Postpartum hemorrhage or bleeding is defined as the loss of more than
500 mL of blood after delivery. Postpartum hemorrhage occurs in up to 1
in 5 births. Excessive blood loss exceeding 1,000 cc is considered significant and can result in complications.
Even with appropriate management, approximately 3 percent of vaginal deliveries will result in severe post-partum hemorrhage. It is the most common maternal morbidity in developed countries and a major cause of death worldwide.
Complications from postpartum hemorrhage include:
- Hemorrhagic shock
- Maternal death
Anemia can develop after excessive blood loss and if untreated can increase the risk of post-partum depression.
Blood transfusion may be necessary and carries associated risks. In the most severe cases, hemorrhagic shock may lead to anterior pituitary ischemia with delay or failure of lactation (i.e. postpartum pituitary necrosis).
Occult myocardial ischemia, dilutional coagulopathy, and death also may occur. Delayed postpartum hemorrhage, bleeding after 24 hours as a result of sloughing of the placental implantation site, inadequate uterine contraction (atony), or retained placental fragments, also can occur.