The time following the delivery of a baby should be a time of joy for the family. However, it can quickly become very stressful if the mother experiences a postpartum hemorrhage, which can have dire consequences for her health.
Postpartum hemorrhage is a leading cause of maternal death, accounting for nearly one-third of maternal deaths worldwide.
Rosenfeld Injury Lawyers, LLC is a personal injury law firm with extensive experience in medical negligence cases. Our personal injury attorneys know what it takes to win these cases, and we will work tirelessly on your behalf to get you the compensation you deserve.
If you or your child suffered from medical malpractice, you might be entitled to compensation. Contact our birth injury lawyers today at (888) 424-5757 to schedule a free consultation with one of our knowledgeable and experienced attorneys.
Rate of Postpartum Hemorrhage in the United States
Primary postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality in the United States. An estimated 18% of all pregnancy-related deaths are due to PPH. In addition, PPH occurs in up to 9% of all vaginal births and 16% of all cesarean births.
Among all deliveries, the national PPH rate was 2.4% in 2019, up from 1.9% in 2020. The PPH rate was highest among cesarean births (5.2%) and lowest among vaginal births (1.1%).
While the overall rate of PPH has increased, the good news is that the risk of death from PPH has decreased over time. The maternal mortality ratio for PPH declined by 41% from 2010 to 2019.
According to the most recent data from the Centers for Disease Control and Prevention (CDC) , the rate of PPH increased by 27% from 2010 to 2019. This increase is not fully understood but may be partly due to the increasing number of cesarean deliveries and the aging of the childbearing population.
Understanding Postpartum Hemorrhage
Most postpartum hemorrhage (PPH) occurs when a mother bleeds too much after giving birth. PPH usually occurs within the first 24 hours after cesarean or vaginal birth, but it can happen up to 12 weeks postpartum. PPH is a leading cause of maternal mortality globally, accounting for 11% of maternal deaths.
A cumulative blood loss is more than 32 fluid ounces after delivery can occur regardless of whether it’s a vaginal or cesarean delivery. While it can happen to any woman who gives birth, some factors may increase your risk.
When bleeding is severe enough to produce symptoms of too much blood loss or a substantial change in heart rate or blood pressure, it’s known as postpartum hemorrhage.
Important Risk Factors for Acute Postpartum Hemorrhage
Women with a history of serious postpartum hemorrhage or obstetric hemorrhage are at increased risk of having it happen again. Other important factors include:
- High blood pressure during pregnancy: PPH is more common in women with high blood pressure, including preeclampsia  and eclampsia .
- Obesity: Women who are obese (BMI of 30 or higher) are at increased risk for postpartum hemorrhage.
- Multiple births: Women who deliver twins or triplets are more likely to experience PPH than women who gave birth to one baby.
- Placenta previa: It is a condition in which the placenta covers the cervix; as the placenta covers more of the cervix, the risk for PPH increases. Placenta previa can lead to PPH because it can block the baby’s delivery and cause heavy bleeding.
- Uterine inversion:  Uterine inversion is a rare but severe condition in which the uterus turns inside out during delivery. It can lead to PPH because it can block the baby’s delivery and cause heavy bleeding.
- Cesarean birth: Women with C-sections are more likely to experience PPH than women with a vaginal delivery.
- Excessive umbilical cord traction: Excessive traction on the cord or abnormally adherent placenta usually happens during vaginal delivery and can lead to PPH.
- Genital tears: Tears in the vagina or perineum (the area between the anus and vulva) can occur during childbirth. These tears can lead to PPH because they can cause heavy bleeding.
Replacing lost blood and fluids is crucial when treating the condition. In some cases, a blood transfusion might be necessary, or the infusion of intravenous (IV) fluids, blood, and blood products may be given rapidly to prevent shock.
Types of Postpartum Hemorrhage
There are two types of postpartum hemorrhage:
Primary Postpartum Hemorrhage
Primary postpartum hemorrhage occurs during delivery or within the first 24 hours after the baby is born. It’s usually caused by uterine atony when the uterine muscles don’t contract properly and the bleeding vessels aren’t sealed off. It can also occur when you have an overdistended uterus (due to too much amniotic fluid). It can be referred to as early postpartum hemorrhage and can be caused by:
- Uterine rupture
- Retained placental tissue
- Genital tears
Secondary Postpartum Hemorrhage
Secondary postpartum hemorrhage occurs more than 24 hours after the baby is born; an infection or a clotting disorder usually causes it. It can also be referred to as late postpartum hemorrhage and can be caused by:
- Uterine infection
- Clotting disorder  (such as disseminated intravascular coagulation)
- Retained blood products of conception (such as the placenta)
Signs and Symptoms of Postpartum Hemorrhage
The symptoms of postpartum hemorrhage can vary depending on how much blood you’ve lost. Some women may lose so much blood that they feel faint, have a rapid heart rate, or go into shock. Other women may not have any symptoms at all.
