Bloody discharge after childbirth is a completely natural phenomenon. On average, they last up to 1.5 months, but the specified period may change in one direction or another. Some women worry when they are still bleeding a month after giving birth. What could this be connected with, is this considered normal and what symptoms should alert a young mother? Let's look at these questions in our article.
The nature of postpartum discharge
During pregnancy, women experience a significant increase in the volume of blood circulating in the body. According to statistics, the amount of blood can increase by 30–50%. In this way, nature provides sufficient nutrition and oxygen supply to the baby developing in the womb, and also creates a kind of blood reserve to alleviate the consequences of childbirth and the postpartum period. The vessels of the uterus dilate and by the time of birth its blood supply reaches a maximum.
During and after childbirth, quite active discharge is observed for 2–3 days, which is designated by the medical term “lochia.” This natural process, you shouldn't be afraid of him. With such secretions female body may lose up to 1.5 liters of blood and this is also normal. Moreover, a small amount of lochia excreted may indicate their accumulation in the uterus, which can cause an inflammatory process. However, it is extremely important to distinguish lochia from uterine bleeding, which has approximately the same appearance. After all, such bleeding is fraught fatal, therefore requiring urgent medical intervention.
Late postpartum discharge
Bleeding that occurs in women a month after childbirth can have various causes. If a woman in labor is tormented by any doubts, then it is better for her to consult a doctor.
Long-lasting lochia. Spasmodic contractions of the uterus, which begin after childbirth and continue for some time, intensify when the baby is attached to the breast and help the uterus to cleanse itself of blood particles and clots in it. Lochia are remnants birth canal, placenta, endometrium, which are excreted for several days after birth. By the end of the first week after birth, their color changes, they acquire a brown tint, become paler, more and more scanty, and by the end of the first month, the release of lochia stops. In some women, the discharge of lochia continues for 1.5 months after childbirth or even more. This is within the normal range and can usually be caused by the following reasons:
- The woman is not breastfeeding. At the same time, the hormone prolactin, which stimulates uterine contractions, is not produced, so its cleansing occurs more slowly. If there are no blood clots in the discharge or bad smell, then there is no reason to worry, they will gradually disappear.
- The birth was carried out with the help caesarean section. The suture on the uterus prevents it from contracting properly, causing its recovery process to be delayed. Injuries and ruptures received during childbirth and the application of internal sutures have a similar effect on the duration of bleeding.
- The uterus was greatly distended during pregnancy due to large sizes fetus or the presence of several fetuses, which increases the period of restoration of the previous form.
- The presence of fibroids, fibroids, and polyps prevents normal uterine contractions, which increases the duration of discharge.
- Blood clotting is impaired. The doctor should be warned about the existence of this problem at the stage of planning the child. And, of course, a woman should be prepared for the fact that natural bleeding after childbirth will last much longer than usual.
- Excessive exercise can lead to muscle tears and even bleeding, which will slow down the process postpartum recovery and will prolong the duration of discharge.
What a woman should know and do to avoid ruptures after childbirth
The appearance of menstruation. Typically, women do not have periods for two months after giving birth. But this is true for those mothers who are breastfeeding their baby. In this case, the released prolactin inhibits the production of estrogen, which is responsible for the maturation of follicles and the restoration of the menstrual cycle.
For those women who, for one reason or another, do not put their baby to the breast, menstruation can resume within a month or a month and a half after giving birth.
This is a good sign and indicates the rapid restoration of the uterus and hormonal levels of the female body. Since during menstruation the discharge becomes abundant and has a bright red color, the woman needs to correctly determine whether she is really talking about menstruation, or whether she has started bleeding from the uterus, which is extremely dangerous to health and requires emergency medical care.
Inflammatory process in the internal genital organs. May be caused by particles of the placenta, endometrium remaining in the birth canal, or attached during surgical intervention infection.
Early sexual relations. Doctors usually recommend abstaining from intimate relationships for two months after the birth of the baby. During this period, the pelvic organs should recover. If partners begin sexual relations earlier than the recommended period, this can lead to bleeding.
The presence of cervical erosion can provoke brown or bloody discharge in the late postpartum period. A gynecologist can confirm the diagnosis. He will prescribe appropriate treatment, during which sexual relations are not recommended.
What should cause concern
If, instead of decreasing, the volume of discharge suddenly increases sharply, the woman needs to consult a doctor, since in this case this may be a symptom of uterine bleeding. If for several hours in a row a standard pad becomes saturated with blood within 40–60 minutes, we are talking about internal bleeding.
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If the discharge becomes unpleasant putrid smell or a yellowish-green tint, then most likely an inflammatory process is developing in the internal genital organs. It may be caused by kinking of the uterine tubes and, as a result, the accumulation of lochia there.
An inflammatory process in the uterus can lead to the development of endometritis. It may be accompanied severe pain in the lower abdomen, increased body temperature and purulent discharge. Once the diagnosis is confirmed, the doctor will definitely prescribe a course antibacterial drugs and curettage of the uterus.
In addition to the factors listed above, reasons for urgently seeking medical attention are also:
- the appearance of clots and mucus;
- pain in the lower abdomen;
- increased body temperature, weakness, deterioration of health;
- The duration of discharge is more than 6–7 days.
In order for the uterus to recover quickly after the birth of the baby, doctors advise sleeping on your stomach more often, or at least resting in this position. Also, you should not walk with overcrowded bladder, it is better to go to the toilet when the first urge occurs.
How many there's blood coming out after childbirth? Postpartum hemorrhage is a physiological norm that manifests itself in ninety-eight cases. With its help, a woman’s body can gradually return to normal. Postpartum bleeding cleanses the uterus itself from the placenta and so-called lochia present in it, as well as from the remaining pieces of the placenta. These specific discharges begin to appear almost immediately after the completion of labor, and this can last for about a month and a half, in some cases more. But this does not always happen and the blood can flow quite heavily, which is a pathology.
Causes of bleeding
The duration of this discharge can range from two to six weeks, which is normal. The amount of time that blood flows after childbirth directly depends on the blood clotting of the woman who gave birth, the ability of the uterus to contract, the function of tissue repair, and so on. An interesting fact is that women who breastfeed undergo the recovery process much easier and faster.
Normally, bleeding after childbirth is quite intense, but then gradually less blood begins to be released and eventually it turns into scanty brown discharge, which is where it ends. This condition is the norm and lasts about six weeks.
Postpartum bleeding itself after the birth of a child during the first two hours and the first day is caused by the following reasons:
Postpartum bleeding itself after the birth of a child during the first two hours and the first day is caused by the following reasons:
- Poor blood clotting of a woman in labor; it is quite simple to distinguish it - bleeding in succession period occur without clots and lumps, that is, in a stream. That is, thrombus formation in this situation is impaired. To prevent the occurrence of such a situation, immediately before the birth itself and shortly before it, you should donate blood for a general analysis. In addition, the use of any drugs with anticoagulant effects should be discontinued.
- Too rapid delivery, which is accompanied by ruptures, that is, the uterus and its cervix in particular, as well as the vagina, are damaged; here, bleeding continues much longer.
- Placenta accreta, which makes it difficult to restore the uterus and causes bleeding in the afterbirth period.
- Impossibility of contractile function of the uterus, which occurs due to excessive stretching of the walls, due to polyhydramnios, a large fetus or twins.
- Uterine fibroids and fibroids inside it.
There are also certain reasons for bleeding, due to which blood discharge continues even after two weeks, these include:
- after a caesarean section, a woman may experience spasms, after which blood clots are released;
- if parts of the placenta remain in the uterine area;
- inflammation, which hinders the recovery process.
Thus, if a woman has early period The discharge of blood from the genital organs does not stop for a long time and, on top of everything else, it is profuse, you need to address it, since the reason lies in pathological changes.
Peculiarity
Bleeding after childbirth is a physiological process that occurs normally, but women often have a question: how long does bleeding last after childbirth and why. The answer to this question is quite simple; the point here is that when carrying a baby, the placenta is attached to the uterine walls and communicates with it using blood vessels. During labor activity the placenta is freed from its attachment, exposing the vessels. Naturally, they begin to bleed, which leads to copious discharge blood.
Normally, literally after the birth of a baby, mothers who have given birth experience new contractions, which provoke the uterus to contract and squeeze blood vessels, which prevents postpartum bleeding; this happens at an early stage.
You should not be afraid of blood loss, since this is invented by nature itself, that is, when carrying a baby, the volume of this fluid doubles and bleeding in the early postpartum period is a protective reaction of the body itself, aimed at a speedy recovery.
When visiting a doctor because blood discharge does not stop after childbirth, a woman must indicate two parameters for research: the specificity and volume of blood. In this case, the specialist often notes disturbances in heart rhythm, blood pressure, as well as general malaise.
Based on physiological parameters, normal bleeding in the early postpartum period is no more than 0.5% of the total body weight of the woman who gave birth. But there are often situations in which the indicator turns out to be higher and severe bleeding occurs after childbirth, which is a pathology.
If this volume of lost blood begins to exceed 1% of the total body weight of the woman in labor, then critical blood loss occurs. Such conditions lead to irreversible consequences and can be fatal.
This condition occurs when the tone of the uterus is weak or completely absent. The more advanced the condition, the less amenable to recovery with treatment. Moreover, the use of drugs whose action is aimed at reducing the myometrium can slightly stop heavy postpartum bleeding, but only for a short time.
The body's reaction in this case manifests itself as follows:
- Arterial hypotension.
- Paleness of the skin.
- Tachycardia.
- Dizziness.
- General malaise.
In the female body, the blood released from the uterus after childbirth is called lochia; it consists of the blood itself with remnants of the endometrium of the uterus and an admixture of bacteria.
A deviation from the norm is considered to be a condition in which the following situations occur:
- the duration of bleeding exceeds six weeks;
- deterioration of health;
- the discharge becomes yellow-green in color, periodically turning brown, which also occurs in the early postpartum period;
- after childbirth, bleeding of an unstable nature, which can be either scanty or heavy;
- there is pain in the lower abdomen;
- unpleasant smell of discharge;
- symptoms of intoxication.
An unpleasant odor indicates the presence of an infection in the body, which penetrates quite easily into the body weakened after childbirth.
If a woman experiences the symptoms described above and they last more than a month, she should urgently seek help from a doctor, as they indicate the development of infectious diseases, endometriosis, and so on. This should be done in the early postpartum period, which will greatly facilitate the recovery process.
Diagnostic and therapeutic measures
Diagnosis of the presence of pathologies is possible even during pregnancy, using the study of red blood cells, hemoglobin, platelets, which can be done even at early stage carrying a baby. It is also important to take into account blood clotting.
The muscular reaction of the uterus is examined in the third stage of labor, and the muscles should not be flabby or contract weakly, and also:
- first of all, it is necessary to examine the placenta, which after the birth of the child should come out intact;
- the fetal membrane is examined;
- The birth canal is examined, where no injuries should be noticed.
IN special cases Doctors practice giving the woman who has given birth a general anesthesia, after which the uterus can be manually examined for ruptures, placenta residues, tumors and other pathologies that will interfere with the contractility of the myometrium.
If bleeding needs to be examined in the late postpartum period, then exclusively the method is used ultrasound examination, which helps to detect the remains of the placenta or fetal membranes.
Normally, the discharge of blood itself should eventually change to a yellowish leukocyte discharge, but if this does not happen and the discharge begins to smell strange or the blood is released with greater intensity, then you need to seek help from specialists. The same applies to the situation if a month has already passed after giving birth, but the blood continues to flow with the same intensity.
To begin treatment, it is necessary to establish the cause of this situation. For the purpose of treatment, an exclusively comprehensive approach should be used, including the use of medications and invasive methods.
In order to provoke the contractile function of the uterus, a special catheter is inserted into the woman’s urethra, allowing her to urinate, and ice is applied to her stomach. If necessary, massaging the uterus is allowed, but only using a gentle method. Sometimes all the measures taken do not produce results, then uterotonic medications are administered intravenously, and sometimes injections of drugs with prostaglandins are given into the cervix.
The lost plasma volume is replenished with specific infusion-transfusion therapy. To do this, plasma replacement medications, as well as blood components, are injected into the vein of the mother.
When tears are noticed, anesthesia is administered, after which the specialist stitches up the damage. Excessive bleeding after childbirth, the cause of which is trauma and injury, is eliminated using the same method.
The used manual cleansing of the uterus takes place in the event of a violation of the integrity of the placenta, which occurs only after the introduction of general anesthesia; this will help the discharge pass faster.
