women s health issues
Excessive Uterine Bleeding at Delivery
Treatment of Postpartum Hemorrhage
Massage of the uterus Medications to help the uterus contract Fluids given by vein (intravenously) Sometimes a blood transfusion Removal of any remaining fragments of the placenta Sometimes a procedure to compress the arteries to the uterus If excessive bleeding occurs, a woman's uterus is massaged by pressing on her abdomen, and she is givenoxytocincontinuously through an intravenous line. These measures help the uterus contract. A woman is also given fluids intravenously to help restore the amount of fluid in the bloodstream. If bleeding continues, another medication that helps the uterus contract is also given. These medications can be injected into a muscle, placed as a tablet in the rectum, or, for a woman undergoing cesarean delivery, injected into the uterus. A woman may need a blood transfusion. Doctors look for the cause of excessive bleeding. The uterus may be examined to see whether any fragments of the placenta remain. Any fragments that remain in the uterus are removed by hand. Rarely, Dilation and Curettage is needed to remove these fragments. In this procedure, a small, sharp instrument (curet) is passed through the cervix (which is usually still open from the delivery). The curet is used to remove the retained fragments. This procedure requires an anesthetic. The cervix and vagina are examined for tears. If the uterus cannot be stimulated to contract and bleeding continues, the arteries supplying blood to the uterus may have to be compressed to stop blood flow. Procedures that may be used include the following: A balloon may be inserted into the uterus and inflated. Packing may be inserted into the uterus. A doctor may place stitches (sutures) around the bottom of the uterus—a procedure that requires abdominal surgery. A device that applies gentle suction to the uterus and thus helps the uterus contract may be placed in the uterus. The procedures usually do not cause infertility, abnormalities in menstruation, or other lasting problems. Sometimes the arteries supplying blood to the uterus must be blocked surgically or by inserting material through catheters into the arteries. Removal of the uterus (hysterectomy) is rarely necessary to stop the bleeding. 