Patient's question:
The patient is 29 years old, post Cesarean section, with severe bleeding. The doctor diagnosed poor uterine contraction. After treatment, vaginal bleeding has stopped for 3-4 days. Now there is a small amount of bleeding again, and it is unclear whether it is menstruation or uterine bleeding.Doctor's answer:
Postpartum uterine atony. It is the main cause of postpartum hemorrhage. Due to uterine atony, after the placenta is delivered, the blood sinuses of the uterine wall at the placental attachment site cannot close, leading to excessive vaginal bleeding. It is common in cases where the mother is overly anxious or fatigued during labor, the use of large amounts of sedatives or anesthesia during labor, prolonged labor, or maternal exhaustion. Of course, factors such as a large fetus, polyhydramnios, or twin pregnancy that cause excessive uterine expansion and extreme stretching of uterine muscle fibers can also affect uterine contractions, leading to postpartum hemorrhage. Additionally, uterine fibroids during pregnancy can also commonly cause uterine atony. Pregnant women who have given birth multiple times have a higher chance of poor postpartum uterine contractions due to uterine muscle fibrosis.In most cases, uterine atony is evident during labor, causing slow progress. After the fetus is delivered and the placenta is detached, poor uterine contraction leads to significant postpartum hemorrhage. When the bleeding is excessive, the mother may experience palpitations, cold sweats, dizziness, weak pulse, and hypotension. During abdominal examination, the uterine outline may appear unclear, and the uterus may feel soft. Once uterine atony is suspected, the principle is to rapidly strengthen uterine contractions to stop bleeding, while simultaneously administering blood transfusions to the mother, correcting shock, and using antibiotics to control infection. For cases where vaginal bleeding remains excessive after general methods to promote uterine contractions, laparoscopic ligation of the uterine or internal iliac arteries may be considered.