In postpartum haemorrhage, there are two main types of bleeding:
1. “Primary” bleeding occurs within the first 24 hours of delivery and usually occurs as a direct result of uterine atony (loss of tone in the uterine musculature) and this leads to an inability of the uterine muscles to contract and compress blood vessels.
2. “Secondary” bleeding occurs after 24 hours and is generally due to retained placenta or tissue from the placenta and the secondary infection that this causes.
Treatment of both types of postpartum haemorrhage includes:
1. Assessment of ABCs
2. Inspect the vagina and perineum – if the bleeding is clearly from the perineum and not from within the vagina, use a trauma pad and apply direct pressure to the perineum.
3. Massage the uterus to stimulate contraction (it should be noted that this is often quite painful and the patient may require pain relief). Uterine massage will usually have to be maintained until you arrive at hospital. To massage the uterus, basically press straight down where approximately at the point of the belly button. If you can feel something that is firm and tight (like a small fist in the abdomen) then the uterine wall is already contracting and this is not necessary; however, if it is soft, uterine massage may help.
4. Let the mother breast feed if she or the baby is up for it. This will not hurt the mother, and if anything, it will stimulate the release of more oxytocin this will lead to greater uterine contractions.
5. Treat hypovolaemia if required.