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What can doctors do to prevent obstetric hemorrhage in mothers?

An obstetric hemorrhage is when a woman bleeds heavily during pregnancy, labor, or post-delivery. The bleeding is typically vaginal, but in some very rare cases there can be internal bleeding directly into the abdominal cavity.

Types of obstetrical hemorrhage

There are two types of obstetrical hemorrhage: antepartum hemorrhage and postpartum hemorrhage.

  • Antepartum hemorrhage

An antepartum hemorrhage refers to bleeding in early pregnancy, late pregnancy, and during labor. There are many types of antepartum hemorrhage but the most common includes problems with the placenta or a uterine rupture.

In the case of antepartum hemorrhage it may not be possible to prevent placental problems, however they can be monitored closely in order to keep blood loss to a minimum.

Postpartum hemorrhage

A postpartum hemorrhage, or hemorrhage after delivery, means the mother looses more than 500ml of blood after a vaginal delivery or 1000ml of blood after a cesarean section. It is a leading cause of maternal death worldwide and kills an estimated 150,000 women each year. In the United States the statistics are much lower due to accessible and quality medical care. With the intervention of a physician, obstetric hemorrhage can be treated with surgery and/or a blood transfusion.

A prolonged third stage of labor, which is the period from the completed delivery of the baby until the completed delivery of the placenta, is a risk factor for developing an obstetric hemorrhage. Other risk factors include multiple deliveries, an episiotomy, a history of a postpartum hemorrhage, and shoulder dystocia, which means that a baby’s head is out of the birth canal, but its shoulder gets stuck behind the mother’s pelvic bone.

Reducing risk of herm to mother

There are ways to prevent a postpartum hemorrhage, the most effective being actively managing the third state of labor. Women need to have a skilled physician who can detect slow progress, unsatisfactory progress, and do not have the mother push before the cervix is completely dilated. Additionally, early cord clamping decreases the risk of postpartum hemorrhage as does enhancing natural contractions of the uterus.

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