Externally Peer Reviewed by Mosby Definition Postpartum hemorrhage is most often defined as a blood loss greater than 500 ml in the first 24 hours after delivery. However, blood loss after spontaneous vaginal delivery is frequently up to 600 ml and between 1 and 1.5 liters after instrumental or operative delivery. Therefore, clinical experience is necessary to determine when bleeding is occurring too rapidly or at the wrong time or is unresponsive to appropriate treatment. Blood loss will be less well tolerated if the patient has not had the normal expansion of blood volume during pregnancy, as in cases of preeclampsia. Diagnosis Risk factors.
Uterine atony accounts for most cases.
Other causes include retained placenta, cervical or vaginal tear, coagulopathy. Uterus should be palpated for evidence of atony, tenderness, or lack of involution. A hematocrit is helpful only in comparison to the value before delivery. It will not adequately reflect acute blood loss. Management Evaluate promptly once excessive bleeding is detected.