Bleeding in labor and delivery: What you need to know

Bleeding (bleeding) that occurs during labor can be a serious threat to a woman's health and life, and will require immediate medical attention. Bleeding can be divided into three time points: before labor, during labor and after birth.

Due to low placenta (placenta previa): Normally the placenta attaches to the body and fundus of the uterus, but there are also cases where the placenta attaches low to the lower uterine segment, sometimes covering the uterine opening (called placenta previa). ), causing intermittent bleeding in the last months of pregnancy, until labor, the lower uterine segment stretches (due to uterine contractions pushing the fetus down) causing the placenta to slip and fall off, causing severe bleeding, and the mother's death quickly. Due to the uterus: Normally after birth, the uterine muscle contracts, compresses the blood vessels located in the muscle, has the effect of stopping bleeding, called the phenomenon of "physiological hemostasis". Uterine atony is caused by overstretched uterine muscles during pregnancy or labor, symptoms of uterine atony include: bleeding immediately after delivery is the most common symptom, uterus dilatation large, floppy, poorly elastic or not elastic, no safety block, can lead to shock if not treated promptly. Uterine atony usually occurs in the following cases:
Labor is too long (more than 12 hours for the puerperium, or more than 16 hours for the labor). Uterine is too dilated due to twins, triplets, polyhydramnios, too large fetus. The uterus is flabby due to multiple births. Abnormalities due to placental abruption, placental abruption: Left placenta, retained membrane: Bleeding often occurs after placental abruption, the uterus may contract poorly, bleeding profusely, the amount of blood may be less or more, bright red blood mixed with blood clots. A missed placenta can be detected early by examining the placenta and membranes. If detected late, not timely, with a lot of blood loss, there are signs of shock. No placental abruption: The placenta does not abruperate within 30 minutes of delivery or active management of the third stage of labor has not been successful. The placenta adheres tightly and does not bleed. The placenta is partially attached, after 30 minutes of pregnancy, the placenta does not completely shed, bleeding more or less depending on the wide or narrow area of ​​the placenta. Placenta with full comb teeth: rare, no bleeding. Genital tract trauma: tearing of the vulva, vagina, perineum, cervix, uterine rupture, genital hematoma or into the abdomen. This is one of the dangerous obstetric complications that, if not detected in time, can quickly lead to the death of the mother. Often seen in difficult procedures such as forceps when the throne is still high, intrauterine rotation of the fetus, or in women with old surgical scars. Cervical tear, vaginal tear, vulva: During childbirth, uterine contractions push the fetus down, causing the cervix to open, the vagina, vulva and the muscles in the vaginal area also relax so that the fetus can pass through. . If the labor time is too fast, the mother pushes hard, too soon when the cervix is ​​not fully opened or the muscles of the vagina and vulva are not stretched enough, it will cause tearing of these parts. Tear damage can be shallow, deep, cause bleeding or leak a little and last for hours, if not detected, the mother will die. Coagulation disorders: May be primary due to blood diseases but is often secondary to profuse bleeding, loss of fibrinogenesis (disseminated intravascular coagulation). Diffuse intravascular coagulation may be associated with severe preeclampsia, intrauterine fetal death, occult placental abruption, amniotic infection, or amniotic fluid embolism. All of these conditions can lead to fibrinolysis.

Before labor, if there is bleeding, the mother can detect it herself and go to the hospital for examination, but during childbirth or after giving birth because the mother is too tired, falls asleep (physiological sleep after labor) delivery), so it can't be detected on its own, so pregnant women need to be carefully monitored by the medical team during 3 to 6 hours after birth to detect and treat them promptly.

During and after birth, bleeding complications often occur quickly and unexpectedly, so it is difficult to control the disease, so it is better for pregnant women to take the following measures to prevent complications:
Prenatal check-up Regularly follow the instructions and appointment from the doctor to early detect blood diseases as well as other abnormal fetal cases. Attend antenatal treatment at medical facilities for cases of blood diseases, diseases related to blood clotting disorders, old caesarean sections, large fetuses, twins, triplets, polyhydramnios, striker vegetable. During labor, pregnant women need to calm down, trust and listen to instructions from the doctor. Vinmec International General Hospital offers a Package Maternity Care Program for pregnant women right from the first months of pregnancy with a full range of antenatal check-ups, periodical 3D and 4D ultrasounds and other routine tests to ensure that the mother is healthy and the fetus is developing comprehensively. Pregnant women will no longer be alone when entering labor because having a loved one to help them during childbirth always brings peace of mind and happiness.
Pregnant women will be consulted and checked for health under the close supervision of experienced and specialized Obstetricians, helping mothers have more knowledge to protect their health during pregnancy as well as reduce reduce complications for mother and child.