The materials are published for review and are not a prescription for treatment! We recommend that you contact a hematologist at your healthcare facility!

Postpartum hemorrhage - physiological process. Discharge from the genitals of a woman lasts an average of several weeks. In some cases, bleeding is observed up to 6 weeks after birth - this is also a variant of the norm.

Postpartum hemorrhage is an inevitable part of the post-pregnancy and delivery period. This is a normal physiological process that accompanies the postpartum period of every woman. After childbirth, the uterus is greatly enlarged and is a huge wound. In order to recover, get rid of the placenta, the remnants of the placenta and take the previous size, it needs to be reduced. Uterine contractions are accompanied by secretions, or lochia. Such bleeding after childbirth is considered normal.

Features of the postpartum period

It is generally accepted that the postpartum period lasts from 6 to 8 weeks. Discharge from the uterus during this period is a variant of the norm. During this time, the uterus gradually returns to its previous state, menstruation may even return to the woman. Sometimes uterine bleeding stops a month after childbirth, the following factors contribute to such an early recovery of the body:

• lactation- lactation stimulates uterine contraction, and therefore - the discharge increases;
• regular emptying Bladder .

Important! If a woman often lies on her stomach, the outflow of lochia occurs faster.

Bleeding after childbirth: duration

Many women who have given birth do not know how long afterbirth bleeding lasts, and begin to worry if it does not end immediately after childbirth. how many days go by bleeding?

Earlier postpartum bleeding is observed in the first few days. The discharge has a bright red tint. Gradually, the color and intensity of lochia changes. Bleeding may be light pink, brown, or yellowish red.

Late period uterine secretions called pathological. This condition is accompanied by heavy bleeding a week after childbirth. As a rule, this happens due to the fact that part of the placenta or afterbirth remains in the uterus.

If the bleeding after childbirth after a month is bright red, you should immediately seek help from a doctor. It often happens that postpartum discharge accompanied by elevated body temperature and painful sensations. Often this indicates the development of an inflammatory process in the uterus.

Prevention

1. Compliance with the rules of personal hygiene. Women who have given birth should wash themselves thoroughly after each emptying of the bladder. Gaskets should be changed as needed, but at least every 3-4 hours.
2. Do not rush to resume sexual activity. sexual intercourse in postpartum period increases the chance of infection.
3. Within 6-8 weeks after childbirth, in no case do not use vaginal tampons and douche.

Read also the article

Right after

The postpartum period lasts for 1.5 months. During this time, the woman is fully restored, that is, she returns to normal, as before pregnancy. The main changes affect the genitals. This is characterized by the following features:

• involution of the uterus, that is, its reduction, restoration of the structure of the endometrium;
• the presence of lochia (these are postpartum discharges from the genital tract), which change over time. At the beginning they are bloody, later brown, and then they become lighter and lighter;
• the formation of lactation and its preservation for a long time.

• The placental tissue remaining in the uterine cavity, which violates contractility;
• Traumatic injuries;
• Primary violation of uterine contractions;
• Primary disorders of blood coagulation.

During the onset of symptoms, the woman is still moving away from childbirth and is in the appropriate department. The definition of the problem and its neutralization is the result of the qualified work of doctors and hospital staff.

Late bleeding has other causes:

As you understand, the separation of the placenta leads to the appearance of ruptures of blood vessels and the formation of wounds on the mucous surface of the uterus. In addition, the uterus begins to contract, gradually coming into normal condition. Therefore, it is observed bloody issues after childbirth.

After about 2-3 days, the wound heals a little, the vessels are compressed, and profuse bleeding stops after childbirth. Usually on the 4th day they become brown discharge after childbirth, then their color becomes yellow-brown.

This happens due to the cessation of bleeding and the predominance of leukocytes, white cells that contribute to the healing of the wound surface of the uterus. Then appear yellow discharge after childbirth, which can continue for about 5-7 more days.

Normally, blood after childbirth should be replaced by yellow leukocyte secretions, and if after a week this process has not even begun, blood clots after childbirth do not change color and continue to go very plentifully, especially if they smell strange, here you already need to go to the doctor and find out the cause of the pathology. Often these complications are caused by infectious diseases that develop after childbirth, when the body is practically defenseless, and most importantly, stop this process in time, without waiting for the development of a more serious or chronic form. Therefore, whether there is time or not, you need to go to the gynecologist, and you also need to pass all the tests.