Decreased Blood Pressure
If you’re hemorrhaging a lot of blood, it may result in a severe drop in pulse and blood pressure, restricting blood flow to your organs. When you notice that your blood pressure has decreased, seek medical attention.
Blood Vessels in the Skin
If you’re losing blood, the bleeding vessels in your skin may become more visible. Your body is trying to compensate for blood loss by sending more blood to your skin.
The blood vessels bleed freely, and the skin around them looks purple or red.
Nausea or Vomiting
You may feel nauseous or vomit during or after a hemorrhage because of the stress that bleeding puts on your body.
Fainting or Dizziness
When you lose a lot of blood, you may feel dizzy or lightheaded and faint. The brain isn’t getting enough blood.
Pale skin is another sign that you’re losing blood. When you lose blood, your skin may become pale or clammy.
A rapid heartbeat signifies that your body is trying to compensate for the lost blood. When you lose blood, your heart has to work harder to pump blood throughout your body.
Shortness of Breath
When you lose blood, you may feel short of breath because your heart isn’t getting enough blood, and your lungs may not be getting enough oxygen.
Of course, one of the most obvious signs of postpartum hemorrhage is excessive blood loss. If you’re losing more than 500 mL of blood (about 2 cups), it’s considered a postpartum hemorrhage. Blood clots the size of a golf ball or larger can also signify postpartum hemorrhage.
Shock is one of the most serious complications of postpartum hemorrhage. Usually, shock is a life-threatening condition that occurs when your organs don’t get enough blood and when there is a severe drop in your blood pressure.
Shock can lead to organ failure and death. If you think you might be going into shock, you must get medical help immediately.
Symptoms of shock include:
- Cold, clammy skin
- Rapid heartbeat
- Lightheadedness or dizziness
- Shortness of breath
- Severe drop in pulse and blood pressure
- Pale skin
If you think you or someone you know is going into shock, call 911 or go to the nearest emergency room. Shock is a medical emergency and needs to be treated immediately.
The Four Most Common Causes of Postpartum Hemorrhage
There are four leading causes of postpartum hemorrhage:
Uterine atony: Uterine atony is the most common cause of postpartum hemorrhage, accounting for approximately 60-80% of all cases.
Uterine atony occurs when the uterine muscle and other pelvic tissues fail to contract properly after childbirth, causing the uterine walls to slack where blood vessels bleed freely. It can lead to an overdistended uterus due to too much amniotic fluid.
Lacerations: Lacerations of the vagina, cervix or the lower uterine segment can occur during childbirth and are a common cause of postpartum hemorrhage. These lacerations can cause the blood vessel to be torn, resulting in uncontrolled bleeding.
Placental abruption: It is a relatively rare cause of postpartum hemorrhage, occurring in approximately 1% of all pregnancies.
Placental abruption occurs when the placenta (the organ that provides oxygen and nutrients to the fetus during pregnancy) prematurely separates from the uterine wall before childbirth, causing uncontrolled bleeding as the blood vessel that connects the placenta to the uterine wall is torn.
Retained placenta: In some cases, the placenta may not be wholly expelled from the uterus after childbirth. When some pieces of the placenta stay attached to the uterine wall, it can cause heavy uterine bleeding. Treatment for a retained placenta typically involves manual removal of the placenta by a healthcare provider.
While any of these four causes can lead to postpartum hemorrhage, uterine atony or uterine tone is the most common, accounting for most cases. If you are pregnant or have recently given birth, it is important to be aware of the signs and symptoms of postpartum hemorrhage to seek medical attention if necessary.
Prevention and Treatment of Postpartum Hemorrhage
An effective system for the prevention and treatment of postpartum hemorrhage must be comprehensive, evidence-based, and multidisciplinary. Below is a description of the key components of such a system.
Education and awareness: Education and awareness are essential for preventing postpartum hemorrhage. All pregnant women or planning to become pregnant should be educated on the risks and signs of postpartum hemorrhage.
Healthcare providers should also know the latest evidence-based guidelines to prevent postpartum hemorrhage.
