What Can Doctors do to Prevent Obstetric Hemorrhage in Mothers?

woman on hospital bedObstetric hemorrhages are very serious medical conditions that can pose a threat of imminent harm to a mother or baby. Characterized by heavy bleeding during pregnancy, labor, or shortly after delivery, obstetric hemorrhage can lead to death without proper or timely treatment. The bleeding of an obstetric hemorrhage is typically vaginal, but it can be internal, in the abdominal cavity itself.

Classifications of Obstetrical Hemorrhage

Two main types of obstetrical hemorrhage occur in pregnancy and delivery:

  • An antepartum hemorrhage is one that occurs during early pregnancy, late pregnancy, or labor. Most commonly, these arise from the rupture of the uterus or placenta. These are life-threatening emergencies for both mother and baby. While providers cannot prevent them, they can monitor both baby and mother closely and diagnose potential abnormalities that could increase the likelihood of them occurring.
  • Postpartum hemorrhages are those that happen after the delivery of a baby. A provider classifies them as more than 500 mL of blood loss after a vaginal delivery or 1000 mL after a C-section. Postpartum hemorrhages are one of the leading causes of maternal death worldwide. Timely recognition of the condition is essential to help save the life of the mother. While a physician cannot always prevent a postpartum hemorrhage, a timely intervention like a blood transfusion or surgery can help save a mother's life.
Risk Factors for Obstetrical Hemorrhage

Identifying the risk factors for an antepartum or postpartum obstetrical hemorrhage can help health care providers better assess the mother and baby and reduce the incidence of maternal or fetal death. Some of the most common risk factors for hemorrhage during or after pregnancy include:

  • Placenta previa
  • Placental abruption
  • An overdistended uterus, which may occur from a large birth weight baby or excess amniotic fluid (polyhydramnios)
  • The presence of certain maternal infections
  • Obesity or gestational diabetes
  • Prolonged labor
  • Use of medications to induce labor
  • Use of forceps during delivery
  • Anatomical abnormalities of the cervix
  • Blood clotting disorders
  • Previous uterine surgery
  • Multiple deliveries
  • Previous postpartum hemorrhage

Providers can pinpoint many of these risk factors during routine obstetric care. It’s important for women with identifiable risk factors to receive careful monitoring and patient counseling, when appropriate.

How can Health Care Providers Reduce Risk of Harm to a Mother?

In many cases, the act of postpartum or antepartum hemorrhage is not in itself preventable. However, providers play an important role in reducing the risk of their occurrence. Proactively managing conditions that could lead to poor health outcomes, for example, is essential.

Postpartum hemorrhage can occur due to the poor management of the third state of the labor process, or delivery. A physician must intervene in instances such as lack of timely progression or pushing before the cervix is fully dilated. Other conservative measures, such as early cord clamping and enhancing contractions, may be appropriate for people with risk factors for obstetric hemorrhage.

What are my Options After an Obstetrical Hemorrhage?

A mother who experiences an antepartum or postpartum hemorrhage may experience harms such as loss of her baby or the need for intensive medical procedures. When hemorrhage occurs as the result of physician negligence, a family may be able to file a claim for tangible and intangible losses. Damages may be economic in nature, such as payment of medical bills or compensation for missed work.

Families may also be able to collect damages for intangible losses, such as pain, suffering, and emotional anguish. An obstetrical hemorrhage is a serious medical condition that can lead to imminent harm to mother and baby, and providers must follow a standard of care for diagnosis and treatment. Failure to do so may constitute negligence.

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