bleeding in the puerperium You remember which sacrament is considered the mostsacred on earth? That's right, it is the birth of a new life. All parents are waiting with trembling for the birth of their baby. This is particularly true for future mothers. And it is not surprising - they are directly involved in this sacrament. Moreover - basically it depends on the woman how healthy a child is born. From a woman and, of course, from doctors. Fortunately, to date, the qualifications of doctors and the level of modern medicine are high enough, so the cases of child death are extremely rare. But, nevertheless, women are very much worried about childbirth. And psychologists say that the main nature of this fear is nothing more than the lack of necessary information. And if the birth itself is becoming more and more less clear - there is a lot of information, then with the postpartum period everything is more complicated. Women do not know what to expect in the early postpartum period. By the way, sometimes women do not notice the complications that have begun. As a rule, this happens for two reasons. Firstly, the newly-born Mom is so encouraged by the appearance of crumbs into the light, which poorly perceives the surrounding reality. And secondly, the woman can not overlook the problem for quite a trivial reason - because she simply does not know how normal the postpartum period should be. This is exactly what will be discussed in this article. We will tell you about how the postpartum period should normally go on, and also about what pathologies are noted by physicians in this interval of time most often. Of course, we will not go into details of how to eliminate this or that complication - the woman does not need this information at all, as this is the immediate task of doctors. However, in general terms, you will learn this knowledge - this knowledge will help you avoid fear of the unknown - in this case, before the manipulation of doctors.

Features of the course of the postpartum period

So, the crumb was born. But the woman is still in childbirth - until the latter separates and comes out. After this, the immediate postpartum period begins. And the woman is called a woman by a woman. The postpartum period itself is divided into two stages:

  • Early postpartum period

This period is the shortest - only two hoursafter the birth of the placenta. This stage is the most responsible - it is he who determines all the further course of the recovery period after childbirth. A young mother at this time should be under the strict supervision of doctors, midwives and nurses. About what happens during this period in the body of a woman, we will tell you a little later.

  • Late postpartum period

It begins two hours after birththe placenta and lasts 40 days. As a rule, women relax and believe that their health is no longer threatened. However, this is not so - until the uterus is reduced to its original size, there is always a certain risk of developing various complications. In particular, postpartum endometritis.

The condition of a woman in the early postpartum period

So, let's talk about what happenswith the body of a woman in the early postpartum period. The walls of the uterus begin to decrease very actively, so that in just a couple of hours the uterus decreases several times in size. Its walls begin to thicken, and the uterus body itself becomes globular. In just a couple of hours, the hindbut and the anterior wall of the uterus are already tightly pressed together. The cervix also has a very peculiar appearance - it resembles a sac, wrinkled and with very thin walls. The doctor can easily insert into the uterus cavity a hand - and the woman will not feel a special discomfort due to the extension of the cervix. The weight of the uterus immediately after birth is approximately 1000 grams. During the birth, the fixation apparatus, like the ligament of the uterus, is quite stretched. And because of this, the uterus is very mobile and easily displaced. By the way, the condition of the muscles of the pelvic floor also contributes to this phenomenon. That is why it is so important to empty the bladder in time. Otherwise, the overflowing bladder will lead to a permanent displacement of the uterus. So, to the deterioration of its ability to reduce. This phenomenon is fraught with the development of a variety of complications. Among the women who have never given birth, there is an opinion that immediately after the birth, Mom immediately falls asleep. However, this is not so. Of course, the woman is very tired, since her body did very hard work. However, the nature is smarter than us - a woman produces a huge amount of tonic substances. And the emotional shock makes itself felt. Therefore, the first few hours after giving birth, women clearly are not up to sleep. But this is only if the woman is healthy. In the same case, if a woman has drowsiness, or worse still, vomiting has added to drowsiness, the doctor has every reason to suspect the presence of hypoxia of the brain. And this pathology, in turn, most often indicates extensive blood loss. And often it is internal, so it is almost impossible to guess by external signs. Changes do not bypass the functioning of the cardiovascular system. And it's not surprising - it's worth the baby to appear, as in the woman's body there are a number of changes:

  • Elimination of the utero-placental additional circle of blood circulation.
  • Decrease in intra-abdominal pressure.
  • Sharp changes in the hormonal background in the body of a young mother.