If you started taking birth control pills taking a progestin (mini-drink) or receiving an injection of Depo-Provera, you may continue to have spotting for up to two months, and this is completely normal.

What should be done when lochia comes?

one more bad symptom is elevated temperature. When breastfeeding, it should be measured at the elbow. The thermometer will have to be held for a long time, about twenty minutes.

You also need to visit a doctor if, after a birth recovery, blood is bleeding during sex.

Yana: “After the birth, the discharge began to decrease and practically only “smeared”, but after a couple of weeks they resumed again with the same force, perhaps even stronger. I began to worry, I turned to the midwife from the maternity hospital, but I was reassured that the uterus continues to clear itself. After 8.5 weeks, there was no discharge at all, and menstruation began a month after that "

Restoration of the menstrual cycle after childbirth

The cause of bleeding after childbirth may be a violation of uterine contractions if parts of the fetal membrane remain in its cavity. Usually, such discharges appear even in the hospital, and treatment is carried out immediately.

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Childbirth is always accompanied by blood loss. This is a natural process that usually does not exceed the physiological norm. But sometimes after childbirth it develops uterine bleeding, which threatens the life of a young mother. This emergency situation and it requires prompt and well-coordinated work of a gynecologist, midwife and anesthetist. Why is hypotonic bleeding dangerous? And what if it developed a month or two after discharge from the hospital?

Physiology of blood loss

For each woman entering the maternity hospital, the doctor must calculate the physiologically acceptable blood loss. To do this, mathematically find 0.5% of body weight. For example, for a woman in labor with a weight of 68 kg, this volume will be 340 ml. Blood loss of 0.7-0.8% or more is considered pathological.

In childbirth, the volume of blood lost is calculated most often by collecting it in a special tray. It is placed under the buttocks of the woman in labor, and bloody discharge flows freely into it. In addition, weighing of diapers is used.

Other methods for assessing blood loss are also used, but in practice the assessment is most often used. clinical condition and hemodynamic parameters. There are three degrees of severity of the condition:

• 1 degree - there is weakness, palpitations up to 100 beats per minute. The skin becomes pale, but remains warm. The pressure is low, but not lower than 100 mm Hg. Art. Hemoglobin is not critically reduced, up to 90 g/l.
• Grade 2 - weakness increases, severe tachycardia over 100 beats per minute worries. Systolic pressure decreases to 80 mm Hg. Art. Pale skin becomes wet. Hemoglobin decreases to 80 g/l.
• 3 degree - state of shock skin is pale and cold. The pulse is palpable with difficulty, it becomes threadlike. The pressure is critically low, urine output stops.

The state of acute blood loss is very dangerous in the postpartum period. This is due to the peculiarities of hemostasis in a pregnant woman.

Dangerous symptoms in the delivery room

After giving birth, the woman remains in the delivery room for 2 hours under the supervision of medical staff. During this period, hypotonic bleeding most often occurs. It is characterized by a sudden onset against the background of apparent well-being and a rapid course: in a short period of time, the puerperal can lose up to a liter of blood. Such a volume can be critical and lead to rapid decompensation, the development of hemorrhagic shock and death.

Therefore, in order to notice adverse signs in time, to have time to respond to them and reduce the time for rendering assistance, the patient does not shift from the chair to the couch or gurney: in the gynecological chair they will provide medical assistance in the event of a critical situation.

How long does bleeding last after childbirth?

It all depends on individual features. It continues directly in the delivery room, when transferred to the ward, and even during the first day it looks like liquid blood. By the second day, it is no longer blood, but lochia, thicker in consistency, containing a mucous component. Over the next four days, the discharge decreases, first becomes dark brown, and then gradually brightens. Lochia continues to stand out for another month.

Signs of bleeding in the early postpartum period are difficult to determine on their own. It is accompanied by weakness, which already worries a woman after childbirth. There may be a feeling of chills, but this nonspecific symptom. After muscle tension during the straining period, the puerperal may experience a period muscle tremors, which is difficult to distinguish from the state of severe blood loss.

