11.1.1  How much bleeding is ‘excessive’?

You learned how to measure blood pressure and pulse in Session 9 of the Antenatal Care Module; the causes and management of haemorrhagic shock were covered in Sessions 20–22 of that Module.

In normal births, the mother usually loses a small amount of blood (about 150 ml or a cupful) as the baby is born and after delivery of the placenta. When the amount exceeds 300 ml (2 cupfuls) it is considered as heavy bleeding (Figure 11.1). Excessive bleeding is often defined as more than 500 ml of blood loss. However, for severely anaemic women, blood loss of even 200–250 ml can be fatal. For that reason, a better definition of postpartum haemorrhage might be ‘any amount of bleeding that causes deterioration in the woman’s condition and signs of haemorrhagic shock’, i.e. low blood pressure, fast pulse, pallor, weakness or confusion).

Excessive bleeding from the vagina.
Figure 11.1  Heavy bleeding is more than 300 ml; excessive bleeding is more than 500 ml.

11.1  What is postpartum haemorrhage?

11.1.2  Classification of postpartum haemorrhage