A C-section, also known as a cesarean section, is a surgical procedure used to deliver a baby through incisions made in the abdomen and uterus. It is a common concern for pregnant women undergoing a C-section whether it is possible to bleed excessively or hemorrhage during the procedure, which could potentially lead to death. Though rare, bleeding complications can occur during C-sections. However, with proper precautions and medical care, fatal hemorrhaging is highly preventable.
What causes bleeding during C-section?
Some potential causes of bleeding during a C-section include:
- Placenta accreta – When the placenta attaches too deeply into the uterine wall.
- Placenta previa – When the placenta covers the cervix.
- Uterine atony – Failure of the uterus to contract after delivery.
- Surgical complications – Laceration of blood vessels or uterus during surgery.
- Coagulation disorders – Problems with blood clotting.
Placenta accreta and previa are common causes of hemorrhage during C-sections. They can lead to excessive placental separation bleeding after delivery.
Uterine atony occurs when the uterine muscles fail to contract after the baby is delivered. This can lead to heavy bleeding. Surgical complications like uterine laceration or damage to blood vessels can also result in hemorrhage.
Underlying coagulation disorders in the mother, like von Willebrand disease, hemophilia or thrombocytopenia, increase the risk of excessive bleeding during delivery.
How much blood loss is considered excessive?
While an average C-section results in a blood loss of around 1000 ml, any blood loss exceeding 1500 ml is considered excessive. Blood loss of 2000 ml or more is categorized as postpartum hemorrhage (PPH). According to American College of Obstetricians and Gynecologists, PPH occurs in about 3-5% of deliveries.
Can you die from hemorrhage during C-section?
Maternal death from hemorrhage during C-sections is very rare in developed countries. The rate has reduced dramatically from 1 in 100 C-sections in the early 1900s to less than 1 in 10,000 currently. However, hemorrhage still accounts for over 10% of maternal deaths worldwide. Excessive blood loss leads to shock and organ failure if untreated. So prompt medical intervention is vital.
With adequate surgical expertise, blood transfusion and ICU care, the chances of dying from C-section hemorrhage are extremely low in healthcare facilities of developed nations. However, it can still prove fatal in less equipped facilities or due to delays in receiving proper emergency care.
Risk factors for excessive bleeding
Certain factors predispose women to higher risks of bleeding complications during C-sections:
- Placenta previa or accreta
- Previous C-section deliveries
- Multiple pregnancies (twins/triplets)
- Abnormal placental implantation
- Pre-eclampsia
- Prolonged labor
- Obesity
- Advanced maternal age
- Clotting disorders
- Anemia
- Uterine fibroids
Identifying risk factors ahead of time allows doctors to take added precautions and be prepared for excessive bleeding in high-risk patients.
Preventing fatal hemorrhage during C-section
Several techniques and precautions can help reduce severe blood loss during a cesarean delivery:
- Careful surgical technique – Meticulous hemostasis and avoiding uterine/tissue trauma.
- Availability of blood products – For rapid transfusion if needed.
- Medications – Oxytocin infusion and prostaglandins promote uterine contraction.
- Uterine compression sutures – Stitches tighten the uterus to reduce bleeding.
- Cell salvage – Collecting and re-transfusing the mother’s lost blood.
- Interventional radiology – Blocking bleeding vessels through arterial embolization.
- Hysterectomy – Removing the uterus as a life-saving last resort.
Skilled obstetricians, anesthesia personnel, availability of blood bank and prompt interventions are key to managing severe hemorrhage during C-sections.
Emergency treatment for severe hemorrhage
If excessive bleeding occurs during the surgery, urgent treatment measures include:
- Fluid resuscitation and blood transfusion
- Medications to improve clotting
- Surgical techniques like compression sutures, uterine artery ligation
- Transfer to ICU for close monitoring
- Interventional radiology procedures if needed
- Removal of uterus (hysterectomy) in life-threatening cases
With active hemorrhage treatment protocols in place, most cases of severe bleeding can be successfully managed.
Can you get a hysterectomy during C-section?
Emergency hysterectomy, or removal of the uterus, may be performed during a C-section in cases of life-threatening hemorrhage that cannot be controlled by other measures. It is, fortunately, a very rare complication.
An emergency peripartum hysterectomy is done when:
- Bleeding cannot be stopped despite medications, surgical interventions, arterial embolization etc.
- Bleeding is so severe that the patient develops coagulopathy (clotting problems)
- Placenta is found to be deeply ingrown into the uterine wall (placenta percreta)
The surgery involves clamping and tying off the uterine arteries, cutting and removing the uterus before closing up the hysterotomy (uterine incision).
Recovery after hemorrhage
Recovering from significant blood loss during delivery takes time. Effects can include:
- Fatigue and exhaustion
- Dizziness
- Irregular heartbeats
- Shortness of breath
- Headaches
- Depression
A healthy diet, iron supplements, plenty of rest and help with baby care will aid the mother’s return to full strength. Most mothers make a full recovery within 1-2 months. But some may experience fatigue for longer periods.
Long term impacts
For mothers who needed hysterectomy, coming to terms with infertility can be difficult emotionally. But with counseling and family support, many women adjust well.
Some studies show a slight increase in the risk of heart disease later in life in women who had severe postpartum hemorrhage. But the overall risk is still low. Other long term health impacts are rare.
Conclusion
While postpartum hemorrhage during C-sections can be life-threatening if untreated, occurrences of fatal bleeding are extremely rare in developed countries. With adequate precautions and prompt medical care, most cases can be managed successfully. Though the recovery period maybe prolonged, mothers can get back to full health with proper care and support.