Final answer:
The main causes of early postpartum hemorrhage are uterine atony, where the uterus fails to contract effectively, and retained placenta, which prevents the uterus from contracting properly to control blood loss. Prompt and careful examination of the afterbirth is necessary to prevent hemorrhage.
Step-by-step explanation:
The two main causes of early postpartum hemorrhage are uterine atony and retained placenta. Uterine atony refers to the inability of the uterus to contract effectively following childbirth, which can lead to significant bleeding because the contractions help to restrict blood vessels where the placenta was attached. A retained placenta occurs when all or part of the placenta or membranes are left behind in the uterus after delivery. This can also result in significant hemorrhage, as the uterus cannot contract properly until the remaining tissue is expelled.
It is crucial for the obstetrician to examine the expelled placenta and fetal membranes carefully, ensuring that the afterbirth is complete. If fragments of the placenta remain, this can cause a postpartum hemorrhage and might require manual removal or even surgery if it does not birth spontaneously.
Additionally, breastfeeding helps facilitate the process of involution, the shrinking of the uterus to its pre-pregnancy size, which also helps minimize blood loss post-delivery by promoting uterine contractions.