From the Guidelines
The most common cause of vaginal bleeding on the third day postpartum is likely subinvolution of the placental bed, as it is a common etiology of secondary postpartum hemorrhage, which can occur between 24 hours and 6 weeks postpartum 1. This condition occurs when the uterus fails to contract down efficiently after delivery, leading to excessive bleeding. Other possible causes of vaginal bleeding at this time include retained products of conception (RPOC) and infection, but subinvolution of the placental bed is a significant concern due to its potential impact on morbidity and mortality. Key factors to consider in the diagnosis and management of postpartum bleeding include:
- The amount and characteristics of the bleeding, such as heavy flow or passage of large clots
- The presence of accompanying symptoms like fever, dizziness, or rapid heart rate
- The patient's overall clinical condition and medical history It is essential to monitor postpartum women closely for signs of complications and to provide prompt intervention if necessary to prevent adverse outcomes and ensure the best possible quality of life. In the context of real-life clinical medicine, it is crucial to prioritize caution and consider the potential for serious conditions like postpartum hemorrhage or infection when evaluating vaginal bleeding on the third day postpartum, as these conditions can have significant implications for morbidity, mortality, and quality of life 1.
From the Research
Causes of Vaginal Bleeding Postpartum
- Uterine atony is identified as the underlying etiology in up to 80% of postpartum hemorrhage cases 2
- The four main causes of postpartum hemorrhage are uterine atony, lacerations, retained placenta, and bleeding diathesis 3
- Endometritis is also a common cause of secondary postpartum hemorrhage, especially after 24 hours of delivery 4
Uterine Atony as a Cause of Postpartum Hemorrhage
- Uterine atony is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases 2
- Risk factors for uterine atony include induced or augmented labor, preeclampsia, chorio-amnionitis, obesity, multiple gestation, polyhydramnios, and prolonged second stage of labor 5
- Uterotonic agents such as oxytocin are used to prevent and treat uterine atony 5, 3, 6
Specifics of Vaginal Bleeding on the 3rd Day Postpartum
- Secondary postpartum hemorrhage can occur after 24 hours of delivery, with endometritis being a leading cause 4
- The incidence of severe secondary postpartum hemorrhage is significant, with 60 cases per 10,000 deliveries 4
- Management of postpartum hemorrhage includes medical treatment, resuscitative measures, and surgical intervention if necessary 4