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Excessive Uterine Bleeding at Delivery

(Postpartum Hemorrhage)


The Manual's Editorial Staff

Reviewed/Revised Sep 2023
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What is excessive uterine bleeding?

Some bleeding after you deliver a baby is normal. More than 4 cups (more than 1000 mL) of blood loss after vaginal delivery is excessive uterine bleeding.

  • The most common reason for too much bleeding is your uterus stays stretched out and isn't contracting (squeezing) like it's supposed to

  • Doctors treat too much bleeding by massaging your belly and giving you medicines to help your uterus contract

  • Doctors may give you a blood transfusion

  • Rarely, you'll need surgery

What causes too much bleeding during delivery?

Most often, you have too much bleeding because:

  • Your uterus doesn't contract after delivery like it's supposed to

Other reasons for too much bleeding include:

  • Your vagina or cervix (the lower part of your uterus) was torn during delivery

  • A bleeding disorder that stops your blood from clotting

  • Part of your placenta (the afterbirth) stayed inside your uterus after delivery

You have a higher risk for bleeding if you:

  • Have had a lot of babies

  • Were in labor for a long time

  • Deliver more than one baby (such as twins or triplets)

  • Deliver a very large baby

What can doctors do to stop me from bleeding too much?

Before you go into labor, doctors take steps to prevent or to prepare for bleeding after delivery.

  • They check you for risks of bleeding, such as having too much amniotic fluid or a bleeding disorder

  • If you have an unusual blood type, doctors make sure that your blood type is available

  • They try to deliver your baby as slowly and gently as possible

  • After delivery, doctors watch you for at least 1 hour—they make sure your uterus has contracted and check for bleeding

How will doctors know if I am bleeding too much?

Doctors will:

  • Watch for too much blood loss

  • Press on your belly area to see if your uterus is firm like it should be

  • Watch your blood pressure and how fast your heart beats—a drop in blood pressure or a rapid heart rate may mean you're losing too much blood

What happens if I start bleeding too much?

Doctors will:

  • Firmly press on and massage your belly to help your uterus contract

  • Check for tears in your vagina and cervix

  • Give you medicines to make your uterus contract

  • Give you fluids or blood through your vein to replace lost blood

Pressing on your belly helps the uterus contract and shut off bleeding. There are several different medicines doctors may give in your IV or as a shot in your arm.

If bleeding continues, doctors may do surgery including:

  • Scraping the inside of your uterus to remove any leftover pieces of the placenta (afterbirth)

  • Putting a balloon inside your uterus to cut off blood flow

  • Packing the inside of your uterus with gauze

  • Putting in stitches around the bottom of your uterus

  • Blocking major veins that bring blood to your uterus

  • As a last resort, a hysterectomy (removing your uterus)

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