Can perineal tear cause postpartum haemorrhage?

Heavy bleeding after delivery can also come from the uterus, retained placental tissue or a clotting problem, and more than one cause can occur together.

A perineal tear affects tissue between the vaginal opening and anus. Deeper tears or extensions into nearby vaginal tissue can damage blood vessels, allowing ongoing bleeding even when the uterus has contracted firmly.

Clinicians examine the vagina and perineum under good lighting to locate the injury. Pain relief or anaesthesia may be needed so the full extent can be assessed and repaired safely.

Treatment focuses on stopping blood loss and supporting circulation. The team may massage the uterus, give medicines that help it contract, place an intravenous line, take blood tests and inspect the birth canal for a bleeding tear.

A tear that is actively bleeding is usually closed with stitches. Further treatment may be needed if bleeding continues, a collection of blood forms within the tissue, or another source is identified.

Call the maternity unit or emergency services immediately for sudden or increasing bleeding, blood soaking pads quickly, large clots, faintness, confusion, breathlessness, a racing heartbeat, cold or clammy skin, or collapse. Do not drive yourself if you feel weak or dizzy.

Bleeding can also become abnormal after leaving hospital. New heavy flow, worsening perineal swelling, severe pain, fever or foul-smelling discharge needs prompt assessment rather than waiting for a routine postnatal visit.

Ask where the bleeding came from, how the tear was repaired, how to care for the stitches, which pain relief is suitable while feeding your baby, and what changes in bleeding or swelling should bring you back urgently.