Postpartum Hemorrhage

Extreme measures to control postpartum blood loss:
-- Vigorous external uterine massage
-- Uterine compression (one hand placed in the vagina and one hand on the abdomen)
-- Exploration of the uterine cavity (one hand in the uterus to remove clots or retained placental fragments)
-- Packing of the uterus with gauze
-- Surgery (dilation and curettage, or D&C) to remove retained placental fragments
-- Ligation of the uterine artery (partially cutting off the blood supply to the uterus)
-- Hysterectomy (removal of the uterus)

What can mothers do to minimize the risk of postpartum hemorrhage?
Provide your midwife or doctor with a thorough and accurate history of bleeding and a family history of clotting disorders.

Plan your pregnancies. You can prepare your body by building and maintaining healthy iron stores. Spacing pregnancies will enable your body to replenish its iron stores. It would be best if each woman could start pregnancy with a hemoglobin level between 12 1/2 and 13 1/2, as levels fall as much as 1 to 1 1/2 grams by the seventh month.

Eat a healthy diet and maintain a lifestyle free from substance abuse and smoking.

Seek care early during the pregnancy and take a folic acid supplement three months before conception and for at least three months into the pregnancy.

Maintain a healthy lifestyle and diet and exercise program during the pregnancy. Excess weight gained during pregnancy can result in larger babies, which prolongs labor and makes the birth more traumatic.

Note your daily intake of iron. A diet during pregnancy should include about 18 mg of elemental iron each day. Iron levels are usually checked at three times: the initial visit, at about 26 weeks and sometimes at 36 weeks. Take iron supplements if suggested by your care provider. As iron can cause constipation and upset stomach, dietary sources of iron may be best.

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