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Pregnancy is a challenging and life-changing experience for stage in a woman's life but does not come without its string of complications. One common complication that can arise just when a pregnant woman she thinks the stress and fears of pregnancy are behind her is postpartum bleeding after delivering a child. This occurs in 3 percent of pregnancies but even though it is rare, it is still something that must be addressed. 

Blood coming from the vaginal cavity can represent a number of different potential pathologies that can be very dangerous for new-mothers but thankfully, the most common cases are completely expected. During pregnancy, the uterus is highly vascularized to bring sufficient blood to the developing fetus and once the placenta has been delivered, the tissue will not have the same attachment to the uterine wall that had been present for nearly 9 months and blood vessels will rupture. As estrogen and progesterone levels re-balance to levels similar to what the mother had before her pregnancy, these delicate vessels will continue to rupture and the uterine wall will begin to thicken again. These bleeding episodes can last for a few weeks after pregnancy. Another important feature of this would be that there is no pain associated with the bleeding. 

Although this first condition is common, there is another life-threatening condition that a patient noticing bleeding after childbirth must be aware of and goes by the name of uterine atony. This is one of the most common causes of postpartum hemorrhages and is responsible for 79 percent of postpartum hemorrhages. It occurs because the muscles of the uterus do not contract like they are supposed to after the baby has been born. Normally, once the baby leaves the uterine cavity, the relaxed muscle will contract in order to stop blood from flowing. It becomes uterine atony when blood loss is over 500 milliliters. [1]

Patients will present with uterine atony when they have unrelenting bleeding, decreased blood pressure, increased heart rates, severe pain and a "doughy abdomen." This is the idea where the abdominal muscles are very related and when a doctor palpates the abdomen, it feels like he is kneading dough. 

You are at risk for uterine atony when you had a prolonged labor or very rapid descending of the fetus. Those at greatest risk are women over the age of 35 and who have large babies. If you are obese, have multiple births before or are delivering twins or triplets, you are also more likely to have uterine atony. 

Physicians must act fast when uterine atony is suspected because the patient can destabilize quite quickly. The first step to try to alleviate this condition is to try a procedure called a uterine message. The physician will need to insert his arm into the uterine cavity and try to activate the musculature from the inside the uterus in order to tense it up. If this does not rectify the bleeding, the next step is oxytocin. This is a pharmacological way to stop blood from flowing and can help treat patients. 

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