Chapter 16: Hematomas

Question 1

Hematoma

Answer 1

localized collection of blood in connective or soft tissue under the skin that follows injury of or laceration to a blood vessel without injury to the overlying tissue
>at the time of injury, pressure necrosis ad inadequate hemostasis occurs
>results in a large amount of blood loss

Question 2

Risk Factors

Answer 2

• genital tract lacerations
• episiotomies
• operative vaginal deliveries
• difficult or prolonged second stage of labor
• multiparity

Question 3

Signs and Symptoms

Answer 3

unremitting pain and pressure
-pain and pressure worsens if active bleeding continues; uterus remains firm
-If located in vaginal area; sensation of “heaviness” in the vagina and/or rectal pressure
>on examination of perineal or vulvar areas; bluish discoloration and bulging of the tissue at the hematoma site; if touched, complains of tenderness, describes tissue as “full”
-if hematoma is large, Signs of shock (e.g. tachycardia and hypotension) may be evident and may show absence of lochia and inability to void

Question 4

Assessment for the presence of a hematoma

Answer 4

• listening to patients subjective complaints
• measuring vital signs
• examining the perineal and vulvar areas to identify a buldging mass

Question 5

How to examine the perineal and vulvar areas

Answer 5

• side-lying position
• gently lifts upper buttocks, and asks to bear down
• nurse watches for behavioral signs and symptoms shock
• assess patients and family’s understanding of what is occurring

Question 6

What Should the Nurse do if findings from the assessment are strongly suggestive of a hematoma

Answer 6

immediately notify the physician or midwife and implement pain relief measure
-if < than 3 to 5 cm in diameter = palliative treatments such as ice to the area for the first 12 hours along with pain medication and close observation of the area for extension of the hematoma
>after 12 hours, sitz baths are prescribed to replace application of ice; provide comfort and facilitate reabsorption of clot
-if > 5 cm = incision and drainage with possible placement of a drain; performed in OR and sedated with anesthetic

Question 7

Large Hematomas

Answer 7

can lead to shock
-aggressive treatment that includes IV fluids, oxygen, frequent measurement of vital signs, urinary catheter placement, and strict intake and output measurements to stabilize the patient before taking to the operating room