While the patient lies motionless, blood can accumulate in the uterine cavity, gradually stretching it. When pressing on the uterus through abdominal wall stands out a large number of blood, sometimes with large clots. Gradually, normally, this amount should decrease. But with the development of pathology, this does not happen.

Measurement required blood pressure. With a significant decrease, as well as an increase in signs of tachycardia, a conclusion is made about significant blood loss.

Why won't the bleeding stop?

Causes postpartum hemorrhage are to reduce the contractility of the uterus. Several risk factors influence this:

• large fruit;
• diseases of the blood coagulation system.

They also increase the risk of excessive postpartum blood loss. frequent childbirth. If a woman has a break between births that does not exceed two years, and births are more than four, then hypotension must be prevented.

The immediate cause most often becomes a delay in the uterine cavity of parts of the placenta or fetal membranes. To prevent this condition, after the birth of the placenta, the midwife carefully lays it out on the diaper, blots it from the blood, aligns and matches the edges. This allows you to assess whether all parts have separated from the walls of the uterus and come out.

The delay of any parts in the uterine cavity violates its contractility. The vessels to which the placenta was attached do not collapse and bleed. Release from the placenta is also important active substances that prevent blood clotting.

Sometimes blood loss in the postpartum period is the result of tight attachment or. In this case, in the first case, the villi are woven into the tissues of the uterus and can be separated manually. And in the second case it is impossible to do it. The only way to save a woman is to have a hysterectomy.

Emergency care for postpartum hemorrhage includes a mandatory manual examination of the uterine cavity. The purpose of this manipulation is as follows:

1. Determine the presence in the uterine cavity of the remnants of the placenta or membranes.
2. Determine if the organ has a contractile potential.
3. Determine if there are ruptures of the uterine wall.
4. The ability to identify organic abnormalities that can cause bleeding, for example, a myomatous node.

The sequence of actions of a doctor during a manual examination includes the following steps:

1. The volume of blood loss and the condition of the woman are assessed.
2. The external genitalia are treated with antiseptics.
3. Anesthesia and contraction drugs are given (or uterotonics are continued).
4. The hand is inserted into the vagina and gently into the uterine cavity.
5. All clots and parts of pathological tissues are gradually removed.
6. The tone of the uterus is determined. It should be tight.
7. The hand is removed, the evaluation is carried out birth canal for injuries that can also cause bleeding.
8. The condition of the woman in labor is reassessed. Compensation for blood loss is carried out using solutions of crystalloids and colloids. If necessary, transfusion of blood plasma or uniform elements is performed.

Additional actions to stop hypotonic bleeding after manual examination are the following:

1. Introduction of additional reduction funds. Usually, a solution of methylergometrine is used for this purpose. It is administered while maintaining the drip of oxytocin.
2. You can inject oxytocin into the cervix to improve its contractility.
3. Swabs soaked in ether are inserted into the posterior fornix of the vagina. Bleeding should stop reflexively.
4. Evaluate blood loss and compensate for it.

The uterus does not always respond to ongoing activities, and its contractility. This condition is called atonic bleeding.

If blood loss continues after manual examination, the following tactics are used:

1. There are a lot of receptors on the posterior lip of the cervix that are responsible for contractility. Therefore, suturing is used with a thick catgut ligature on this area according to Lositskaya. Bleeding should reflexively stop.
2. In case of ineffectiveness, clamps are applied to the uterus by passing them through the vagina. This is due to the anatomical location of the uterine artery.

But if in this case the condition continues to worsen, the only way to help is surgery. During it, it is possible to save the organ if an intervention is carried out in short time and apply special intraoperative methods.

You can reflexively stop blood loss by tying the vessels according to Tsitsishvili. To do this, they tie up the vessels that pass in the round ligament of the uterus, own bundles ovary. A more outdated method is electrical stimulation. The last way is . It is resorted to with the ineffectiveness of previous manipulations, and if the loss is more than 1200-1500 ml.

Bleeding in the room...

The postpartum period can be complicated by bleeding a few days after birth. There are symptoms that should alert a woman. The first sign is a decrease in the number of lochia. They become scarce or. This must be reported to the doctor.

Earlier postpartum hemorrhage develops when the cervix is ​​blocked by clots that do not allow the lochia to flow normally. They stagnate in the uterine cavity, leading to its subinvolution. This symptom is clearly visible on ultrasound.

