Hemorrhage is the medical term for bleeding. This is blood escaping from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally, either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a break in the skin.

Hypovolemia is a massive decrease in blood volume, and death by excessive loss of blood is referred to as exsanguination. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties (by comparison, blood donation typically takes 8–10% of the donor’s blood volume). The stopping or controlling of bleeding is called hemostasis and is an important part of both first aid and surgery.

Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breath rate. As more blood is lost the women may feel cold, their blood pressure may drop, and they may become restless or unconscious. The condition can occur up to six weeks following delivery.

Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta, and coagulopathy, commonly referred to as the “four Ts”

Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony. Uterine atony is the most common cause of postpartum hemorrhage.

Trauma: Injury to the birth canal which includes the uterus,cervix,vagina and the perineum which can happen even if the delivery is monitored properly. The bleeding is substantial as all these organs become more vascular during pregnancy.

Tissue: retention of tissue from the placenta or fetus may lead to bleeding.

Thrombin: a bleeding disorder occurs when there is a failure of clotting, such as with diseases known as coagulopathies.

Prevention involves decreasing known risk factors including if possible procedures associated with the condition and giving the medication oxytocin to stimulate the uterus to contract shortly after the baby is born. Misoprostol may be used instead of oxytocin in resource poor settings. Treatments may include: intravenous fluids, blood transfusions, and the medication ergotamine to cause further uterine contraction. Efforts to compress the uterus using the hands may be effective if other treatments do not work. The aorta may also be compressed by pressing on the abdomen.

Suggested Reading
Postpartum bleeding: How much is too much?
By Mary M. Murry, R.N., C.N.M. Mayo Clinic

Postpartum bleeding. (2016, August 18). In Wikipedia, The Free Encyclopedia. Retrieved 14:25, August 18, 2016, from https://en.wikipedia.org/w/index.php?title=Postpartum_bleeding&oldid=735084798