Risk factor identification: It is essential to identify women at risk for postpartum hemorrhage to be monitored closely and receive appropriate care. Risk factors for postpartum hemorrhage include, but are not limited to:
- Previous history of postpartum hemorrhage
- Uterine rupture
- Multiple gestations
- Induction of labor
- Intrapartum hemorrhage 
- Placental abruption
Several evidence-based interventions can be used in preventing or treating postpartum hemorrhages, such as the use of active versus expectant management of the third stage of labor and prophylactic use of uterotonics. These interventions have been shown to reduce the incidence of postpartum hemorrhage by up to 50%.
Treating Postpartum Hemorrhage
If postpartum hemorrhage occurs, prompt and effective treatment is essential. Treatment and management of postpartum hemorrhage typically include:
- Bleeding blood vessels are clamped using uterine compression sutures to prevent blood loss and promote healing.
- Replacing lost blood with intravenous fluids, blood products, and blood transfusions as needed. Medications such as uterotonics (e.g., oxytocin, misoprostol, and methergine) can also be given intravenously or intramuscularly to help stimulate uterine contractions and stop the bleeding.
- Examining the uterus and other pelvic tissues during a cesarean birth to determine if there are any tears or lacerations that need to be repaired
- Uterine massage can also help the uterus contract and stop the bleeding. Most times, uterine massage is combined with the administration of uterotonics
- Manual removal of the placenta (known as manual placenta extraction) may be necessary if some part of the placenta stays attached to the uterine wall
- In some cases, surgery may be necessary to control the bleeding. It may involve using uterine compression sutures or performing a hysterectomy  (removing the uterus) and tying off or sealing bleeding blood vessels
- Uterine artery embolization (UAE) is a minimally invasive procedure that can be used to treat postpartum hemorrhage that is not responding to other medical treatments
Postpartum hemorrhage is a potentially life-threatening complication of pregnancy that requires prompt and effective treatment.
A comprehensive, evidence-based, and multidisciplinary approach is necessary to treat and prevent postpartum hemorrhage. The type of treatment required will depend on the severity of the hemorrhage and the underlying cause.
Postpartum Hemorrhage FAQs
Our personal injury lawyers know that many families have unanswered questions about who might be responsible for severe postpartum hemorrhage when delivering a child. An attorney from our law office has provided some answers below.
What Is Postpartum Hemorrhage?
Postpartum hemorrhage is a potentially life-threatening complication of pregnancy that occurs when there is excessive bleeding after the baby’s delivery.
What Are the Complications of Postpartum Hemorrhage?
Complications of postpartum hemorrhage include, but are not limited to:
- Uterine rupture
- Maternal mortality 
How Can I Prevent Postpartum Hemorrhage?
Several evidence-based interventions can help to prevent postpartum hemorrhage, such as:
- Active management of the third stage of labor
- The use of prophylactic uterotonics to help stimulate uterine contractions
How Is Postpartum Hemorrhage Diagnosed?
Key diagnostic features are based on the amount of blood loss and the symptoms the patient is experiencing. The doctor may also do a blood test to check your hemoglobin and hematocrit levels and clotting factors.
If you’re experiencing symptoms of postpartum hemorrhage, your healthcare provider will likely perform a physical examination to look for signs of blood loss. They may also order additional tests, such as:
- Ultrasound 
- CT scan
- Angiography 
- Blood test (clotting factors, coagulation panel, fibrinogen levels)
Is It Safe to Have Another Baby After Postpartum Hemorrhage?
Most women who have had postpartum hemorrhage will be able to have a successful pregnancy and delivery in the future. However, you may be at an increased risk for postpartum hemorrhage in subsequent pregnancies. Your healthcare provider can help you manage your risk factors and make sure you’re prepared for your next pregnancy.
How Can I Reduce My Risk for Postpartum Hemorrhage?
There are several things you can do to reduce the risk for postpartum hemorrhages, such as:
- Eating a healthy diet
- Exercising regularly
- Getting regular prenatal care
- Managing any chronic health conditions you have
- Avoiding smoking and drinking alcohol
After delivery, you can also help to reduce your risk for postpartum hemorrhage by:
- Breastfeeding within the first hour after birth
- Using a perioperative uterotonic, such as oxytocin, during the third stage of labor
- Avoiding constipation and straining during bowel movements
- Wearing sanitary pads during the postpartum period
- Avoid douching, using tampons, or having intercourse until your six-week postpartum checkup.
Talk to a Medical Malpractice Attorney
When a complication like postpartum hemorrhage occurs, it can have devastating consequences for the mother and her family. If you or a loved one has been harmed by postpartum hemorrhage, you may be entitled to compensation.
An experienced medical malpractice attorney at Rosenfeld Injury Lawyers can help you understand your legal rights and options. Contact us today at (888) 424-5757 to schedule a free consultation. We will fight tirelessly to get you the justice and compensation you deserve.