![]() Bright blood is arterial and can indicate deep lacerations of the cervix. For example, dark blood is probably of venous origin, perhaps from varices or superficial lacerations of the birth canal. From birth of the fetus until separation of the placenta, the character and quantity of blood passed can suggest excessive bleeding. Today’s health care environment encourages shortened hospital stays after birth, which increases the potential for acute episodes of PPH to occur outside the traditional hospital or birth center setting.Įxcessive bleeding after birth can be considered with reference to the stages of labor. ![]() Late or secondary PPH occurs more than 24 hours but less than 6 weeks after the birth (Francois and Foley, 2012). Early, acute, or primary PPH occurs within 24 hours of the birth. ![]() Postpartum hemorrhage is classified as early or late with respect to the birth. Diagnosis is often based on subjective observations, with blood loss often being underestimated by as much as 50% ( Cunningham, Leveno, Bloom, et al., 2010). However, defining PPH clinically is not a clear-cut undertaking. Either a 10% change in hematocrit between admission for labor and postpartum or the need for erythrocyte transfusion is used to define PPH (Francois and Foley, 2012). PPH is defined as the loss of 500 mL or more of blood after vaginal birth and 1000 mL or more after cesarean birth. It is preventable in more than half of the cases ( Della Torre, Kilpatrick, Hibbard, et al., 2011). Postpartum hemorrhage occurs in approximately 3% of births (Callaghan, Kuklina, and Berg, 2010). It is a life-threatening event that can occur with little warning and is often unrecognized until the mother has profound symptoms. Postpartum hemorrhage (PPH) is among the leading causes of maternal death in the United States and worldwide.
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