All this leads to the fact that a womanalmost immediately after childbirth, the pulse is significantly reduced, and the level of blood pressure also changes. And in most cases it is greatly reduced. Although there are exceptions - cases in which blood pressure, on the contrary, increases. Typically, this is typical for those women who both before pregnancy and during it regularly experienced hypertension. Such women need to closely monitor their condition. Body temperature in most cases remains normal. But sometimes it can briefly raise to 37, 5 - 38 degrees. This hyperthermia is a consequence of tension - both physical and emotional. As a rule, doctors do not particularly worry about such temperature rises. Of course, if they last no more than an hour - otherwise it is necessary to sound an alarm, as more often a prolonged rise in temperature indicates the development of an inflammatory process. early postpartum period

Bleeding in the early postpartum period

One of the most serious complications in the earlythe postpartum period is bleeding. In the event that it arose in the first two hours after delivery, it is called - early postpartum hemorrhage. There are several reasons that lead to the development of bleeding:

  • Hypotension and atony of the uterus

Doctors call this term such a state,at which there is a strong decrease in the normal tone of the uterus. As a result, the walls of the uterus contract much worse than expected, and excitability is also significantly reduced. Complete loss of these abilities does not occur - the uterus continues to react to the introduction of medications, mechanical and physical stimuli. Although the strength with which the uterus should react to these stimuli, with hypotension is much weaker than in other cases. Moreover: in some women doctors note a peculiar paradox - the stronger the action of the stimulus, the weaker the response of the uterus. In especially severe cases, a critical degree of hypotension of the uterus - atony can take place. When atony there is a complete loss of the tone of the uterus, the ability to contract. And in this case, the response of the uterus is not caused even by the strongest stimuli and medications. Simply put, the uterus is in a state of so-called paralysis. Fortunately, this phenomenon is extremely rare. But it can cause a fatal outcome. In the event that the cause of bleeding occurred in the early postpartum period, it was precisely the hypotonia of the uterus, it is rarely too intense and stable. Of course, in the event that it is not about atony - with her bleeding is very abundant and intense, it is extremely difficult to stop it. With hypotension, blood is secreted little by little, in small portions. As a rule, blood clots are most often contained in the blood. This is especially often observed with incomplete separation of the afterbirth. In addition, the cause of hypotension of the uterus may be too strong over-stretching. For example, in the event that a twin was born, or if the baby was born very large. In addition, a similar pathology can occur as a result of prolonged labor lasting more than 24 hours. Although for the sake of fairness it should be noted that doctors are well aware of this feature and in advance take all the necessary measures to prevent bleeding. In addition, the cause of hypotension of the uterus can be a long and systematic use of drugs that reduce the tone of the uterus. As a rule, these drugs are prescribed to maintain pregnancy with increased uterine tone. No less dangerous and premature detachment of the placenta. Not only can it lead to hypoxia and even the death of a baby, it also provokes the development of hypotension, and sometimes atony of the uterus. And, as a consequence, bleeding that developed in the postpartum period. And the risk of colliding with this And this type of bleeding is very peculiar - a very significant part of the blood accumulates both in the cavity of the uterus itself and in the vagina. This is why, in some cases, this bleeding is not immediately apparent. However, there is no need to worry about this - a gynecologist very often examines a woman in the early postpartum period. And he will notice the inevitable increase in the size of the uterus, which is due to the accumulation of blood in it. And blood will sooner or later start to stand out. As a rule, due to the fact that the uterus contraction is rather weak, it is not able to get rid of blood clots in its cavity. However very often doctors quickly eliminate them by simple, but very cautious pressure on the body of the uterus. After this, the woman is given intravenous medicines. In some cases, a manual examination of the uterus may be necessary - during which the doctor enters the hand in the uterine cavity and manually removes the remains of the placenta and blood clots. To be frightened of it it is not necessary - it goes without saying that this manipulation is carried out exclusively under general anesthesia. In most cases, these measures are sufficient to eliminate the problem.

  • Violation of blood clotting

In some cases, the cause of postpartumBleeding is nothing more than a systemic disease, as a result of which coagulability of blood worsens. Although these days, as a rule, this happens very rarely. After all, women undergo a thorough examination during pregnancy. And all diseases are revealed in advance. So, doctors already know exactly what to expect and prepare in advance. Therefore it is very important to visit a doctor in time during pregnancy.

  • Ruptures of the uterus and its cervix

Sometimes heavy bleeding occurscase, if during the delivery there was a rupture of the body of the uterus. Or in the case of severe damage to the cervix. Such cases are diagnosed by doctors in the very first minutes after delivery, emergency measures are taken to eliminate the damage. As a rule, a simple suture closure is sufficient. But in some cases, to save a woman's life, removal of the uterus may be necessary. Women who wear twins, too large a baby, are at risk. And, of course, those mothers who already have a child who was born with the help of a cesarean section. Especially in the event that the interval between births is less than three years.

Types of bleeding that occurred in the early postpartum period

Of course, any bleeding is a pathology. However bleeding to bleeding is different. Doctors distinguish two main types:

  • Profuse bleeding

In this case, the bleeding is very strong,massive. It begins, as a rule, suddenly, and the loss of blood is extremely high. The body of the uterus is very flabby, losing its ability to contract normally. The uterus does not respond properly to stimuli - manual massage, external, the introduction of various medications designed to shrink the walls of the uterus. Very quickly develops hemorrhagic shock - a condition that poses a serious danger to a woman's life.

