A C-section, or cesarean section, is a common surgical procedure for childbirth. Like any major surgery, it carries potential complications. One concern is a C-section hemorrhage, which involves excessive blood loss. Medical professionals are prepared to manage this complication.
Defining C-Section Hemorrhage
A C-section hemorrhage refers to significant blood loss during or after a cesarean delivery. It is a specific type of postpartum hemorrhage (PPH), defined as excessive bleeding following childbirth. For a C-section, blood loss exceeding 1,000 milliliters (approximately 1 quart) is considered a hemorrhage.
Beyond a specific volume, signs of hypovolemia, such as changes in vital signs, can also indicate a hemorrhage. Postpartum hemorrhage is categorized into two main types: primary and secondary. Primary (or early) PPH occurs within the first 24 hours after delivery. Secondary (or late) PPH can occur from 24 hours up to 12 weeks postpartum.
Factors Increasing Risk
Several factors can increase a person’s susceptibility to a C-section hemorrhage. Medical conditions, such as pre-existing bleeding disorders, can impair the body’s natural clotting abilities. Placenta previa, where the placenta covers or is near the cervical opening, and placental abruption, the early detachment of the placenta from the uterus, both elevate the risk of significant bleeding. Uterine atony, where the uterus fails to contract adequately after delivery, is the most common cause of postpartum hemorrhage, accounting for about 80% of cases.
Surgical complications during the C-section itself can also contribute to hemorrhage. Issues with the uterine incision, such as extensions or lacerations, can lead to increased blood loss. Retained placental tissue, where small pieces of the placenta remain attached to the uterine wall after delivery, prevents the uterus from contracting effectively and can cause continued bleeding.
Other circumstances can heighten the risk. Multiple pregnancies, such as twins or triplets, can overdistend the uterus, making it less effective at contracting. A prolonged labor or the delivery of a large baby (fetal macrosomia) can also fatigue the uterine muscles, contributing to uterine atony. A history of previous C-sections increases the risk of abnormal placentation, like placenta accreta, where the placenta is abnormally attached to the uterine wall, making its removal difficult and prone to severe hemorrhage.
Recognizing and Responding to Hemorrhage
Recognizing the signs and symptoms of a C-section hemorrhage is important for prompt medical attention. Visible signs include heavy vaginal bleeding that is more profuse than typical postpartum bleeding, often soaking sanitary pads quickly, or passing abnormally large blood clots, sometimes described as larger than a golf ball. While some bleeding is normal after a C-section, an increase in quantity or the presence of very large clots warrants immediate evaluation.
Systemic signs, which indicate the body’s response to blood loss, include dizziness, lightheadedness, or feeling faint. A rapid heart rate, low blood pressure, and pale or clammy skin are also indicators of hypovolemic shock. Shortness of breath, difficulty breathing, or unexplained abdominal bloating or bruising can also be present. Healthcare providers diagnose hemorrhage by closely monitoring blood loss, assessing vital signs, and conducting blood tests, such as checking hematocrit levels.
Medical Interventions and Recovery
Medical interventions for C-section hemorrhage begin with immediate steps to control bleeding. Uterine massage is often performed to encourage the uterus to contract and compress bleeding vessels. Simultaneously, uterotonic medications, such as oxytocin, are administered intravenously to stimulate uterine contractions and reduce blood loss.
If initial measures are insufficient, more advanced interventions may be necessary. Blood transfusions are given to replenish lost blood volume and red blood cells. In some cases, uterine artery embolization, a procedure to block blood flow to the uterus, can be performed to stop the bleeding. Surgical repair of any identified lacerations or tears in the uterus or surrounding tissues is also undertaken. In severe situations where other methods fail to control bleeding, a hysterectomy, the surgical removal of the uterus, may be required.
The immediate recovery period involves close monitoring of vital signs, continued assessment of bleeding, and providing adequate rest and pain management. Emotional support is also offered.
Preventive Strategies
Healthcare providers implement several measures to minimize the risk of C-section hemorrhage. A thorough pre-operative assessment helps identify individuals with increased risk factors, allowing for proactive planning. During the C-section, active management of the third stage of labor is standard practice. This involves administering prophylactic uterotonic medications, such as oxytocin, immediately after the baby’s delivery to promote strong uterine contractions.
Controlled cord traction, a gentle pull on the umbilical cord, can also assist in the complete and timely delivery of the placenta, reducing the chance of retained placental fragments. Meticulous surgical technique during the C-section is employed to minimize trauma to surrounding tissues and ensure proper closure of blood vessels. Close monitoring of blood loss throughout the procedure and in the immediate postpartum period allows for early detection and prompt intervention if excessive bleeding occurs.