There are cases where, as a result of a manual rupture, a uterine rupture is discovered; in this case, there is a need for suturing, laparotomy, or even removal of this organ.
Surgery is necessary in case of placenta accreta to the uterus, as well as if it is impossible to stop bleeding in the postpartum period.
These manipulations are carried out only in conjunction with replacement of lost blood and stabilization of blood pressure. All these manipulations are carried out in the maternity ward.
As for preventive methods, the following measures will help reduce the intensity and duration:
- Try to go to the toilet as often as possible, since your intestines are full and bladder they compress the uterus, which prevents it from contracting normally and it bleeds with renewed vigor.
- Maintain genital hygiene, do not engage in sexual intercourse or take a bath. These measures will help to avoid infection of the weakened body of the woman who has given birth.
- Avoid physical activity for a month after giving birth.
- To stop bleeding as soon as possible, you need to sleep on your stomach, which will help the uterus contract faster.
- Feed your baby exclusively breast milk, which leads to the fact that blood discharge ends faster.
- Don't overheat.
Using Data simple tips, many women will be able to protect themselves from many unpleasant consequences during the period when they have bleeding in the placenta and early postpartum period.
But, first of all, you should know that the fact how many days after giving birth women bleed from the genitals is purely individual feature and the approach to this problem should also be individual.
With the birth of a child, a woman’s body is freed from excess fluid and a woman should not be afraid that she will become severely dehydrated due to blood loss.
In this article:
Postpartum bleeding is a normal process, which results in the natural cleansing of the uterine cavity from lochia and retained remnants of placental tissue. The severity of bleeding depends on its nature, total blood loss and duration. How long does blood bleed after childbirth is a question that concerns every young mother.
For many women, bleeding as a result of childbirth is not a cause for alarm and does not pose any threat. Abundant in the first days, it gradually decreases and disappears within a few weeks. Severe bleeding, which occurs with painful contractions and nagging pain, pronounced odor and putrefactive discharge, is not normal and requires urgent medical intervention.
Causes of bleeding after childbirth
Severe bleeding in the first hours after the birth of a newborn can be caused by:
- Poor indicators of blood clotting, individual for a woman in labor, as a result of which blood flows out of the genital tract in liquid streams without any symptoms of incipient thrombosis (thickened lumps, darkening of the color of the blood). It is not difficult to prevent such bleeding if, on the eve of giving birth, a woman undergoes an appropriate blood test for coagulation.
- , resulting in injury to the birth canal.
- Incremental tissue of the placenta, as a result of which blood will flow, since the uterus cannot fully .
- Unsatisfactory ability of the reproductive organ to contract due to overstretching of its tissues caused by, and.
- Gynecological problems associated with changes in the structure of the reproductive organ - uterine fibroids or fibroids.
Late bleeding may develop 2 hours after delivery and over the next 6 weeks.
Why does there bleed after childbirth in this case:
- particles of placental tissue are retained in the uterus;
- a bloody clot or several clots cannot leave the uterus as a result of its spasm in the cervical area;
- the recovery time of the uterus is delayed due to the inflammatory process in the pelvic area, this condition is characterized by an increase general temperature body and prolonged bleeding.
How long does bleeding last after childbirth?
Every woman who cares about her health is sure to ask her doctor about how and how many days the blood flows after childbirth. Fine postpartum discharge have a duration of up to 6 weeks, but for many young mothers they end a little earlier.
During this period of time, the mucous layer of the uterus is restored, and the organ takes on its prenatal form. bleeding continues longer because the muscles and walls of the uterus were injured during surgery, and it takes longer for it to return to its original state.
How much blood will flow after childbirth directly depends on the following factors:
- features of the course of pregnancy and labor;
- way of delivery - or;
- natural contractile activity of the uterus;
- , For example, inflammatory phenomena in the pelvic organs;
- features of a woman’s physiological status, health status;
- features of lactation - regular application of the baby to the breast, on demand, reduces the number of lochia and enhances the contractile activity of the uterus, as a result of which the organ begins to cleanse itself more effectively.
To reduce the duration of postpartum bleeding and avoid possible complications, it is recommended to follow the following rules:
- regularly empty the bladder and intestines so that overfilled organs do not create excess pressure on the uterus and do not interfere with its contractility;
- carefully observe hygiene rules to prevent infection of the birth canal;
- avoid physical activity and intimate relationships within 6 weeks after the birth of the child;
- sleep on your stomach, as in this position the uterus is cleansed more intensively;
- establish breast-feeding, as much as possible.
Despite the fact that bleeding after childbirth is a natural process, this condition requires attention from the woman and the doctor.
Normal bleeding
How long after childbirth bleeding normally occurs was stated above - about 6 weeks. Postpartum hemorrhage is divided into several stages, which differ from each other in specific characteristics: coloring and intensity of discharge.
On the first day after birth, the amount of discharge will be greater than with normal menstruation. The blood will flow bright scarlet. On the first day, blood is removed from the vessels that attached the placental membranes to the wall of the uterus, so there will be a lot of it. Such bleeding is considered normal from the first to the fourth day after delivery.
Over the next 10-14 days, the amount of discharge decreases significantly. The scarlet tint of the discharge, which was accepted immediately after childbirth, at this time changes to faint pink, brownish or yellow. The uterus continues to contract, and after 2 weeks bleeding is minimized to a small amount of discharge per day.
Less commonly, bleeding continues longer, and until the 6th week of the postpartum period, a woman is bothered by uterine discharge with scarlet blood. If they are not abundant and inconsistent, there is nothing wrong with that. Most often, their appearance is preceded by physical exertion, nervous shock and other unfavorable factors.
Pathological bleeding
We described above how long postpartum bleeding will last normally and what it depends on. But they meet pathological conditions.
Necessity medical care occurs if postpartum discharge is accompanied by the following symptoms:
- they last more than 6 weeks;
- slight bloody discharge suddenly changes to bright scarlet blood;
- health worsens and general state women;
- discharge is accompanied by significant pain in the lower abdomen;
- clinical manifestations of intoxication develop - body temperature rises, dizziness, general weakness, nausea, etc. appear;
- bloody discharge instead of physiological shades acquires yellow-green and dark brown colors, complemented by a repulsive odor.