  • Wavy bleeding

This bleeding is radically different fromof the previous type. In this situation, the relaxation of the uterus is not permanent, but periodic. Therefore, the blood flows in equal portions, approximately 200 ml. In this case, the uterus responds adequately to external stimuli and the introduction of medications - begins to decline. This condition is less dangerous for a woman's life and health. Yes, and doctors cope with it much faster. But this is only if the problem is noticed in a timely manner. Otherwise, the compensatory possibilities of the new mummy's organism are exhausted sooner or later: the bleeding is greatly intensified, the hemorrhagic syndrome develops. Fortunately, in the event that a woman gives birth in a maternity hospital, this can not happen, because doctors are very carefully watching her.

Treatment of bleeding in the early postpartum period

We sincerely wish you all information,which you just learned, has never come in handy for you in practice. But, unfortunately, sometimes this happens. And in the event that a woman knows what to expect, she will be more calm. So, the methods of eliminating bleeding in the early postpartum period are divided into:

  • Mechanical

In this case, doctors stimulate the uterus by direct exposure to it. This effect, as a rule, is a massage of the uterus - both external and direct.

  • Medicamentous

There are a number of pharmacologicaldrugs that most effectively stimulate uterine contraction. If necessary, the doctor will choose the most suitable drug for each specific case.

  • Operational

In the event that other methods prove to beineffective, doctors are forced to resort to operational methods. These include manual examination of the uterus, two-hand massage, in particularly severe cases - removal of the uterus. As a rule, treatment is often complex. The first thing doctors do is use a catheter to empty the bladder. After this, an external massage of the uterus begins through the abdominal wall. Simultaneously with these women intravenously injected drugs - most often oxytocin. If necessary, if the bleeding is too strong, or if the woman is emaciated, an intravenous infusion of glucose solution can be prescribed, which will provide the woman with the necessary support. In the event that this measure is ineffective, the "game" is entered by anesthesiologists. Mammy injected intravenous anesthesia, after which the gynecologist penetrates the uterine cavity with the hand and begins her study. The doctor should make sure that there are no pieces of the afterbirth in the uterus, and that the integrity of the uterus and its neck is not broken. Simultaneously, a very powerful uterine massage is performed. These manipulations are most effective in the early stages of bleeding. In addition, the introduction of prostaglandins into the cervix is ​​very effective - even very heavy bleeding stops. Of course, all these manipulations should be accompanied by maintenance therapy - the blood volume should not fall below the critical level. Therefore, if necessary, a woman can be prescribed infusion of physiological solutions, and sometimes a blood transfusion. In especially severe cases, when all other measures are useless, it is possible that doctors will make a ligation of the uterine vessels. If these measures prove to be insufficiently effective, doctors may decide to remove the uterus. In medicine, this operation is called extirpation of the uterus. Of course, this measure is used by doctors in the most extreme case, when a woman's life is under real threat and there are no other ways to help her. bleeding in the puerperium

Bleeding in the Late Postpartum Period

All those bleedings that occur later,than two hours after birth, are called bleeding in the late postpartum period. This type of bleeding is much less common than in the early postpartum period. However, it also has a place, so you can not lose sight of it. The causes of this bleeding are similar to those that trigger complications in the early postpartum period. This and incomplete separation of the placenta, and various blood diseases, and serious birth injuries. In addition, and in the late postpartum period, the development of hypotonic bleeding is possible - as a rule, it occurs in the first day after birth, not later. Treatment in this case is appointed, based on the causes that caused bleeding. The first thing the doctor will do is to carefully examine the woman. In the event that the cause of bleeding is delayed afterbirth, the size of the uterus is greater than it should be. The uterus itself has an extremely soft consistency, and its neck easily passes two fingers. To clarify the diagnosis in most cases, an ultrasound is performed. However, the doctor can immediately conduct a manual examination of the uterus. And, if necessary, remove the remaining parts of the afterburn. Women will be prescribed haemostatic drugs, drugs that stimulate its reduction. In addition, mandatory powerful antibiotic therapy will be prescribed, which is necessary in order to exclude the possibility of attaching a secondary infection and, as a consequence, the development of the inflammatory process. Strictly speaking, this is how often endometrium develops. In the same case, if the cause of bleeding that began in the late postpartum period, are trauma to the birth canal, most likely, the technique of suturing was broken. In most cases this leads to the formation of extensive hematomas in the vagina. In this case, the woman will be injected with intravenous anesthesia, after which the doctor will remove the old stitches, squeeze the bleeding vessels, connect the edges of the wound and re-sow them. For a woman, this procedure is completely painless, because she is under anesthesia at the time of manipulation. As you can see, there is something to fear in the postpartum period. However, do not forget - who is forewarned is armed. And all sorts of bleeding in the postpartum period are rare. So do not wind yourself up and remember that all this information is given just for reference. The chances that you will fall into the risk group are quite small. We wish you a light birth! We advise you to read: