How to Prevent Postpartum Hemorrhage and Stroke

Most people have healthy pregnancies and births. But a small number of patients develop serious conditions during and after birth that may threaten their health. Two of these conditions are stroke and postpartum hemorrhage (PPH).

Fortunately, there are ways to reduce your risk of having these conditions in some cases. Knowing the warning signs can help you get timely treatment to prevent serious complications.

Emily S. Reiff, MD, a Mass General Brigham obstetrician-gynecologist who practices at Brigham and Women’s Hospital, cares for pregnant and postpartum patients. Dr. Reiff reflects on serious health conditions that can develop during pregnancy and after birth. Learn about risk factors, warning signs, and ways to prevent these conditions.

High blood pressure and preeclampsia in pregnancy can lead to stroke.

High blood pressure (hypertension) occurs when your blood puts too much pressure on your blood vessels. Some people develop high blood pressure for the first time during pregnancy. Others already have high blood pressure before they get pregnant. About 8 in 100 people have high blood pressure during pregnancy.

Very high blood pressure during pregnancy can lead to serious problems. It can be a sign of a condition known as preeclampsia. If you have preeclampsia, your liver and kidneys may not work properly. Without treatment, high blood pressure in pregnancy and preeclampsia can cause seizures, stroke, or maternal mortality. They can also harm your baby.

Heavy bleeding following birth

PPH happens when you bleed more than you should after giving birth. Bleeding can occur because of injury or other problems with your cervix, vagina, uterus (womb) or placenta. Between 1 and 5 in 100 women have PPH.

Most often, PPH happens when your uterus doesn’t contract (get smaller) quickly enough after birth. It may also happen when a piece of your placenta remains in your uterus after birth.

Risk factors for postpartum hemorrhage

“Any patient can develop postpartum hemorrhage,” says Dr. Reiff, “But there are factors that raise the risk.”

These include:

• Being pregnant with more than one baby
• Long labor
• Cesarean birth (C-section)
• Having a bleeding or clotting disorder, or having conditions that affect your placenta or uterus
• Prior birth with postpartum hemorrhage

PPH can cause you to lose a large amount of blood very quickly. Fast treatment can bring about a full recovery. Without treatment, though, PPH can lead to a sudden drop in blood pressure, shock, or even death.

Keeping you safe during birth

To help protect birthing people, doctors at Brigham and Women’s Hospital have created what’s known as an obstetric comorbidity index (OBCMI). This tool helps to assess the risk that each patient has of developing severe complications during birth. If a person receives a high score on the OBCMI, the Brigham and Women’s Hospital care team takes extra steps to protect the patient.

“For example, if a patient is at high risk for postpartum hemorrhage, we have blood ready in case they need a transfusion,” Dr. Reiff says. “And we have medicines immediately available to easily give to them as soon as they are needed.”

As for high blood pressure, many at-risk patients now receive blood pressure devices to use at home. They also get information about what to do if their blood pressure goes up. For example, your provider may ask you to come into the office for a check-up or change the amount of medication you take.

What are the signs and symptoms of postpartum hemorrhage and high blood pressure?

PPH typically happens immediately after birth. But it can also occur days later, after patients leave the hospital. The same is true for high blood pressure. Although it generally improves after birth, patients can be at risk of postpartum high blood pressure for a week or two following birth.

Signs and symptoms of postpartum hemorrhage include:

• Fast heartbeat
• Feeling faint
• Feeling lightheaded
• Pain in your pelvis or vagina
• Very heavy bleeding
  

Signs and symptoms of high blood pressure or preeclampsia include:

• Changes in vision
• Pain in the chest or belly
• Severe headache
• New severe swelling

Patients who have symptoms should call 9-1-1, or go to the closest hospital emergency department. “We’re used to having lots of phone calls, and we would rather hear from you sooner than later,” says Dr. Reiff.

How to reduce your risk of pregnancy complications

You can protect yourself by taking these steps:

• If you have any medical conditions that put you at risk of high blood pressure or bleeding, schedule a checkup with a high-risk obstetrician before you get pregnant (a preconception visit) and between pregnancies.
• Get regular prenatal care checkups during pregnancy. Be sure to keep all your appointments.
• Call your doctor or go to the hospital if you have symptoms.
• Follow your doctor’s advice about self-care caring during pregnancy and taking care of yourself after having your baby.

Not all complications can be prevented, but you can lower your risk. Working together, you and your care team can boost your chances of having a safe birth and a healthy baby.