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After labor it is the contraction of these muscles that physically squeeze the blood vessels so that hemostasis can occur after the delivery of the fetus and the placenta. [1] Local hemostatic factors like tissue factor type-1 plasminogen activator inhibitor and platelets and clotting factors aid in stopping the blood flow.
Performing a uterine massage Side view of a uterine massage with underlying anatomy. Uterine massage is a simple first line treatment as it helps the uterus to contract to reduce bleeding. [18] Although the evidence around the effectiveness of uterine massage is inconclusive, it is common practice after the delivery of the placenta. [18]
Uterine contractions are a vital part of natural childbirth, [6] which occur during the process of labour and delivery, (typically this excludes caesarean section). These labour contractions are characterized by their rhythmic tightening and relaxation of the myometrium , the most prominent uterine muscle.
After birth, the fundus contracts downward into the pelvis one centimeter each day. After two weeks the uterus will have contracted and return into the pelvis. [9] The sensation and strength of postpartum uterine contractions can be stronger in women who have previously delivered a child or children. [10]
After delivery, the myometrium contracts to expel the placenta, and crisscrossing fibres of middle layer compress the blood vessels to minimize blood loss. A positive benefit to early breastfeeding is a stimulation of this reflex to reduce further blood loss and facilitate a swift return to prepregnancy uterine and abdominal muscle tone.
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
Postpartum hemorrhage, also known as PPH, is defined as a loss of 500 mL or greater of blood within 24 hours after giving birth. It is one of the leading causes of maternal mortality in women and adolescent girls worldwide, with mothers from low-resource countries being at a larger risk when compared to mothers of higher-resource countries.
Some women feel uterine contractions, called afterpains, during the first few days after delivery. They have been described as similar to menstrual cramps and are more common during breastfeeding, due to the release of oxytocin. The cramping is the compressing of the blood vessels in the uterus to prevent bleeding. [25]