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Following Childbirth, Several Risk Factors Can Increase Likelihood of Postpartum Hemorrhage

Jason Reese

New Mothers Left at Risk When Postpartum Hemorrhage Prevention and Treatment Methods Fail

According to the American College of Obstetricians and Gynecologists (ACOG), while maternal mortality rates due to postpartum hemorrhage (PPH) have decreased in the last four decades it still accounts for more than 10 percent of pregnancy-related deaths. PPH is excessive bleeding (1,000 mL or greater) within the first 24 hours after birth but can occur up to 12 weeks postpartum.

Researchers have found that some women could have several risk factors that make them more likely than others to have PPH. While having a risk factor isn’t a complete indicator a woman will experience the excessive bleeding, it may increase their chances. When a risk factor is known, care providers should have a plan in place for prevention and treatment of PPH. For example, if a mother has experienced a prior PPH she may be more likely to have one again. In this scenario, her medical care providers should take all extra steps necessary to prevent this horrifying occurrence from happening again.

However, postpartum hemorrhage also occurs in women with no risk factors so physicians must be prepared to manage this condition at every delivery and postpartum check, follow protocol, and not delay treatment since PPH can be a potentially life-threatening condition.

Common Cause of Postpartum Hemorrhage: Uterine Atony

According to the March of Dimes, several medical conditions that affect the uterus, placenta, and the labor and birth process can also serve as risk factors for PPH.

Uterine atony is the most common cause of PPH and happens when the muscles in the uterus don’t contract after birth. Atony of the uterus causes up to 90 percent of PPH cases, according to Blood Transfusion in Clinical Practice. Hemorrhage usually happens after the placenta is delivered. It is important that when this happens, nurses and staff provide immediate treatment to help stop the bleeding and to prevent another occurrence of blood loss. Early detection and treatment can lead to a full recovery.

Other complications of uterine atony include:

  • lightheadedness or dizziness due to low blood pressure
  • anemia
  • fatigue
  • an increased risk of postpartum hemorrhage in a later pregnancy

Anemia and fatigue after birth also increase the chances of a mother having postpartum depression. A serious complication of atony of the uterus is hemorrhagic shock; this condition can even be life-threatening.

Uterine inversion and rupture happens more rarely but can also be a cause of PPH.

Placental Conditions

Several other conditions that affect the placenta and attribute to PPH include placental abruption, placenta accreta, placenta previa, and a retained placenta.

  • Placental abruption is when the placenta separates partially or completely from the wall of the uterus before birth.
  • Placenta accreta, placenta increta, or placenta percreta happen when the placenta grows into the wall of the uterus too deeply.
  • Placenta previa is when the placenta lies very low in the uterus and covers all or part of the cervix.
  • Retained placenta occurs in women who don’t pass the placenta within 30 to 60 minutes after they give birth. A provider should always check the placenta to make sure it’s not missing any tissue. If tissue is missing and is not removed from the uterus right away, it may cause bleeding.

Labor and Delivery in Relation to PPH

Labor and delivery can create extra risk factors related to PPH. Women who are having a C-section or just receiving general anesthesia can be of greater risk of bleeding. Induction medicines to accelerate labor like Pitocin, or medicines to stop or slow preterm labor called tocolytics, can also contribute to a higher risk of PPH.

Women who labor longer than 14 hours or women who give birth rather quickly may have a higher chance of serious hemorrhage. Perhaps the choice to induce or receive the proper medical treatment to help labor move along safely were not the wishes of the mother. Women may also have tearing if they give birth to a large baby or have a baby born through the birth canal too quickly. Tearing also can happen if the provider performs an episiotomy or uses birthing tools, like forceps or a vacuum, to help move the baby through the birth canal easier. These tears can cause a critical hemorrhage.

Other Risk Factors

The March of Dimes identifies several other conditions related to a higher chance of experiencing a PPH. These include:

  • Blood conditions, like von Willebrand disease or disseminated intravascular coagulation (also called DIC) can cause a woman to develop a hematoma in the vaginal area.
  • Chorioamnionitis is an infection of the placenta and amniotic fluid.
  • Preeclampsia or gestational hypertension are types of high blood pressure that only pregnant women can get. Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after pregnancy. Signs of preeclampsia include having protein in the urine, changes in vision and severe headache. A care provider should be checking for these signs and symptoms at each appointment. Gestational hypertension is high blood pressure that starts after 20 weeks of pregnancy and goes away after you give birth.

Prevention and being prepared to provide immediate treatment to stop a postpartum hemorrhage are necessary to reduce the number of women who are at risk of maternal death or serious complications. If medical staff – including nurses and doctors – fail to quickly diagnose and treat the cause of the bleeding, the occurrence can lead to shock, brain damage or hypoxia, organ failure, or even death. In an effort to reduce rates of maternal mortality related to PPH, it is recommended that all hospitals have an organized, systematic process in place to help coordinate the response and management of PPH.

We Can Handle Your Medical Malpractice Claim

Our attorneys hold the medical profession in high regard, but when a physician or medical staff does not perform up to professional standards, legal accountability becomes necessary. Labor and delivery complications like PPH may have had a chance to be prevented and in return, maternal death risks or injury outcomes could have been greatly reduced.

If you have a medical claim caused by a PPH or other birth complication, contact the law firm of Wagner Reese by completing our online form, and one of our attorneys will review your information, and respond promptly. If you wish to speak with us today, please call (888) 204-8440.


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