Bleeding during childbirth

The blood loss, which is 0.5% of the body weight of the parturient child, but not exceeding 400 ml, is considered physiological. The blood loss of more than 400 ml( regardless of the weight of the parturient mother) is considered as pathological.

The causes of abnormal blood loss in the consecutive and early postpartum periods may be:

• uterine hypotonia due to prolonged or excessively rapid delivery, overgrowth of the uterus in the presence of a large fetus, multiple fertility or polyhydramnios, underdevelopment or malformations of the uterus, etc. Of particular importance are operationson the genitals, inflammatory diseases of the genitals, abortions in the anamnesis. Hypotension of the uterus provokes a delay in separation of the placenta and discharge of the placenta, increased blood loss;

• atony of the uterus with overflow of the bladder and rectum;

• abnormalities of placenta attachment. Under normal conditions, the villus of the chorion penetrates into the mucous membrane of the uterus not at its full thickness. Therefore, an easy detachment of the placenta from the uterine wall occurs within the mucous membrane. When the chorionic villi penetrate the entire thickness of the mucous membrane up to the basement membrane, which delimits it from the muscular membrane, there is a tight attachment of the placenta. In such cases, the expected separation of the placenta from the uterine wall does not occur, and there is a need for its manual separation. The penetration of the villus chorion is even deeper, i.e.in the muscular membrane of the uterus, leads to an increase in the placenta. This is detected when trying to make a manual separation from the wall of the uterus. Sharp and violent separation of the placenta can lead to perforation of the uterine wall and to a life-threatening bleeding. In this case, an urgent condition arises that requires urgent surgery - abdominal and uterine removal with the placenta attached to it;

• clotting disorders in the form of hypo- or afibrinogenemii with the subsequent onset of fibrinolysis;

• incorrect management of postpartum and early postpartum periods: attempts to speed up the process of placental separation by rough uterine massage and pulling on the umbilical cord until signs of separation appear.

As a prophylaxis for possible bleeding in the consecutive and early postpartum periods, the following measures should be applied:

• at the end of the expulsion period with the last effort, inject 0.5 ml of oxytocin, methylergometrine or other uterine contracting agents intramuscularly;

• immediately after the birth of the child, release urine through the catheter;

• after the birth of the afterbirth, put an ice pack and a load on the bottom of the uterus;

• carefully inspect the born after.

In the absence of the effect of the measures taken, it is necessary to urgently perform a manual examination of the uterine cavity under anesthesia and simultaneously begin intravenous administration of blood-substituting solutions, canned blood, uterus reducing agents and drugs that stimulate tissue metabolism( glucose, vitamins, cocarboxylase, etc.).With massive blood loss, it is necessary to carry out oxygenation of the body, including artificial respiration.