4 Postpartum Emergencies
Recognize postpartum hemorrhage, infection, hypertensive disorders, blood clots, and other warning signs that require urgent assessment.
Recognizing postpartum emergencies
Postpartum complications can begin in the hours after birth or develop later at home. Hemorrhage, infection, and hypertensive disorders can worsen quickly, so warning signs call for urgent medical assessment rather than waiting for a routine postpartum visit.
means blood loss of at least , or bleeding accompanied by signs of low blood volume, within hours after birth. Heavy bleeding can also happen later, up to weeks postpartum. Blood loss may be underestimated, so clinicians assess bleeding together with vital signs and the person's overall condition.
The organize common causes:
Tone: The uterus does not contract firmly after birth (uterine atony), the most common cause.
Trauma: Tears of the cervix, vagina, or perineum; uterine rupture; or uterine inversion.
Tissue: or placental fragments.
Thrombin: A blood-clotting problem.
For increasing bleeding with a soft, enlarged uterus, uterine atony is likely, but the care team must also check for retained tissue, trauma, and clotting problems.
Responding to severe bleeding
A response begins with activating the obstetric emergency response and assessing airway, breathing, circulation, vital signs, and blood loss. Clinicians rapidly massage a soft uterus, establish IV access, give fluids and uterotonic medicines, and look for trauma or retained tissue.
Further treatment depends on the cause and response. It may include tranexamic acid, blood products, uterine balloon tamponade, or surgery. The coordinated treatment bundle recommended by WHO includes uterine massage, uterotonic treatment, tranexamic acid, IV fluids, examination for the source of bleeding, and escalation of care.
and tissue
A has not been delivered after the baby is born. It can prevent the uterus from contracting and cause severe bleeding. If the placenta remains undelivered, or bleeding begins before it is delivered, urgent assessment and skilled obstetric management are needed.
A trained clinician may remove the placenta manually and provide other treatments; this is not a procedure to attempt outside a clinical setting. Retained placental fragments can cause bleeding or infection days or weeks later.
Infection and
Infection may involve the uterus (), a cesarean or perineal wound, the urinary tract, or the breast. Warning signs include a temperature of at least (), chills, worsening abdominal or pelvic pain, uterine tenderness, foul-smelling vaginal discharge, or a wound that becomes red or painful, or drains pus. can progress to if treatment is delayed.
is a medical emergency. Possible signs include fast breathing or heartbeat, confusion, severe weakness or pain, low blood pressure, reduced urination, or cold, clammy, pale, or mottled skin. Fever may be absent. Suspected requires immediate medical care; clinicians assess for infection and organ dysfunction and start prompt treatment, including antimicrobial therapy when indicated.
can occur even when high blood pressure was not present during pregnancy. It often develops within days after birth but can occur up to six weeks later. Severe headache, vision changes, pain in the upper abdomen or shoulder, shortness of breath, or blood pressure at or above systolic and diastolic requires immediate evaluation.
Blood clots and cardiac warning signs
One-sided leg pain, swelling, warmth, or redness may indicate . Sudden shortness of breath, chest pain, rapid breathing, or coughing blood may indicate a and requires emergency help.
New severe shortness of breath, chest pain, fainting, or difficulty breathing when lying flat also needs urgent assessment because these symptoms can signal serious heart or lung problems.
When to seek emergency care
Call emergency services for severe bleeding, fainting, confusion, trouble breathing, chest pain, seizures, or signs of shock. Seek urgent medical care for bleeding that soaks through one or more pads in an hour, clots larger than an egg, fever, foul-smelling discharge, severe persistent pain, or any rapidly worsening symptom. Tell the care team when the birth occurred.
Serious pregnancy-related complications can occur during the year after delivery, not only during the first six weeks. Severe bleeding, fever with illness, severe headache or vision changes, chest pain, shortness of breath, and fainting should never be ignored.