Diagnosis is necessarily carried out in the postpartum period for all women in order to exclude this pathology. On ultrasound, signs of subinvolution are:

• expansion of the uterine cavity more than 1 cm;
• discrepancy between the size of the organ to the postpartum period;
• the presence of homogeneous contents in the cavity.

After prolonged absence discharge, sudden bleeding may begin. Therefore, treatment is carried out immediately after diagnosis. To do this, it is necessary to eliminate the remnants from the uterine cavity that prevent it from contracting. By the third day, the neck is already beginning to form, so the procedure cannot be performed only by hand, a surgical instrument is needed.

To remove leftovers membranes, clots, use a curette. She is carefully scraped. After the procedure, an intravenous solution of oxytocin or methylergometrine is administered to improve contractility. Be sure to replenish blood loss with special saline solutions.

The duration of the discharge in this case should correspond to those during normal childbirth.

...and on the operating table

In most cases during surgery caesarean section not happening emergencies. But sometimes the variant anatomy of the location of organs and vessels can lead to an inadvertent injury to one of them, and, as a result, to internal bleeding which will appear already on the operating table.

Very rarely, its cause is the divergence of the seams in postoperative period. Then the puerperal has all the symptoms of hemorrhagic shock:

• pale skin;
• cold sweat appears;
• tachycardia is observed;
• blood pressure drops sharply.

There may also be symptoms of irritation of the peritoneum by the outflow of blood. Clinical protocol in this case provides the only way blood stops - abdominal operation, which will allow you to find a bleeding vessel and bandage it.

The woman is usually in serious condition. Compensation for blood loss is possible with blood substitutes, colloid and crystalloid solutions, plasma, shaped elements. Sometimes they collect their own poured into abdominal cavity blood and return it back to the bloodstream through a vein.

After being discharged home

Bleeding in the late postpartum period occurs after discharge home. Its symptoms are similar to the processes that occur during subinvolution of the uterus. The release of lochia suddenly stops, after a while there is a cramp-like pain in the abdomen. Blood clots come out of the genital tract, causing blood retention in the uterus. After this, profuse bleeding usually begins.

If these symptoms appear, you should urgently seek medical help. Treatment is no longer carried out in the hospital, but in a gynecological hospital. The Right Tactic lies in . Be sure to prescribe oxytocin drip.

To continue therapy at home, oxytocin tablets are prescribed.

The development of bleeding in the late postpartum period - a month or 2 months after birth, - alarm symptom, which may be a sign of a placental polyp. This is a neoplasm that occurs at the site of the remaining placental villi. They are covered with fibrin clots, connective tissue and outwardly initially look like a flat formation. Bleeding is the main symptom of this pathology. Its consequence can be severe anemia, endometritis, sepsis and infertility in the long term.

Diagnosis is based on ultrasound of the pelvic organs. Further tactics include holding, during which you can finally make sure that pathological education and remove it. In some cases limited to separate diagnostic curettage followed by histological examination received material.

Prevention is easier than cure

Prevention of bleeding in the postpartum period is the proper management of pregnancy and childbirth. The anamnestic and clinical data of a particular pregnant woman are assessed and a risk group for the development of bleeding is established. Such women in labor need Special attention. Already in childbirth, they are prescribed oxytocin, but not for the purpose of strengthening labor activity but to reduce the risk of massive blood loss. Prevention measures include examining the child's place, a thorough revision of the birth canal and suturing the existing ones.

Restoration of the menstrual cycle

Sometimes menstruation begins even during breastfeeding.

How to distinguish between menstruation and bleeding after childbirth?

It is necessary to focus on the normal amount of blood lost during menstruation. On average, for all days, it should be no more than 100 ml. In this case, menstrual blood can come out in small mucous clots - rejected endometrium. In the first, second, sometimes third, the intensity of the secretions is slightly greater, but gradually this process should decline.

The duration of menstruation after childbirth may differ from that before pregnancy. Normally, it is 3-7 days. With the extension of this period, as well as with copious secretions, which does not decrease in accordance with the days of the cycle, you should consult a doctor.

