When the doctor or midwife identifies risk factors for postpartum hemorrhage in the mother, special precautions are taken during the labor and birth. They may include starting an intravenous fluid (IV) line, giving medications such as oxytocin by injection during or shortly after the birth, massaging the uterus to help it contract following the delivery, and actively delivering the placenta through traction on the umbilical cord.
Causes of excessive blood include:
-- Previous postpartum hemorrhage
-- The birth of five or more babies
-- The prolonged use of oxytocin
-- Uterine infection at the time of birth
-- An overdistended uterus caused by twin gestation, a very large baby (nine pounds or greater) or an abnormal amount of amniotic fluid
-- The use of magnesium sulfate as treatment for preterm labor or preeclampsia
-- Previous scarring of the uterus, which might cause an abnormal attachment of the placenta to the uterine wall (placenta accreta)
-- Episiotomy or laceration
If the mother is at particularly high risk for excessive blood loss, a number of interventions may be necessary.
Interventions that may help prevent postpartum hemorrhage:
-- Monitoring the mother for any risk factors
-- Examining the placenta to check for missing pieces
-- Putting baby to breast if the mother is breastfeeding, to facilitate uterine contractions
-- Maintaining IV access for the rapid administration of medications
-- Actively managing the third stage of labor by delivering the placenta and not waiting for spontaneous expulsion
-- Inspecting for any lacerations and appropriate suture placement
-- Evaluating the mother for any infection during labor
-- Massaging the uterus following the birth
-- Encouraging the mother to urinate (a full bladder can impede uterine contraction)
-- Monitoring the mother's pulse and blood pressure frequently
-- Assessing blood loss often during the postpartum period
Very rarely, when blood loss will not stop with massage or IV medications, more extreme measures are needed to stem the flow.