What Is Postpartum Hemorrhage?

Postpartum hemorrhage (PPH) is excessive bleeding and loss of blood after childbirth. It usually occurs shortly after giving birth, but it can also happen in the days and weeks after delivery. The most common cause of PPH is the uterus not contracting properly after birth.

While PPH is fully treatable if your medical team can find the cause and stop the bleeding quickly enough, it's a serious condition that can lead to shock and sometimes death due to a dangerous drop in blood pressure. Roughly 1 to 5 out of 100 people will experience PPH, which is one of the leading causes of maternal mortality.

Definition

Some bleeding after childbirth, known as lochia, is normal. This is where the uterine lining is sloughed off as the uterus heals and shrinks down to its prepregnancy state. But with PPH, an excessive amount of blood is lost, which makes it dangerous and potentially life-threatening.

The World Health Organization (WHO) generally defines postpartum hemorrhage as losing more than 500 milliliters (mL)—about a half of a quart—of blood 24 hours after vaginal birth, and more than 100 mL of blood (or about a quart) after a cesarean (C-section) birth.

Symptoms

Although some vaginal bleeding—even bleeding that's moderate or slightly heavy—is expected after giving birth, you shouldn't be soaking through more than one pad per hour.

In addition to abnormally heavy bleeding, there are some other signs to look out for that may indicate you're experiencing PPH and need to seek medical attention as soon as possible:

• Acute pain
• Fever
• Chills
• Feeling disoriented
• Excessive fatigue
• Increased, rather than decreased, bleeding 
• Nausea or vomiting
• Pale skin
• Blurred vision

Causes

Issues with the delivery of the placenta are common causes of postpartum hemorrhage. This includes conditions such as:

• Uterine atony, the most common cause of PPH, happens when the muscles in the uterus don't contract or tighten well enough after birth to control bleeding where the placenta was attached.
• Retained placenta fragments, the second most common cause of PPH, happens when the placenta doesn't fully separate and partially remains in the body.
• Uterine inversion is a more rare condition where the uterus turns inside out after birth.
• Uterine rupture is another rare condition where the uterus ruptures during labor. This may be more likely to happen if you have a scar in the uterus from a past C-section or uterine surgery.
• Bleeding disorders that are either diagnosed at birth or during pregnancy can put a person at a higher risk of PPH.

Diagnosis

Because postpartum hemorrhage is serious, your healthcare provider will likely want to quickly perform a few tests to confirm the diagnosis and try to find the cause of it. Along with considering your symptoms and medical history, this could include tests such as:

• Checking your pulse and blood pressure
• Pelvic exam to evaluate your vagina, uterus, and cervix to help find the source of the bleeding
• Blood clotting tests
• Red blood cell count tests
• Blood loss measurement
• Ultrasound to check for issues with the uterus or placenta

Treatment

Treatment for postpartum hemorrhage is critical to avoid shock—when your body’s organs don’t get enough blood flow—and even death. You’ll need medical attention and treatment right away to find and stop the cause of bleeding as quickly as possible.

The exact treatment will often depend upon the severity of the postpartum hemorrhage. This could include steps such as uterine massage to help the muscles contract, placing the person's feet above the heart, and giving the person oxygen by mask.

If the PPH is considered to be more severe, it's possible that your healthcare provider could take additional treatment steps, such as:

• IV fluids and medication to stimulate uterine contractions
• Blood transfusion
• Removing a remaining piece of the placenta from the uterus
• Embolization (tying off or sealing) of the blood vessels that supply the uterus
• Surgery to try to find and control the source of bleeding (in some severe cases the uterus has to be removed)

Risk Factors

Postpartum hemorrhage can happen in people with or without any risk factors. That said, those with certain risk factors are considered to have a higher chance of experiencing PPH.

For example, you’re more likely to have PPH if you’ve had it in the past or if you have certain medical conditions that affect the uterus, placenta, or blood clotting. These can include:

• Placental abruption: Early detachment of the placenta from the uterus
• Placenta previa: Placenta covering or near the cervical opening
• Overdistended uterus: Larger-than-normal uterus due to a large baby
• Gestational hypertension or preeclampsia: High blood pressure during pregnancy
• Twin or multiples pregnancy
• Several prior pregnancies
• Prolonged labor
• Obesity
• Certain medications used during labor

If you have any of these risk factors, your healthcare provider will likely take additional precautions to prevent PPH and monitor you closely after birth.

Prevention

After birth, medical care teams at hospitals and birth centers will take routine steps to prevent postpartum hemorrhage.

This includes watching for signs of placental separation to indicate the placenta is ready to be delivered. An injection of Pitocin (synthetic oxytocin) or similar medication is often used to prompt a quick and complete placental delivery.

In addition, some experts recommend breastfeeding, if possible, after giving birth as a way to prompt a hormone known as oxytocin. This helps contract the uterine and expels the placenta. Uterine massage may also help expel blood clots and make sure the uterine muscles are properly tightening to prevent excessive bleeding.

Emptying the bladder (by voiding or with use of a catheter) shortly after giving birth may also help prevent PPH.

A Word From Verywell

While postpartum hemorrhage happens in 5% of births or less, it's still a leading cause for maternal deaths worldwide. Your healthcare provider is aware of this and will follow necessary protocols to help prevent it from happening, but it's also important to keep an eye on your own postpartum bleeding.

Excessive bleeding should be checked out right away, and any bleeding that lasts for more than six weeks after delivery should be evaluated by your healthcare provider in case of PPH or another pregnancy complication.

If you think you may be at risk, it may be helpful to start this conversation early during prenatal check-ups by speaking with your healthcare provider or other healthcare professional about your risk factors, and the prevention strategies in place to keep you safe.