Q: Hello Doctor. I just put to birth, one month plus now and I am having heavy menstrual flow with clots. A scan had been done but no retained products of conception were found; the uterus is clear. Please what should be done?
A: Bleeding after having a baby is normal. When the placenta separates from the wall of the womb, the open blood vessels start to bleed. And so for the first couple of days there is bleeding composed of blood, bacteria and tissue from the area of separation. In the first few days, the discharge is made up of more blood making it bright red in colour which changes to pinkish and eventually yellowish/whitish as the uterus contracts and seals up open blood vessels. This process is supposed to be over within 2 to 4 weeks. Some may extend to about 6 weeks!
Heavy bleeding that occurs within 24 hours of putting to bed is called primary post-partum (after delivery) haemorrhage (bleeding) and any bleeding that occurs between 24 hours and 12 weeks is known as secondary post-partum haemorrhage (PPH).
Bleeding can be caused by any remnant of the product of conception which may be a piece of membrane or part of the placenta or it could be caused by a uterus that has not contracted properly to stop the bleeding. Infections are also a common cause of secondary PPH.
People who are more prone to having PPH include those who are anaemic, obese people (BMI above 35), those who had a history of bleeding in pregnancy due to placenta previa or placenta abruptio, having ha a PPH in a previous pregnancy or having had more than 4 children etc. During labour, women who are older than 40 years or deliver through Cesarian Section, have an episiotomy, have an induction or forceps delivery etc are also likely to experience PPH.
For primary PPH, focus is on ensuring that placenta has been delivered, that there are no remaining membranes left in the uterus and that the uterus has contracted. Different procedures to effect this will be instituted as the doctor deems it.
If the bleeding is due to infection as can happen with secondary PPH, antibiotics will be instituted.
Depending on how heavy the bleeding is, blood transfusion may also be given. In all of this be guided by your doctor and ensure that if this bleeding continues with clots, is still bright red, you start to feel dizzy or get irregular heartbeats, please get to the hospital immediately.
Finally, ensure that you are under the care of an obstetrician.
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All the best.
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