Postpartum hemorrhage: Clinical

Postpartum hemorrhage is worrisome when more than 500 milliliters of blood are lost after a vaginal delivery, or more than 1000 milliliters of blood are lost after a C-section.

Postpartum hemorrhage usually occurs in the 24 hours following delivery, in which case it’s called early, or primary postpartum hemorrhage.

But in rare situations, it happens later than 24 hours after delivery, and that’s where it’s called late, or secondary postpartum hemorrhage.

Postpartum hemorrhage, like any ongoing bleeding, can be classified according to the degree of hypovolemia and vital signs status.

Stage 1 is when 500 to 1000 milliliters of blood have been lost. Blood pressure is usually normal, but there may be palpitations, tachycardia and slight dizziness.

Stage 2 is when 1000 to 1500 milliliters have been lost. Systolic blood pressure drops to 80 to 100 mmHg, tachycardia is obvious, and there may be weakness and sweating.

Stage 3 is when 1500 to 2000 milliliters have been lost. Systolic blood pressure drops between 70 and 80 mmHg, and there may be restlessness, pallor and low urine output.

Finally, stage 4 is when more than 2000 milliliters have been lost, systolic blood pressure is less than 70 mmHg, and symptoms may include cardiovascular and respiratory collapse, loss of consciousness and and anuria.

Now, before elucidating the cause, some immediate measures should be taken in order to compensate the blood loss. These follow an A-B-C pattern.

A stands for airway, so you’ll want to protect the airway, especially when there’s loss of consciousness.

B stands for breathing, so you’ll want to administer Oxygen through a non-rebreather mask.

C stands for circulation - meaning measuring vital signs and establishing the degree of hypovolemia, inserting two large caliber peripheral IV catheters - of at least 14 gauge or even larger-gauge -, and starting fluid resuscitation immediately, with 500 milliliters of normal saline or lactated Ringer’s solution given over 30 minutes.