Bleeding After Delivery, Post-Partum Hemorrhage

Categories: Obstetrics or Midwifery

Bleeding from the womb
occurring six hours after delivery is called post partum and after that

time, is known as puerperal child-birth bleeding or hemorrhage.



Causes. A relaxed condition of the womb, the retention of clots or parts

of the membranes, etc., in the womb, a full rectum or bladder, fibroid

tumors, deep tears of the cervix.



Symptoms. If the bleeding is profuse, the pulse is fast, the wom n looks

pale, anxious and feels cold, restless, gaping, usually it comes from a

relaxed, softened and enlarged womb.






Treatment. In severe forms no time must be lost in securing contraction

of the womb and the method employed for expelling the after-birth should

be employed to expel clots. Grasp the womb over the abdomen, employ firm

but gentle kneading, pressing downward. The pillows should be removed, the

foot of the bed elevated twelve to eighteen inches, a preparation of ergot

given by the mouth or hypodermically in the thigh. If these measures fail

the hand and arm should be sterilized and inserted in the womb, all clots,

etc., removed and pressure made over the abdomen on the womb while the

hand is still there. This pressure and presence of the hand close the

bleeding vessels in the womb. The hand should remain, while the kneading

goes on externally, on the womb.



This kneading should be kept up until the womb contracts. The hand can

then be removed from the vagina, while gentle kneading is slowly kept up

over the womb. The womb should be closely watched for hours after.

Bleeding very seldom occurs again, but it might. If the bleeding is more

of an oozing, an injection of very hot water, 120 degrees F., through a

long douche nozzle, directly into the womb cavity may be given. This is

very effective for any kind of bleeding. Lemon juice or boiled vinegar can

be added to the injection. Everything used must be perfectly clean or

child-bed fever may be caused by these measures. After the womb has

thoroughly contracted, it is sometimes of benefit to place a rubber bag

filled with cold water over the pubic bone to prevent subsequent

relaxations of the womb. Weakness can be met by hypodermics of whisky or

brandy and strychnine, one-thirtieth of grain, injected hypodermically to

stimulate the heart.