Regardless of how much blood flows after childbirth, if the discharge becomes more intense and acquires a scarlet color and a liquid structure, you should urgently contact the ambulance service. Painful sensations, an increase in body temperature, changes in the nature and color of uterine discharge always become evidence of developed postpartum complications, for example, endometriosis, inflammatory process in the pelvis and other pathological conditions. In such cases, the correct course of action will be timely, thorough diagnosis and treatment.
How many days after delivery a young mother will have discharge is a controversial question. Postpartum bleeding normally lasts no more than 6 weeks, but this can be influenced by many factors, including the physiological characteristics of the woman.
During the postpartum period, the mother should monitor the nature of the bleeding, any changes and accompanying symptoms of this condition. If everything is normal, and the body recovers without complications after the birth of the child, then after 6 weeks any uterine discharge should stop.
Helpful video about postpartum bleeding
Childbirth is a labor-intensive process, which in many cases occurs with complications. Such a postpartum pathology is postpartum hemorrhage. Of course, with uterine bleeding, the mother’s life is in the hands of medical personnel. After all, qualified monitoring of the health indicators of the postpartum mother, preventive measures, timely provision of suitable health care- all this allows you to save the life and health of the woman who gave birth. Why intrauterine bleeding occurs and how to prevent it are the main questions to which a woman giving birth should know the answers.
Postpartum hemorrhage: what is it?
One of the scary obstetric complications which a woman may experience after childbirth is bleeding.
Postpartum hemorrhage is the cause of death of a woman during or after childbirth, ranking third after death from anesthesia and infection.
The severity of the condition of a young mother, faced with such a terrible deterioration in her health, is determined by the amount of blood lost. Blood loss during and after childbirth is physiologically natural. But this is only in case of blood loss in an acceptable volume (0.3% of body weight).
The female body prepares for this already during pregnancy, increasing the volume of circulating blood. Large blood loss (over 500 ml to several liters), no matter how frightening it sounds, can cause the death of a woman in labor. Such intense bleeding is provoked by the wounded state of the uterus after childbirth. In women prone to hemorrhage, the process of uterine contraction is disrupted or the process of blood clotting and blood clots does not start. Medical statistics registers the opening of bleeding in 2 - 5% of women in labor, which requires taking urgent measures
- ambulance patient
- The outcome of postpartum hemorrhage depends on the following factors:
- volume of blood lost;
- bleeding rate;
the effectiveness of the therapy and the speed of its implementation;
blood clotting disorder. Causes of complications It is considered normal if a woman loses blood in an amount of no more than 0.5% of her body weight. In terms of volume, this is about 300 - 400 ml.
Bloody discharge from the birth canal are explained by physiology. So, at the birth of a child, the placenta is separated from the uterine wall. The uterus is injured, which means bloody discharge is inevitable. If a woman in labor loses more than 400 ml of blood during the postpartum period, it is fatal.
dangerous pathology
, requiring immediate elimination of its cause. What is she like?
Atony and hypotension of the uterus What is hidden behind the medical terms “atony” and “hypotony of the uterus”? The uterus - the organ in which pregnancy develops - has in its structure muscle layer, tends to get excited (come into a state of tone). When after childbirth the myometrial tone decreases along with the ability to contract, we speak of uterine hypotension, and when it is completely lost, we speak of atony. Vessels injured by childbirth must undergo the process of thrombus formation (coagulation into clots). If this does not happen, and the uterus has already lost or decreased its tone, the blood clots are washed out through the bloodstream from the mother’s body. Severe bleeding develops, when a woman can lose several liters of blood. Needless to say, how dangerous this is for the life of a young mother.
What could cause this clinical picture:
- fatigue of muscle fibers due to protracted or, conversely, rapid labor;
- the use of drugs that reduce uterine tone;
- loss of the ability of the myometrium to contract normally.
Conditions predisposing to hypotension and atony are:
- young age;
- pathological conditions of the uterus: fibroids and uterine fibroids; developmental defects; postoperative scars on the uterus; inflammatory processes; a large number of births; excessive stretching of the uterus during multiple pregnancy, with polyhydramnios;
- complications of pregnancy;
- prolonged labor with a large fetus;
- abnormalities of the placenta (previa or abruption) and some others.
How can an obstetrician-gynecologist help a woman in labor? Conducted medical events determined by the type of bleeding and the woman’s condition:
- Hypotonic bleeding: performed external massage uterus through abdominal wall and administration of contraction drugs.
- Atonic bleeding: if blood loss exceeds 1 thousand ml, the uterus is completely removed, removing the woman from a state of hemorrhagic shock as a result of heavy blood loss.
Violation of placental separation
The placenta leaves the uterus at the end of labor. 
Labor has three stages: cervical dilatation, expulsion of the fetus and the postpartum period.
When the placenta is delivered, the early postpartum period begins (it lasts for the first two hours). The placenta is carefully examined by obstetricians: it should be completely expelled. Otherwise, the placental lobes and membranes remaining in the uterus will not allow the uterus to fully contract, which, in turn, will lead to the launch of inflammatory processes and the occurrence of bleeding.
Unfortunately, such bleeding, which suddenly begins a month or more after childbirth, is not uncommon. Of course, the doctor who delivered the child is to blame. I noticed that there was not enough lobule on the placenta, or maybe it was an additional lobule (separate from the placenta), and did not take appropriate measures (manual control of the uterine cavity). But, as obstetricians say: “There is no placenta that cannot be folded.” That is, the absence of a lobule, especially an additional one, is easy to miss, but the doctor is a person, not an x-ray.
Obstetrician-gynecologist Anna Sozinova
http://zdravotvet.ru/krovotechenie-posle-rodov/
Why do parts of the placenta remain in the uterine cavity? There are a number of reasons:
- partial placenta accreta;
- improper management of the third stage of labor;
- uncoordinated labor activity;
- cervical spasm.
Blood diseases
Blood diseases that often cause bleeding include:
- hemophilia: blood clotting disorders;
- Werlhof's disease: the presence of hemorrhages and bruises on the torso and limbs against the background sharp decline number of platelets in the blood;
- von Willebrand disease: increased permeability and fragility vascular wall- and others.
Many blood diseases are hereditary in nature, and a woman should know about a possible diagnosis in advance: before planning a pregnancy and especially before the start of the birth process. This will allow you to plan the birth and avoid a number of complications. Bleeding associated with these diseases is relatively rare. However, women with this diagnosis should be carefully monitored by a doctor during pregnancy and comprehensively prepare for childbirth.
