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The deadly danger of postpartum hemorrhage: Why is the inability of the uterus to contract effectively dangerous?
Postpartum hemorrhage refers to excessive bleeding in women after childbirth, of which inability of the uterus to contract effectively is considered to be the main cause. When the muscles of the uterus contract during labor, they compress blood vessels and slow blood flow, which helps prevent bleeding and promotes clotting. Conversely, if the uterus cannot contract normally, it will lead to acute bleeding and even be life-threatening.
Globally, postpartum hemorrhage is one of the top five causes of maternal mortality.
Risk Factors
Many factors may contribute to ineffective uterine contractions, including prolonged labor, labor lasting less than three hours, uterine rotation, and the use of magnesium sulfate. If a woman is pregnant with twins, has extra amniotic fluid or the fetus is too large, the uterus may also become over-expanded, affecting its function and causing uterine weakness. Retained placental tissue and placental abnormalities such as placenta previa and placental abruption are also risk factors for postpartum hemorrhage. In addition, a body mass index (BMI) above 40 and coagulopathy are also known risk factors for postpartum hemorrhage.
EpidemiologyIn the United States, one in 40 women experiencing postpartum uterine atony will experience uterine atony, which accounts for at least 80% of all postpartum hemorrhage cases.
PathophysiologyThe uterus is made up of muscle fibers called smooth muscle, which form a tissue called the myometrium. After delivery, the contraction of these muscles is the key to stopping bleeding. When the uterus cannot contract effectively, the blood vessels cannot be compressed, resulting in the failure to stop bleeding. The release of oxytocin encourages uterine contractions, but if its receptors are no longer available for this hormone, the uterus will not be able to contract effectively.
After delivery, normal blood loss should be less than 500 ml, and if bleeding exceeds 500 ml within 24 hours after delivery, it is considered excessive bleeding.
Assessment and diagnosis
Early identification of risk factors is crucial for the management of uterine atony and postpartum hemorrhage. This allows the required medical resources to be arranged in advance. Again, diagnosis is usually made soon after delivery, with a physical exam to confirm uterine atony.
Treatment and management
Precautions
All women should be screened for risk factors before delivery and undergo a stratified risk assessment based on the recommendations of the American College of Obstetricians and Gynecologists. If the risk is assessed as moderate, blood typing should be done; if the risk is high, potential bleeding situations should be avoided.
Treatment measures
Uterine atony should require prompt medical management, including continuous uterine fundus massage and medication. Commonly used drugs include oxytocin, carbetocin and metotocin. These drugs stimulate the uterine muscles to contract and stop bleeding.
For most women after childbirth, the main treatment for postpartum hemorrhage is oxytocin, but if bleeding cannot be controlled, combination therapy with other uterotonics is needed.
Complications
Postpartum hemorrhage may lead to a variety of complications, including death, hypovolemic shock, and liver and kidney failure. Particularly in low-income countries, the lack of medical resources and availability of blood products increases the risk of postpartum hemorrhage.
Prognosis
Women with a history of postpartum hemorrhage have a double to triple risk of developing postpartum hemorrhage in subsequent pregnancies. This phenomenon reminds us to continue to pay attention to women's health during pregnancy and postpartum.
The risk of postpartum hemorrhage cannot be ignored. What exactly does this reflect about our lack of attention to maternal health?
