What is delivery hemorrhage?
Delivery is the third phase of childbirth: the expulsion of the placenta, amniotic membranes and umbilical cord. If you'd like to know more about this subject, we've discussed the symptoms and causes in this article: Delivery hemorrhage, what is it?
How can vaginal bleeding be prevented?
To avoid a delivery hemorrhage, a number of preventive measures are sometimes taken. In fact, the Collègue National des Gynécologues et Obstétriciens Français (CNGOF) indicates that in the majority of post-partum hemorrhages, no risk factors have been previously identified. For this reason, measures to prevent this hemorrhage are aimed at all women. This begins with an anaesthesia consultation, the aim of which is to put in place the minimum measures necessary in the event of haemorrhage.
However, as we have already seen, "at-risk" women are particularly closely monitored. In fact, women who have already suffered a delivery hemorrhage will receive an iron supplement in the third trimester to reduce the risk of anemia.
What's more, as we explained earlier, after delivery, the woman is put under surveillance for 2 hours in the delivery room to check, in particular, that the uterus is retracting properly. During this period, her heart rate, blood pressure and uterine tone are checked to ensure that she is not hemorrhaging. If anything abnormal is found during this period, a blood sample is taken from the patient's finger to instantly check her hemoglobin level. If bleeding is detected, the nursing team investigates the cause. A multidisciplinary team is then deployed.
In addition, certain techniques are available, notably in the UK, to improve management of severe bleeding. These include the use of an intra-uterine balloon for internal hemostasis. This would make it possible to avoid certain transfers to accredited maternity hospitals. In the next few years, it is possible to envisage widespread use in France.
Treatment after a delivery hemorrhage?
First of all, if there is the slightest doubt about possible post-delivery haemorrhage, the medical team will, with the patient's agreement, perform a uterine revision, also known as artificial delivery. This procedure verifies that the placenta has been expelled and that nothing remains in the uterine cavity. It involves manual movements in the uterus, under epidural or general anaesthetic, to extract any remnants of the placenta.
If, on the other hand, the cause is uterine atony, i.e., as we saw above, the uterus is not recontracting or is not recontracting sufficiently, a massage will be performed to stimulate it, as it is essential to have contractions again to stop the bleeding. If this is the case, you can use organic cotton menstrual panties to absorb the bleeding. It may also be possible to deliver oxytocin by vein to help the uterus contract back to more or less its original size. For most delivery hemorrhages, treatment stops here. If this is still not enough, prostaglandin, a stronger drug, can be administered to increase contractions.
However, if it's not the uterus that's bleeding (or not just the uterus), but the vagina or cervix, a check will be made using valves to see inside the vagina. If a tear is found, stitches will be needed to stop the bleeding.
If the woman has bled a lot and for a long time, or does not have enough platelets or good coagulation factors, a coagulation test will be carried out to check coagulation and iron levels.
In addition, if the mother is below a critical threshold, she will be placed in intensive care and, in very rare cases, a blood transfusion will be considered.
Finally, if nothing has worked and the haemorrhage is still present, the woman will undergo surgery to stop the bleeding, consisting of embolization of the uterine arteries or artery ligation. Padding may also be considered, which consists of sewing the uterus back onto itself to compact it and prevent bleeding. As a last resort, a hysterectomy is performed, i.e. removal of the uterus.
However, just because you had a delivery hemorrhage during a previous pregnancy, it doesn't necessarily mean you'll have another one the next time around - it all depends on the reasons for the hemorrhage. Nevertheless, the patient will be advised to give birth in a level II maternity hospital, and also to take an iron supplement during the third trimester of pregnancy.
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