Trauma to the birth canal
Bleeding in a woman in labor (usually early) can be caused by trauma to the birth canal during the birth of the baby.
Tissue damage can be detected in the area:
- vagina;
- cervix;
- uterus.
Tissues are damaged spontaneously, as well as due to improper medical actions. Therefore, typical tissue tears can be classified into groups:
- spontaneous ruptures are possible during expulsion of the fetus (for example, during rapid labor);
- ruptures are associated with medical procedures during fetal extraction (application of obstetric forceps, vacuum escochleator);
- Uterine rupture is also provoked by scars on it after previous surgical interventions, curettage and abortion, the use of intrauterine contraceptives, obstetric manipulations (external fetal rotation or intrauterine rotation), stimulation of labor, narrow pelvis.
Early and late bleeding after childbirth and cesarean section: symptoms, duration, difference from lochia
Bleeding after childbirth is classified as early and late:
- early (primary) - occurred immediately after birth or within the first 24 hours;
- later (secondary) - occurred after 24 hours or more.
Video: postpartum bleeding
A visual examination of the birth canal, examination of the uterine cavity, and ultrasound diagnostics helps the doctor determine the fact of bleeding.
Early bleeding
If the medical indicators of a woman who has given birth are normal during the first two hours (pressure, pulse, skin color, amount of discharge), she is transferred from the delivery room to the postpartum ward. There, being in a separate room, the young mother must monitor her own well-being and, in case of any deviations in postpartum recovery, call the medical staff. 
Every woman who has given birth should understand the importance of self-monitoring in the first days after childbirth, since bleeding can occur rapidly
Bleeding after childbirth varies in the amount of blood released and the intensity of blood loss. If the uterus does not contract, the bleeding is profuse. Wherein blood pressure falls, the heartbeat slows down, the woman’s skin turns pale. Such massive blood loss is rare, and successful control of bleeding in this case is difficult.
Bleeding may be continuous or start and stop alternately. This situation (blood discharge in portions when the uterus relaxes) is more common. The body resists, resists blood loss, manages to work defense mechanisms. If assistance is provided in a timely and qualified manner, the bleeding can be stopped.
If bleeding does not stop after medications that contract the uterus or massage the uterus, surgery may be required. The doctor must act immediately so that the woman does not fall into a state of hemorrhagic shock and so that irreversible pathological processes
in organs. 
Late bleeding occurs when the woman is no longer in the hospital. This is the danger of the situation.
Intense bleeding from the birth canal may suddenly appear at the end of the first week after birth, as well as in the second and third weeks. It can be triggered by physical activity or heavy lifting.
What signs of illness should a young mother pay close attention to?
| Table: pathological conditions that cause anxiety in women | Pathology |
| Discharge with an unpleasant odor | An unpleasant smell of discharge indicates an inflammatory process |
| Resumption of bleeding | 4 days after birth, the discharge changes color from bright scarlet to dark red, then brown, grayish, yellow, transparent. Pathology is the situation when, at the end of the recovery period light color lochia gives way to scarlet |
| Increased body temperature | Body temperature should not exceed permissible values |
| Nagging pain in the lower abdomen | Painful sensations in the lower abdomen should not normally disturb a woman who has given birth naturally. |
| Heavy bleeding | Large amounts of blood discharge (possibly with blood clots) may appear once or periodically. This is accompanied by weakness, chills, dizziness. There may be parts of the placenta left in the uterus |
| Heavy bleeding | In case of bleeding (requires changing several pads per hour), the woman should immediately call an ambulance |
| Stopping discharge | An abrupt cessation of discharge is dangerous: it can accumulate in the uterine cavity without finding a way out |
If you observe one of these symptoms, a young mother should consult your doctor. Any delay is a risk to life.
Difference from lochia
Postpartum bleeding cannot be identified with discharge after childbirth (natural or surgical) - with lochia. Lochia leaves the uterine cavity in response to the healing of its wound surface. This is a natural process determined by physiology. When the endometrium lining the uterine cavity is completely restored (by the end of the third week after natural birth , a few weeks later - after a cesarean section), the discharge stops. Recovery period
postpartum is on average 8 weeks. During this time, the woman loses 0.5 - 1.5 liters of lochia, which change color (from scarlet to dark red, brown, yellowish, transparent white), consistency. Bleeding is always a heavy loss of blood, possibly sudden, the blood is liquefied and scarlet in color. Woman feels dizzy arterial pressure
falls, the skin turns pale. This is an indication for urgent hospitalization.
Bleeding after cesarean
Let us separately dwell on cases of bleeding after surgical delivery.
Bleeding after a cesarean section occurs 3 to 5 times more often than during vaginal delivery.
The main causes of bleeding after cesarean section in the early postoperative period are the same as those that cause bleeding after natural childbirth:
- the contractility of the uterus is impaired;
- Intravascular coagulation syndrome (DIC) develops, which leads to massive bleeding and bleeding from unsutured uterine vessels when sutures are not completely applied to the incision.
Bleeding associated with the loss of the ability of the uterus to contract may result from incorrect actions by the doctor during surgery. Obstetricians and gynecologists try to preserve the uterus to the last minute, and often the bleeding intensifies and becomes irreversible. In most cases, amputation of the uterus is inevitable, and it is not advisable to delay it due to the high risks ( state of shock due to excessive blood loss, death).
If a woman preparing for a cesarean section is diagnosed with DIC (blood clotting pathology), complex therapeutic measures are carried out before and after surgical delivery. Medical actions are aimed at the following:
- normalization of blood clotting;
- treatment of the underlying disease or complications of pregnancy that caused the development of DIC syndrome;
- combating shock, eliminating septic infection, improving microcirculation, restoring circulating blood volume, eliminating influences that may maintain or aggravate DIC syndrome.
Late postoperative bleeding is rare and is caused in most cases by purulent-septic processes. 
Incorrectly placed sutures are the main cause of bleeding after cesarean section. For example, not all vessels can be sutured; the sutures on the uterus can come apart. This is the fault of the doctor who performed the operation. According to indications, it is possible to perform a repeat operation with removal of the uterus
Has anyone experienced postpartum bleeding? If someone knows something, please explain why this happens? I had a caesarean section, the reason was simple - breech presentation. I woke up after the second operation. Thank God that everything is fine with my child. After the caesarean section, I was taken to the ward and the bleeding was not immediately noticed at all. Noticed after 30 - 40 minutes. Then they tried to save him for two hours, and then they took him to the operating room again. They say the uterus did not contract. But they somehow stitched me up after the first operation, which means I was contracting... As a result, I lost 2,200 blood and will never be able to get pregnant again.
