has been the first cause of maternal death in recent years. The incidence of postpartum bleeding also accounts for 2% to 3% of the total number of delivery. The reasons for postpartum bleeding are uterine contraction fatigue , soft birth canal damage to the placenta, and coagulation dysfunction. These four major causes can be combined or can be causal.
Expert tips: Postpartum bleeding refers to the amount of blood loss in vaginal delivery within 24 hours after the fetus is delivered, and the amount of blood loss during cesarean section exceeds 1000ml. 80% of postpartum bleeding occurs within 2 hours after delivery, and the large amount of uterine bleeding occurs during the puerperal period is more common at 1-2 weeks after delivery. Among them, if the fetus bleeding exceeds 1000ml within 24 hours after delivery, it is called severe postpartum bleeding; if the vaginal bleeding exceeds 500ml after delivery, it is called advanced postpartum bleeding. Postpartum bleeding is a serious complication during delivery and one of the four major causes of maternal death.
2. Is the chance of postpartum bleeding high
Jiang Feng: Is the chance of postpartum bleeding high? The incidence of postpartum bleeding in my country is not very high, but it is not very low. According to statistics, it accounts for about 2% to 10% of the total risk. However, due to the large subjective factors for measuring and collecting bleeding, we actually believe that its incidence is higher than reported.
Postpartum bleeding has been the first cause of maternal death in recent years, and it seriously threatens the life safety of maternal and newborns, especially in remote and backward areas. This situation is even more prominent. In addition, the incidence of postpartum bleeding varies by different ages, different regions, different economic and cultural backgrounds. Senior high age, low income, low education level, multiple abortion history, scar uterus re-delivery, labor prolongation , etc., these factors are closely related to the onset of postpartum bleeding. With the full liberalization of my country's three-child policy, the proportion of elderly pregnant women with scars and uterine re-delivery has increased, and the incidence of postpartum bleeding may increase, which must be taken seriously.
Expert tip: The incidence of postpartum bleeding in my country is not very high, accounting for about 2-10% of the total number of delivery. In addition, senior age, low income, low education level, multiple artificial abortions, scar uterine re-delivery, prolonged labor, etc. are closely related to postpartum bleeding. With the full liberalization of my country's three-child policy, the proportion of elderly pregnant women and scar uterus re-birth increases, and the incidence of postpartum bleeding may increase.
3. What should I do for postpartum bleeding
Jiang Feng: The principles for postpartum bleeding should be dealt with based on the cause, stop the hemorrhage quickly, replenish blood volume, correct shock, and prevent infection. First, different hemostatic methods should be adopted according to different causes. For hemostasis of uterine contraction and fatigue, the first is to remove the cause of uterine contraction and fatigue, the second is to strengthen uterine contraction, the third is to massage the uterine cavity, the fourth is to fill the uterine cavity, the fifth is to ligate , the ascending branch and descending branch of the bilateral uterine artery, and the internal iliac artery, etc., the seventh is to compress the abdominal aorta, the eighth is to embolize the artery, the ninth hysterectomy, etc.For bleeding caused by damage to the soft birth canal, we must fully expose the soft birth canal, find out the laceration site and give sufficient suture. If the bleeding caused by placental factors is caused by placenta retention, or the residual
Jiang Feng: You should peel the placenta with bare hands as soon as possible, or clear the uterus to remove the residual placental tissue. If you are highly suspicious of placenta implanted with or placenta penetration, you do not need to force the placenta to peel off the placenta. You can choose the same way as uterine contraction and fatigue, and stop bleeding. Bleeding caused by coagulation dysfunction should be quickly supplemented with the corresponding coagulation factors on the basis of actively treating the primary disease.
Expert tips: The principle of handling postpartum bleeding is to target the cause, quickly stop bleeding, replenish blood volume, correct shock and prevent and treat infection. For the treatment of uterine contraction and fatigue bleeding, 1. Remove the causes of uterine contraction and fatigue; 2. Strengthen uterine contraction and ; 3. Massage the uterus; 4. Uterine cavity filling; 5. Surgical suture; 6. Ligate the upper and lower branches of the uterine artery and the internal iliac artery; 7. Compress the abdominal aorta; 8. Transcatheter artery embolization; 9. Hysterectomy, etc. If it is bleeding caused by soft birth canal damage, if the soft birth canal is fully exposed, the laceration site is found and sutured. If it is bleeding caused by placental factors and the placenta is retention or residual, the placenta should be peeled off with bare hands or the uterus should be removed as soon as possible. If it is bleeding caused by coagulation dysfunction, the corresponding coagulation factors should be quickly supplemented on the basis of actively treating the primary disease.