The problem of bleeding in the postpartum period does not lose its relevance, regardless of the level of development of medicine. Sometimes it is impossible to predict how the uterus will contract, how tightly the placenta is attached, and whether it can completely stand out on its own. Therefore, women who decide to experiment with childbirth should also be aware of this risk to own life, at which for medical assistance given a few minutes.

Bleeding after childbirth is a normal process in which the uterine cavity naturally gets rid of lochia and remnants of placental tissue. The very nature of bleeding, its pain, severity and duration (duration) are always different, and can vary greatly in different women. how many is bleeding after childbirth? This question is of great concern to all young mothers, especially those giving birth for the first time.

All women know that without bleeding, childbirth is hardly possible. Everyone is concerned about the question: how much blood should flow, how long will blood flow after childbirth?

Blood can flow for several reasons.

1. Poor blood clotting. This parameter is always individual in nature, and it often happens that blood flows from the female genital organs in liquid small streams, and at the same time no signs of the beginning of the clotting process are visible. Such a situation can be foreseen if a woman passes the appropriate tests before giving birth.
2. Fast (rapid) childbirth, due to which formed serious injury ancestral pathways.
3. An increase in tissue of the placenta and membranes that interferes with the normal contraction of the uterus. This also causes bleeding.
4. failure to reproductive organs to contraction due to excessive stretching of tissues caused by large sizes fetus (either multiple pregnancy or polyhydramnios).
5. Some customized gynecological problems- myoma, fibroma, long recovery uterus, problems with contraction of the myometrium.

How long does it take to bleed after childbirth? It's always different.

How long can blood flow?

How long does bleeding last after childbirth? It depends on several factors:

• How was the pregnancy?
• when did the discharge start?
• how did the birth go - naturally, or did you have to resort to stimulation;
• how natural are uterine contractions;
• Are there any postpartum complications?
• what is the general individual health status of the woman;
• what are the features of lactation (breastfeeding at the request of the child reduces the number of lochia, stimulates contractile activity uterus);
• whether there is an accreta of the placenta.

Each of these reasons, to one degree or another, affects how long postpartum bleeding will go (continue).

Rules for personal hygiene after childbirth

How much blood will flow after childbirth depends largely on the woman's implementation of a number of recommendations. To stop bleeding as quickly as possible and avoid possible complications, you need to follow a few rules.

1. Go to the toilet regularly to eliminate the pressure of a full intestine and bladder on the uterus. The uterus should contract normally.
2. Carefully maintain cleanliness and hygiene to prevent infection.
3. Exclude any physical exercise and sexual relations for at least one and a half months after childbirth.
4. During sleep, try to lie on your stomach.
5. Establish a breastfeeding schedule as much as possible.

How long blood flows after childbirth is always an individual matter. Therefore, an even longer list of recommendations can be added to the general standard requirements for each woman, from correct execution which depends not only on the success postpartum care body of a woman, but also the effectiveness of preparation for the next pregnancy.

Prevention and diagnostic procedures

Modern medicine makes it possible to assess the risks of postpartum hemorrhage in time. A woman should be examined during pregnancy for the level of hemoglobin, the number of erythrocytes and platelets in the blood serum. It is necessary to determine the time of bleeding and blood clotting. Then it will be possible to guess how many days the bleeding lasts after childbirth, how much blood can come out after childbirth. This procedure is required.

Norm and pathology

Normally, postpartum discharge from the uterus () lasts no more than 1.5 months. The woman does not experience much inconvenience from them. During the first 20 hours, blood can flow most intensively, and there is nothing to worry about. After a few days, the amount and intensity of discharge will begin to gradually decrease. If pregnancy and childbirth went well, and if after childbirth a normal lactation regime was quickly established, then the mucous layer of the uterus will heal quickly.

• more than three days there is blood of a dark red color;
• allocation acquired bad smell;
• the postpartum hemorrhage does not just continue in the puerperal, but blood loss increases, it becomes necessary to change hygiene products every hour;
• the number of injuries (ruptures) after childbirth does not decrease;
• the woman is very weak, her temperature is not normal, even loss of consciousness is possible;
• bleeding does not stop after 6 weeks.

normal bleeding

Postpartum hemorrhage is usually divided into several stages. The main differences are in the color and intensity of the discharge. On the very first day after childbirth is in progress the blood is plentiful, the discharge is much more than during menstruation, they have a bright scarlet color. On the first day after birth, it bleeds from the vessels that fastened the placenta to the wall of the uterus. This is precisely the reason why the blood flows profusely at first. How much blood can flow the first time after childbirth? In normal physiological state- no more than 4 days.