Diagnostics
To understand whether a woman is at risk for postpartum hemorrhage, modern medicine conducts examinations of pregnant women.
- During regular blood tests, the following indicators are established:
- hemoglobin level;
- the number of red blood cells and platelets in the blood serum;
- bleeding and clotting time;
state of the blood coagulation system. Knowing the blood characteristics of a particular woman and their changes in dynamics, the doctor predicts the characteristics of the patient’s postpartum period. Insufficient contractility uterus qualified doctor
diagnoses visually even in the third stage of labor.
When a woman has already given birth, the obstetrician-gynecologist examines the placenta, fetal membranes, and birth canal of the mother for ruptures, failed tissue, and blood clots. Under anesthesia, the uterine cavity can be examined for tumors that interfere with contractile processes.
On the 2nd - 3rd day after birth, an ultrasound of the pelvic organs is performed, which makes it possible to accurately determine the presence or absence of unremoved fragments of the placenta and fetal membranes in the uterine cavity.
Treatment Bleeding is eliminated by obstetricians-gynecologists in medical institution . Any self-medication can lead to the death of a postpartum mother
- The algorithm of actions of medical personnel in the development of postpartum hemorrhage is as follows:
- Determining the cause.
- Taking measures to quickly stop bleeding and prevent large blood loss.
Restoring circulating blood volume and stabilizing blood pressure levels.
Performing these medical actions involves therapeutic procedures (medication, mechanical manipulation) and surgical intervention.
| Table: drug treatment | Drug name | Dosage |
| What is it prescribed for? | 0.9 percent sodium chloride solution | up to 2 liters intravenously |
| replenishment of circulating blood volume | oxytocin | at a dose of 10 units, intramuscularly or into the myometrium |
| to contract the uterus | prostaglandin | |
| 250 mcg intramuscularly every 15 to 90 minutes. up to 8 doses | methylergonovine | 0.2 mg intramuscularly every 2 to 4 hours (followed by 0.2 mg twice or thrice daily for 1 week) |
| excessive bleeding continues even after oxytocin is given | misoprostol | at a dosage of 800 - 1 thousand mcg, rectally |
to increase uterine tone Drug therapy is not limited to the named medications, but is supplemented by a doctor depending on the specific clinical picture . The patient is receiving an infusion(erythromass, plasma), blood substitutes are used.
Elimination of early bleeding
If in the first hours after childbirth the bleeding of a woman who has given birth increases (discharge is over 500 ml), medical personnel The following therapeutic actions are carried out:
- Emptying the bladder, possibly through a catheter.
- Introduction medicines contractile properties intravenously (usually methylergometrine with oxytocin).
- Coldness in the lower abdomen.
- External massage of the uterine cavity: the doctor places a hand on the bottom of the uterus and squeezes and unclenches it, stimulating contractions.
- Manual massage of the uterus: under general anesthesia, the uterus is compressed with one hand of the doctor until its natural contraction begins, while at the same time the doctor performs an external massage of the uterus with the other hand.
- A tampon soaked in ether is inserted into the vagina to cause a reflex contraction of the uterus.
- Infusion-transfusion therapy with blood components and plasma-substituting drugs.
Table: postpartum complications and therapeutic measures
The described medical procedures are performed under local anesthesia or general anesthesia after a thorough diagnostic examination of the woman.
I had postpartum bleeding... Then, under anesthesia, they manually cleaned the uterine cavity... They said that the cause could be endometriosis, infections, or just a coincidence... My uterus did not contract... I lay there and said that it was pressing on the rectum, they said that this happens , and they took me to the ward, and there I was alone, and I felt like there was a contraction and an effort, and I went crazy, I could barely stand up, walked to the corridor and called the doctor, but it was pouring from me, I remember that I was dizzy, they took me to the intensive care unit and cleaned the stomach, because I had time to eat, but I can’t take anesthesia with food in my stomach. When I left, everything hurt and I lay with the terminals for another 3 hours.
https://www.u-mama.ru/forum/waiting-baby/pregnancy-and-childbirth/138962/index.html
Elimination of late bleeding
When parts of the placenta or blood clots remain in the uterine cavity, late postpartum bleeding occurs.
What actions are taken by doctors:
- immediate hospitalization of the woman to the gynecology department;
- curettage of the uterine cavity under anesthesia;
- cold on the lower abdomen for 2 hours;
- carrying out infusion therapy, if necessary, transfusion of blood products;
- prescription of antibiotics;
- prescribing reducing medications, iron supplements and vitamins.
I had bleeding 4 - 5 hours after giving birth, the doctors said that this often happens with anemia, the uterus did not contract, I felt dizzy (almost fainting), and clots, like beef liver, began to come out. We cleaned it manually, now everything is fine, the baby is 10 months old.
Julia David'son
https://www.u-mama.ru/forum/waiting-baby/pregnancy-and-childbirth/138962/index.html
Rehabilitation of a woman
After bleeding in the postpartum period, the female body is weak. To recover, he needs additional time and effort. A woman should find time to rest and eat well. It is better to entrust some of the responsibilities for caring for the child to close relatives: their help is now extremely important.
How to strengthen a weakened body? Taking vitamin complexes (for example, Centrum, Complivit, Oligovit, etc.) for several months will help, the use of which is possible during lactation.
Large blood loss can cause iron deficiency (anemia). Therefore, after consulting a doctor and taking blood tests (including hemoglobin levels), it is possible to use iron supplements.
Drugs will help strengthen blood vessels and prevent their bleeding. active substance in which - calcium (calcium gluconate, calcium chloride).
Facilities traditional medicine They will also act as an assistant to the young mother at the stage of recovery of the body after bleeding.
Photo gallery: fruits and berries that help mothers recover
Juice from viburnum fruits and a decoction from the bark of the bush are used as a hemostatic agent. Preparations from lingonberries are excellent. vitamin remedy for bleeding Chokeberry contains, among many useful microelements, vitamins K and P, which help blood clot. Pomegranate fights anemia, improves blood counts
Medicinal herbs have long been used as stimulants of the body's defenses.
