The role of general anesthesia in the treatment of postpartum haemorrhage

The article was professionally consulted by Specialist Doctor I Nguyen Xuan Tinh - Anesthesiologist - Resuscitation - Department of General Surgery - Vinmec Phu Quoc International General Hospital. The doctor has more than 18 years of experience studying and working in the field of Anesthesia - Resuscitation.

When postpartum hemorrhage occurs, the anesthetic resuscitation for the mother is a necessary condition in the treatment of this obstetric complication. Anesthesia and resuscitation always go together and are an important link to contribute to the success of supporting the treatment of postpartum haemorrhage.

Postpartum haemorrhage is bleeding over 500ml for vaginal delivery and more than 1000ml for cesarean section in pregnant women. This blood loss can be massive, sudden, or progressive. Postpartum haemorrhage is divided into 2 types as follows:
Primary haemorrhage: This is bleeding that occurs early, within the first 24 hours after a woman gives birth. Secondary bleeding: Secondary bleeding usually occurs 24 hours to 12 weeks after a woman gives birth or, in some cases, more time. This postpartum hemorrhage is a matter of concern. Normally, after the delivery of the placenta, the contractions of the mother's uterus begin to take place and the body's normal blood clotting mechanism will help form a blood clot in the blood vessel, from which the bleeding will stop. again. However, the abnormality causes the mother's uterus to not retract or the placenta to not come out, leading to postpartum haemorrhage. Some causes of postpartum hemorrhage in pregnant women are:
Uterine atony: This is the most common cause of postpartum haemorrhage in women. Uterine atony occurs when the uterus cannot contract after delivery and the uterine muscles do not contract strongly, so blood flows freely leading to bleeding. Factors that cause uterine muscle to not contract after birth can be labor that is too long or too fast; the uterus is overstretched; in some cases, it may be due to the use of drugs or the pregnant woman has amniotic fluid infection, anemia, weakness, blood clotting disorder and pregnancy over 35 years old; Abnormalities of the placenta: Placenta low, placenta previa or placenta previa often lead to heavy bleeding after birth; Injury to the genital tract: A ruptured or torn vagina or uterus can cause postpartum bleeding, including vaginal delivery. The cause of uterine rupture, vaginal tear is often due to difficulty in childbirth, so it requires surgical intervention.

When postpartum hemorrhage occurs, the anesthetic resuscitation for the mother is a prerequisite in the treatment of this obstetric complication. Anesthesia is a supportive method for painless pregnant women with varying degrees of awakening. At the same time, anesthesia also maintains stable vital functions for pregnant women with postpartum haemorrhage during surgery and procedures, ensuring safety for pregnant women. The main method of resuscitation is the diagnostic and treatment measures for pregnant women with bleeding before, during and after surgery as well as some procedures to maintain, stabilize and improve vital functions. At the same time, resuscitation also helps doctors to correct disorders of vital functions thanks to means of monitoring, cardiovascular support, respiratory support, and the use of resuscitative drugs.
Therefore, for women with postpartum hemorrhage who have chronic diseases such as high blood pressure, cardiovascular disease, diabetes, ..., anesthesia plays an extremely important role in the treatment. Treatment of postpartum haemorrhage.
Therefore, resuscitation anesthesia always goes together and is an important link to contribute to the success of supporting the treatment of postpartum haemorrhage.

The most typical symptom of postpartum hemorrhage is heavy bleeding after delivery and placental abruption. In addition, excessive blood loss can cause dizziness, low blood pressure, sweating, cold hands and feet... Therefore, based on the specific causes leading to bleeding, there will be more Symptoms vary widely as well as different treatments. Specifically:
Treatment of postpartum haemorrhage due to uterine atony: Using uterine massage and inotropic drugs to stimulate uterine contractions. uterotonics including methylergonovine, oxytocin, and prostaglandins; Carrying out the transfusion of blood, fluids and blood products; In the case of women with severe postpartum hemorrhage, the main treatment is surgery to clamp the uterine blood vessels causing bleeding. Uterine artery occlusion by inserting small pieces into the uterine artery to block blood flow to the uterus. In case the above methods do not work, a hysterectomy should be indicated for the pregnant woman. Treatment of postpartum haemorrhage due to placental anomalies In the case of postpartum haemorrhage due to retained placenta and membranes, intravenous fluids should be given immediately to the mother. Take pain medication and proceed to control the uterus. Then, administer systemic antibiotics and monitor bleeding, pulse, blood pressure, and uterine contractions. Blood transfusion resuscitation in case of acute anemia in pregnant women. In the case of postpartum haemorrhage due to non-shedding placenta, it is necessary to remove the placenta while controlling the uterus, massaging the uterine fundus for the mother, resuscitation against shock, and using antibiotics to fight infection. In case of postpartum haemorrhage and the woman has partial or complete placenta previa, hysterectomy is indicated. In case of heavy bleeding, resuscitation against shock, blood transfusion and surgery for pregnant women. Then maintain uterine contractions. Treatment of postpartum haemorrhage due to genital trauma: In addition to general management, the general principle of the treatment of postpartum haemorrhage due to genital trauma is to break the hematoma, stop bleeding, and avoid recurrence. In case of hematoma, depending on the location and size as well as the progression of the hematoma to have an appropriate treatment method. Treatment of postpartum haemorrhage due to coagulation disorders: The treatment of postpartum haemorrhage due to coagulation disorders is mainly medical treatment with fresh blood, treatment of the cause and coagulation factors.

To prevent obstetric complications of postpartum hemorrhage, pregnant women should implement the following main methods:
Fully implement the schedule of regular antenatal check-ups as well as necessary examinations, ultrasounds and tests to screen. abnormalities in pregnancy and fetal malformations, if any; Supplement full of nutrients, iron, folic acid as directed by the doctor to prevent anemia; Have a reasonable and moderate diet, rest, and labor regime; If you notice unusual signs such as abdominal pain, vaginal bleeding and water, headache, dizziness, weakness in pregnancy, etc., you should immediately go to a medical facility for timely examination and treatment. Besides, in addition to regular antenatal monitoring and examination, to prevent postpartum haemorrhage as well as pregnancy complications, pregnant women should choose a reputable medical facility with modern equipment and procedures. safe maternity care... to monitor pregnancy and childbirth.
After 9 months and 10 days of heavy weight, pregnant women go into labor and face a level of labor pain comparable to 20 broken ribs at the same time. In order for the birth to go smoothly and safely, pregnant women need to understand:
How the labor process takes place, how long does it usually take to have a normal delivery or caesarean section, to protect the best health for the unborn baby. Methods to relieve pain during childbirth, limit pain and relieve psychological pressure during labor. The way to push and breathe during childbirth is usually the right way so that the labor takes place quickly, the pregnant woman does not lose strength during childbirth. How to control postpartum uterine contractions in the shortest time. How to take care of the perineal suture does not cause infection and dangerous complications. Early postpartum re-examination to detect dangerous abnormalities such as residual placenta, missing gauze. Take care of newborn until full month healthy. To ease the pain of childbirth, Vinmec offers a full Maternity program with a complete "painless delivery" service during and after birth using non-morphine epidural and sedation techniques. ashamed. During the birth process, the mother will be guided by the midwives on how to push and breathe properly, the baby will be born in just 10-15 minutes. After birth, the baby will be cared for in a sterile room before being returned to the mother.
Pregnant women will rest in a high-class hospital room, designed according to international hotel standards, 1 mother 1 room with full facilities and modern equipment. Mothers will be consulted by nutritionists on how to feed the baby before being discharged from the hospital. Postpartum follow-up with both mother and baby with leading Obstetricians and Pediatricians.