Pathology

To avoid complications after childbirth, it is necessary to be able to distinguish pathology from the norm.

• bleeds unevenly after childbirth - bright scarlet blood suddenly replaces insignificant secretions;
• 2 weeks after childbirth, not only bleeding persists, but also pain;
• bleeding and a month after birth bright red.

When is medical assistance required?

When should you seek medical help? No matter how much blood flows after childbirth, if the discharge becomes more frequent, profuse and redder, then immediate health care. First of all, go to the gynecologist. Especially if the bleeding has not passed and does not pass for more than 4 days.

Bleeding after childbirth is a pathology that should not be ignored by the woman who has given birth and her doctors. There are approximate norms for blood loss in the postpartum period, which must also be monitored upon discharge from maternity hospital, if necessary.

Normally, during childbirth, a woman loses 250 grams of blood. This can be compared to three heavy menstruation. Bleeding in the postpartum period continues. Within 2-3 days, a woman can still change an average of 1 sanitary napkin at one o'clock. Then the discharge should decrease. Excessive uterine bleeding after childbirth may be a reason for infusion donated blood. Fortunately, such a need arises infrequently.

Every day the uterus contracts more and more, returns to its non-pregnant size, the discharge gradually turns into spotting. And they can remain so sparse for up to 6-8 weeks. This is exactly the time period for bleeding after childbirth is normal for a woman.

It is bad when the discharge increases sharply in intensity. This can happen 10-15 days after discharge from the hospital. This is an occasion to urgently visit a gynecologist. Of course, it will no longer be possible to return to the maternity hospital, but diagnostics can be carried out in outpatient settings. If heavy bleeding begins a week after delivery, the doctor should first gynecological examination the patient, to feel her uterus in order to determine its approximate size, consistency, find out if it is painful, see if the cervix is ​​​​closed. Be sure to talk to the patient here important point is the presence elevated temperature body. If such a woman is worried, then you need to find out exactly how she measures the temperature, in what place. V armpit measurements may be uninformative because this period lactation is established, and small lactostasis, stagnation breast milk in the milk ducts, can lead to a local increase in temperature. It would be more correct to measure the temperature, for example, in the elbow bend.
And if there is an increase in temperature not associated with the chest, bleeding, pain - this is most often an indication for hospitalization in a gynecological hospital. On ultrasound, the doctor also examines the uterus. The main goal is to determine the causes of bleeding after childbirth, whether particles of the placenta remained in the uterus, whether placental polyp. Despite the fact that after the birth of the placenta it is always examined for integrity and, in which case, the uterus is audited (“cleansing”), such cases often occur. Especially often this diagnosis is confirmed when heavy bleeding begins a month after childbirth.

If everything is more or less in order according to the results of the ultrasound, the woman takes blood and urine tests. This is done to determine if there is inflammatory process. And if so, then antibiotics are prescribed. The most sparing, so that you can not turn off breastfeeding.

Often the long duration of postpartum hemorrhage is explained by the subinvolution of the uterus, its poorly contractile ability. Doctors call such a uterus “lazy”. The main treatment in this case is the appointment of oxytocin to provoke uterine contractions and hemostatic drugs. For example, Vikasola. If necessary, in parallel with this antibiotic.

After childbirth, the duration of bleeding is normal up to 8 weeks, but on average, discharge is observed during the first 5-6. But sometimes after that, spotting reappears. Could it really be early menstruation when a woman breastfeeds on demand? Yes, it often happens that bleeding occurs 2 months after childbirth. In this case, the woman should take a closer look at the secretions, their smell and abundance. Normally, a woman loses about 50 grams of blood during menstruation. With abundant - up to 80-100 grams. But if a woman is forced to change pads every two hours - this is the main criterion, how to distinguish menstruation from bleeding after childbirth, but about bacterial infection may indicate a foul-smelling discharge. In addition, the presence of large clots is considered a bad symptom, this also indicates a large blood loss and requires a doctor's consultation.