Table: medicinal herbs as a general tonic
| Medicinal plant | How to use |
| Willow bark decoction | 1 tbsp. l. brewed in a glass of boiling water, infused for 5 - 6 hours, after which you can drink 1 tbsp 3 times a day. l. in 20 minutes. after meal |
| Viburnum bark decoction | a mixture of 2 teaspoons of viburnum bark and 1 glass of water is boiled over low heat for 15 minutes, drink this decoction 2 tbsp. l. 4 times a day |
| Decoction of lingonberry leaves | the decoction is prepared from 2 - 3 tsp. crushed leaves and two glasses of water and consume for 2 - 3 days |
| Stinging nettle decoction | 2 tbsp. l. sheet pour 1 cup hot boiled water, heat in a water bath for 15 minutes, then leave for 45 minutes. and filter. Drink half a glass before meals 3-5 times a day |
| Decoction of rhizomes and roots of burnet | 2 tbsp. l. roots are poured into one glass hot water, heat in a water bath for 30 minutes, cool, filter. Take 1 tbsp. l. 5 - 6 times a day after meals |
To restore the body, it is important to drink high-quality mineral water with a high content of calcium and iron (Essentuki, Borjomi and others).
Bleeding is an irreversible condition that is best prevented preventive measures than to cure.
I had postpartum bleeding! I already gave birth to an afterbirth, and they even stitched me up. And when the baby was put to the breast while still in the birthing chair, I complained about nagging pain lower belly! They pressed on the stomach, and from there two clots! They immediately put in an IV and did a manual examination! As a result, everything is fine with the child, blood loss is 800 ml, I can have children!
Yana Smirnova
https://www.u-mama.ru/forum/waiting-baby/pregnancy-and-childbirth/138962/index.html
A woman can protect herself by following the following recommendations.
Prevention of early bleeding
Even during pregnancy, women are at risk (diseases of the circulatory system, gynecological diseases, taking blood thinning medications) are under the supervision of doctors and, if possible, are sent to specialized perinatal centers. A woman preparing for childbirth should be aware of the available chronic diseases (diseases of cardio-vascular system , kidneys, liver, respiratory organs), and the doctor leading the pregnancy - conduct diagnostic examination
future mother in labor. The delivery process, especially for women at risk of bleeding, should be carried out with a minimum amount of medical interventions
, with a careful attitude towards the woman in labor.
Measures to prevent future bleeding are carried out by medical staff immediately after birth.
| Table: preventive measures in the early postpartum period | Pathology |
| Preventive measure The mother remains in maternity ward | after labor is completed |
| Doctors monitor the woman’s condition (pressure, pulse, skin color, amount of blood lost) | Emptying the Bladder |
| At the end of labor, urine is removed with a catheter so that the filled bladder does not put pressure on the uterus, preventing it from contracting and causing bleeding. In the first days after childbirth, the bladder should be emptied every three hours, even if the woman does not feel like going to the toilet. | After the placenta is born, the doctor examines it and decides on the integrity of the placenta, the presence/absence of additional lobules, their separation and retention in the uterine cavity. If the integrity of the placenta is in doubt, a manual examination of the uterus is performed (under anesthesia), during which the obstetrician excludes trauma to the uterus (rupture), removes the remains of the placenta, membranes and blood clots, and also, if necessary, performs a manual massage of the uterus |
| Administration of contractile drugs (oxytocin, methylergometrine) | These medications, administered intravenously or intramuscularly, increase the ability of the uterus to contract and prevent atony (loss of the ability to contract) |
| Examination of the birth canal | During the examination, the integrity of the cervix and vagina, soft tissues of the perineum and clitoris are checked. In case of rupture, they are sutured under local anesthesia. |
Of course, the success and effectiveness of many preventive measures depends on the competence of the doctor, his professionalism and attentive attitude to every patient.
Prevention of late bleeding
Once outside the hospital walls, every mother should follow simple recommendations that reduce the risk of late bleeding.
Table: preventive measures in the late period
It is difficult to overestimate the danger of a situation when a woman who has given birth suddenly or predictably experiences uterine bleeding. At this moment, the doctors’ efforts are focused on stopping the large blood loss, eliminating the cause of the hemorrhage, and subsequent rehabilitation of the patient. In order for qualified medical care to be provided to the postpartum woman in a timely manner, the woman must also be aware of the possibility of such a serious condition occurring. postpartum complication. After all, we are talking about the life or death of a young mother.
After the birth of a child, a young mother must undergo an examination by a gynecologist. The first visit is scheduled two weeks after discharge from the hospital. maternity hospital, then two months later. At the reception…
When bleeding occurs after childbirth, this is considered a normal process of cleansing the uterine cavity. The severity of bleeding depends on factors such as blood loss and duration. The characteristics of the discharge will indicate the presence of pathologies for timely treatment.
Causes
Women believe that when the uterus bleeds after childbirth, there is no cause for alarm, since at first the discharge is abundant, and then decreases and gradually disappears completely. However, prolonged discharge with an unpleasant odor that causes pain should not be considered normal.
Why does blood bleed after childbirth?
- poor clotting;
- rapid labor;
- placental tissue is accreted;
- weak uterine contraction;
- gynecological diseases.
When minimal blood clotting is noted, the liquid flows out in a thin stream. It is recommended to check the indicator using tests before giving birth. With a rapid process, trauma to the birth canal occurs, which leads to bleeding. Problems arise with multiple pregnancies, polyhydramnios, if the child is large. The discharge is affected by the presence of fibroids and fibroids.
How long does it take to bleed after childbirth? The maximum period is two months. During this time, the amount of fluid decreases, and by the end of the period it stops completely. Lochia is secreted regardless of whether a woman gave birth naturally or by caesarean section. The process is divided into several stages, one of which is separation of the placenta.
There are 3 periods of time when bleeding occurs after childbirth:
- two to four hours after birth – heavy bleeding;
- several days of average blood loss;
- a month and a half is a daub.
Late bleeding develops within 24 hours, and blood comes out after childbirth over the next 50 days. The process is delayed due to the retention of tissue particles in the uterus. The timing is individual for each woman, so you need to monitor the increase in temperature, the amount and duration of bleeding.
