One of the most serious complications of the puerperium is postpartum hemorrhage, which nowadays has significantly decreased thanks to greater medical care and the fact that women remain hospitalized under medical supervision after delivery.
Postpartum hemorrhage1 occurs within the first few hours after the baby is born, and it is defined as a blood loss greater than 500 ml after vaginal birth or greater than 1,000 ml following a cesarean section, after removal of the placenta. It is generally external and visible, as the blood is expelled through the vagina and is caused by tears in the birth canal or even in the uterus. It is important to point out that this is different from postpartum menstruation, even when there is heavy bleeding.
Insufficient uterine contraction can also cause postpartum hemorrhage, along with blood clotting disorders. Internal hemorrhage can also occur, resulting from the rupture of a blood vessel due to strong pressure and force as the baby’s head passes through.
In such cases, the hemorrhage cannot be seen externally; instead, it is indicated by intense pain at the site, which should be evaluated by a doctor. The pain is severe and does not improve even with painkillers, and confirmation is given by the appearance of a purple bruise in the area.
When blood loss is abundant, the doctor will recommend a blood transfusion to ensure that vital organs such as the brain, heart, kidneys, and lungs are not affected by this significant loss of blood and the resulting lack of oxygen. Normally, postpartum hemorrhage resolves naturally, subsiding on its own, but in addition to a blood transfusion, intravenous fluids are also administered.
There are some more severe cases where the procedures mentioned above do not provide the expected results and surgical repair of the damaged tissue or even removal of the uterus is required, with the latter being the last resort. It is common for a woman who has suffered postpartum hemorrhage to become anemic, and iron supplements and improved nutrition are recommended for a few months until the condition normalizes.
Other Postpartum Complications
Apart from postpartum hemorrhage, there are other complications that pose risks to both the mother and her baby and must be strictly managed, otherwise they may lead to death. Infections take second place among the most serious postpartum complications and, like hemorrhage, have considerably decreased due to the extreme care and strict asepsis practiced during delivery.
The infection can begin in the uterus, urinary tract, or even the lungs. Specialists point out that most infection cases are due to rupture of the amniotic sac and a labor delay of more than 24 hours, which increases the mother’s risk of infection. The clearest sign of a postpartum infection is a high fever, which should prompt an immediate visit to the doctor as soon as it is noticed2. If the infection is not diagnosed and treated promptly, it can spread throughout the woman’s body, causing serious damage and even death.
Another quite common postpartum complication is urinary incontinence. Usually during pregnancy the woman already experiences some incontinence, due to the pressure of the uterus on the bladder, but this discomfort will persist for an average of about two months.
The problem will usually resolve on its own, but may improve more quickly if the woman helps by doing pelvic exercises, which can even be started in the maternity hospital. Strengthening the perineal muscles is recommended to end urinary incontinence, but in some cases, due to injuries that occurred during labor and delivery itself, the woman should see a specialist for evaluation.
Some cases may require surgery for repairs, while in others just a consultation and treatment with a physical therapist is enough to solve the issue. Another major source of discomfort considered a postpartum complication is nipple injuries from breastfeeding, which can lead to mastitis. Constant sucking on the nipples along with the baby’s saliva can cause cracks along the nipples, especially at the tips.
Mastitis usually does not occur in the first week of breastfeeding; it typically happens after the second week and causes intense nipple pain, redness, and excessive warmth in the breasts that can cause fever and chills. Doctors usually recommend stopping direct breastfeeding as soon as mastitis is diagnosed, advising that milk be pumped and fed in a way that does not involve nipple contact, waiting until full healing before returning to normal breastfeeding.
If not treated immediately and appropriately, this can develop into a blocked duct3 or even a chronic problem. Treatment consists of antibiotics, specific anti-inflammatory ointments, and using a suitable bra to relieve pain and provide more support to the breasts. All postpartum complications should be followed up by the gynecologist or obstetrician responsible for your prenatal care. In case of any unusual symptoms, seek your doctor immediately.
See also: Complications in Childbirth – Inevitable Fear
Photo: Philip Beyer, Daniel Lobo
