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Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta or placental abnormalities, and coagulopathy, commonly referred to as the "four Ts": [12] Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony.
Retroplacental hematomas are entirely behind the placenta and not touching the gestational sac. Subamniotic or preplacental hematomas are contained within amnion and chorion. Rare. Most patients with a small subchorionic hematoma are asymptomatic. [5] Symptoms include vaginal bleeding, abdominal pain, premature labor and threatened miscarriage. [6]
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
Retroperitoneal bleeding is an accumulation of blood in the retroperitoneal space. Signs and symptoms may include abdominal or upper leg pain , hematuria , and shock . It can be caused by major trauma or by non-traumatic mechanisms.
Choriocarcinoma is a malignant, trophoblastic [1] cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also classified as a germ cell tumor and may arise in the testis or ovary.
They may include uterine bleeding not related to menstruation, pain or pressure in pelvis, large uterus and high blood pressure during pregnancy. The cause of this disease is unknown but the identification of the tumor based on total beta-human chorionic gonadotropin ( β-hCG ) in the serum.
Prognosis is variable based on underlying cause. Usually the lesions should resolve within three to six weeks post-delivery. [3] There has been a documented case of the rash completely resolving following a blood transfusion to treat severe anemia in a neonate. [7] The rash is usually transient and will resolve once the underlying cause is treated.
Other types of cancer include cervical cancer; bleeding in that case can sometimes be triggered by postcoital bleeding. Cancers of the vagina or fallopian tubes are rare causes of hemorrhage. Uterine fibroids represent a common, benign condition that may lead to bleeding, specifically if the lesion affects the uterine cavity.