Norm and pathology
Immediately after the birth of the child, the woman is in the delivery room. Doctors monitor the mother and newborn, the risk of hypotonic uterine bleeding increases. In any case, blood should flow after delivery, as a wound opens at the placenta attachment site.
This occurs when uterine contractions are disrupted. There are no painful sensations; the woman feels dizzy and faints. During your stay in the delivery room, about half a liter of blood is lost. It is forbidden to stand up until the doctor makes sure that there are no hematomas or ruptures.
After being transferred to the ward, the mother is under the supervision of specialists for the next two to three days. This time is given for postpartum recovery. The amount of discharge does not decrease, so you should use special pads. After cesarean section, absorbent diapers are used. During the daily round, the nature of the fluid is noted.
If scarlet bleeding occurs without any foreign odor, this indicates proper healing of the uterus without complications.
The exception is for women in labor with multiple pregnancies. When the birth was difficult, there should be bleeding, however, there is a need for curettage or medical intervention. If after a week you start bleeding, you will need an oxytocin drip to quickly contract the uterus.
After the woman is discharged from the maternity hospital, next period- blood comes out similar to normal menstrual cycle with small clots. It is noted that every day the amount of liquid decreases and the color becomes lighter. A month later, when the bleeding stops after childbirth, it is already a scant yellowish discharge.
Deadlines
Every woman's uterus bleeds after childbirth. Primiparas report a shorter period of discharge than mothers after their second birth. At this time, the uterine mucosa is restored, which in the process takes on its previous shape. Blood comes out within 30 days after childbirth if a woman has a second child. The rapid process of birth leads to the fact that the body takes longer to recover, muscles and walls are injured, and they require more time.
How long bleeding will continue after childbirth depends on factors:
- features of pregnancy;
- natural or surgical route of delivery;
- contractile activity of the uterus;
- complications;
- physiological status and health status;
- lactation affecting effective cleansing uterus due to rapid contraction.
There is bleeding after childbirth without rupture for about six weeks. The liquid output differs in color and intensity. On the first day, a scarlet substance is removed from the vessels, so there will be a lot of discharge. This happens from the first to the fourth day.
In the next two weeks after birth, blood bleeds and the color changes to pink or yellow. During this time, the amount of liquid is minimized. Sometimes the period increases; until the end of the second month, the discharge may be light and inconsistent, and scarlet in color. This happens due to physical activity or stress.
Blood after childbirth with a rupture is observed for one and a half months. Doctors' help will be needed if minor discharge suddenly turns bright scarlet, the woman feels unwell, and symptoms are noted in the lower abdomen painful sensations. At this time, intoxication occurs, the temperature rises, weakness, dizziness, and vomiting appear. The discharge is dark or yellow-green with an unpleasant odor.
This condition requires the intervention of medical personnel. Characteristics indicate endometriosis, pelvic inflammation, and pathological conditions. Will need additional examination. The woman needs to be diagnosed and treated.
Diagnostics
Collection of tests begins even before birth. Obstetric and gynecological statistics show that problems can be prevented if you conduct tests on hemoglobin levels, find out the number of red blood cells and platelets. In the third stage of labor, muscle flabbiness and weak contraction of the myometrium are detected.
The occurrence of bleeding leads to the need to determine its cause. When for a long time discharge continues in the postpartum period, this will help diagnostic measures. For early bleeding after delivery, a hemostatic agent is used. They estimate how much blood the woman in labor has lost. This is an important aspect for choosing treatment measures.
Diagnostics is needed for a thorough examination of the integrity of the placenta and to identify birth injuries. If necessary, anesthesia is administered and the uterine cavity is manually examined to identify ruptures, clots, or tumors that interfere with the normal contraction of the organ. At a later stage, blood flows if there is a pathology, so the reason why it arose is first identified.
Methods for diagnosing the causes of bleeding:
- Hysteroscopy;
- Coagulogram.
Using ultrasound, inflammation and placental polyp are detected, and the pelvic organs are studied. New pregnancy and first menstruation are excluded. Hysteroscopy is used to examine the uterine cavity.
If it is impossible to diagnose after natural childbirth using these methods, RDV is prescribed, then the blood is tested for coagulation, then sent for histological examination. Using mirrors, ruptures and inflammatory processes are detected. If the integrity of the placenta is violated, manual inspection and manual cleansing of the uterus are used.
Treatment
Once the cause of bleeding has been determined, it must be stopped quickly. An integrated approach will be required, which includes drug treatment and invasive methods. To stimulate uterine contractions, a catheter is inserted into the urethra to empty the bladder, and ice is applied to the lower abdomen. External massage of the uterus is performed. During prolonged treatment, the blood passes quickly if Oxytocin is administered intravenously, or injections with prostaglandins are given into the cervix.
The volume of circulating fluid can be replenished using infusion-transfusion therapy. The woman is given drugs that will replace plasma and blood components. If examination with mirrors shows the presence of injuries, an anesthetic is used and suturing is performed.
When detecting uterine ruptures using manual method perform emergency laparotomy, suturing or removal. Surgical intervention will be needed if the organ is overgrown and massive bleeding cannot be stopped. Resuscitation actions are practiced in the form of compensation of blood loss, stabilization of hemodynamics and blood pressure.
To stop the release of blood that exceeds 1 liter, Prostin is introduced into the uterus to enhance contractions. The drug is administered intravenously, and transfusions are given from donors. If the prognosis is successful, antihistamines, ATP are prescribed, and IVs with vitamins are placed.
Preventive measures will help reduce the duration of postpartum bleeding. A woman needs to adhere simple recommendations. Going to the toilet should be regular to empty your bladder and bowels. They apply pressure and prevent the uterus from contracting.
Reduce the risk of infection simple rules hygiene. You cannot swim in reservoirs or take baths. You should abstain from sexual activity. Don’t play sports or be active for a month and a half. To speed up the contraction of the uterus and cleanse it, it is recommended to sleep on your stomach. They refuse to use saunas, steam baths, and solariums. Breastfeeding has a positive effect. How many days after delivery there will be discharge depends on physiological feature women. Postpartum bleeding normally lasts no more than 6 weeks.
Bleeding after childbirth is considered a normal process that is important to control. The duration, intensity, and nature of the discharge matters. If you suspect a pathology, call an ambulance or see a doctor. If you follow all the rules, you can reduce the body’s recovery time without complications. By the end of the first month, the discharge will be scanty, and the general condition will be satisfactory.
