Post-operative haemorrhage refers to excessive bleeding that occurs after a surgical procedure. It remains one of the most critical surgical complications managed by midwives and nurses in Nigerian healthcare facilities. Bleeding is broadly classified based on the time of onset after surgery and the anatomical site of the vessel involved.
A structured timeline helps midwives anticipate when post-operative bleeding is most likely to occur.
Primary haemorrhage happens during surgery or within the first 24 hours. It is usually linked to direct surgical trauma, inadequate vessel ligation, or inherent clotting defects.
Reactionary haemorrhage develops within 24 hours to 48 hours post-surgery. This typically occurs as the patient's blood pressure rises during recovery, or when a ligature slips off a blood vessel that was temporarily tied off during the operation.
Secondary haemorrhage appears days later, usually between 7 and 14 days post-operatively. The most common trigger is surgical site infection causing tissue sloughing and erosion of the blood vessel wall. In busy tropical wards, failing to maintain strict aseptic technique during wound care can sadly precipitate this delayed bleeding.
Spotting early signs of blood loss prevents catastrophic shock. The human body does not show dramatic drops in blood pressure immediately; instead, subtle changes appear first.
Restlessness and sudden anxiety are often the earliest neurological clues that the brain is receiving less oxygen. The pulse rate increases as the heart pumps faster to make up for the lower volume of blood. Skin becomes pale, cool, and clammy because blood vessels in the skin constrict to redirect blood to vital organs. The patient may complain of excessive thirst as fluid shifts occur within the body.
When bleeding occurs, the body activates powerful compensatory mechanisms to maintain perfusion to vital organs like the brain and heart. Baroreceptors in the aortic arch and carotid sinuses detect the drop in blood pressure and signal the sympathetic nervous system. This triggers the release of adrenaline and noradrenaline, which increase heart rate and cause widespread vasoconstriction.
At the same time, the kidneys activate the renin-angiotensin-aldosterone system to retain sodium and water, attempting to restore circulating blood volume. However, these mechanisms have limits. If blood loss exceeds thirty percent of the total volume, compensation fails, and the patient plunges into decompensated hypovolemic shock.
When a post-operative haemorrhage is detected, rapid action saves lives.
Medical resuscitation alone cannot stop a bleeding vessel if the source is surgical. Definitive management often requires combining medical therapies with surgical intervention.
Medical treatments include transfusion of whole blood or packed red blood cells to restore oxygen delivery, alongside fresh frozen plasma or platelets if clotting factors are depleted. Antifibrinolytic agents like tranexamic acid may be administered to help stabilize blood clots.
Surgical management involves taking the patient back to the operating theatre for re-exploration. The surgeon identifies the bleeding point, achieves haemostasis through ligation, electrocautery, or suturing, and places appropriate drainage tubes to prevent future fluid accumulation.
Once immediate bleeding is controlled and resuscitation is underway, vigilant post-resuscitation care is vital to prevent secondary complications. Hypovolemic shock occurs when severe blood loss leads to inadequate cellular oxygenation and multi-organ failure if left unchecked.
Midwives must monitor vital signs continuously, paying close attention to urine output through an indwelling catheter—aiming for at least 0.5 mL/kg/hour as a reliable indicator of adequate kidney perfusion. Monitoring laboratory values like hemoglobin, hematocrit, and clotting profiles guides ongoing transfusion therapy. Keeping accurate fluid balance charts ensures the patient neither remains under-resuscitated nor receives excessive fluids that could lead to pulmonary oedema.