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Gynacology and Health

Bleeding Uterus, Childbirth

The Lethal Nature of Postpartum Hemorrhage

By Dr. W. Gifford Jones

August 22, 2001

I'll never forget a scene that happened years ago. I was a young doctor studying to be a surgeon at a university hospital. One evening utter pandemonium erupted in the obstetrical area. Professors of obstetrics and hematology rushed to the bedside of a young woman following the delivery of her baby.

She had experienced normal labour with no reason to suspect trouble was looming. But something suddenly went wrong. Following delivery, bleeding from the uterus would not stop, and despite the combined experience of renowned professors and the superior facilities of this university hospital, she died a few hours later. Today some women still succumb to this tragedy.

Postpartum hemorrhage (PPH) occurs to a lesser degree in two percent of women immediately following birth, or several hours later. It can happen with either a vaginal delivery or cesarean birth.

There's no single cause of PPH, but uterine paralysis is the major one. Following delivery of the baby and placenta the normal uterus begins to constrict. This natural squeezing of uterine muscles clamps down on uterine arteries and within a short time bleeding stops.

But sometimes this normal course of events does not happen. The uterine muscles remain relaxed and bleeding continues. And few things in medical practice are more frightening.

Uterine paralysis can be caused by a large pregnancy, twin births and large amounts of amniotic fluid which cause over distension of the uterus. Or it can be triggered by prolonged difficult deliveries, hypertension, medications to induce labour and infection.

The usual case of PPH is easy to treat. A massage of the uterus along with drugs that stimulate it to contract quickly remove uterine paralysis.

In some instances a flaccid uterus is due to a totally retained placenta (after birth) or a portion of it that remains in the uterus. Bleeding can be stopped by removing the after birth.

Sudden life-threatening postpartum bleeding can also be the result of difficult labour or major tears of the uterus or vaginal wall. That's one reason why it's hazardous to agree to home-deliveries where extensive tears cannot be quickly repaired.

But red lights begin to flash and bells start to ring when there's no obvious cause for the hemorrhage. No tears to repair. All that's present is a totally paralyzed uterus that won't contract and won't stop bleeding.

In the past faced, with this desperate situation, surgeons have attempted to stem the bleeding by tying off the major artery supplying blood to the uterus or as a final last resort, hysterectomy. But even these desperate attempts can fail.

In one case a 31 year old woman delivered triplets, but shortly showed signs of shock from blood loss. Every measure to stop the bleeding failed. Finally, a hysterectomy was done, but the bleeding still continued.

During the next nine days the patient had eight other surgeries in an endeavour to control bleeding. She was repeatedly transfused and given other drugs in an effort to stimulate the blood to clot. But all to no avail. She died on the 9th day. A grief-stricken husband left the hospital without his wife and had three babies to care for. This is a tragedy beyond description when pregnancy is supposed to have a happy ending.

Such scenes of frantic desperation in the obstetrical ward will hopefully soon be a thing of the past. Doctors now know that no amount of surgery will solve this problem. Rather, they know that the normal coagulation system that causes a blood clot to form has gone on the rampage. And like a cancerous growth, once started it's hard to stem.

For years this same problem has plagued people who inherit hemophilia. The slightest injury, which would cause a mild bruise to others, triggers hemorrhagic bleeding that can result in death.

These patients are now treated with a blood clotting factor called Niastase. Clinical trials are being conducted to determine its effectiveness in controlling bleeding both in those with hemophilia and in women who suffer from postpartum hemorrhage. One hopes that husbands need no longer arrive home as new fathers without a wife.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod