Postpartum Hemorrhage Flashcards
Postpartum hemorrhage is blood loss of more than
500 mL
following the birth of a newborn.
EARLY postpartum hemorrhage, which is usually due to
uterine atony, lacerations, or retained placental
fragments, occurs in the first 24 hours after delivery
LATE postpartum hemorrhage occurs after the first 24
hours after delivery and is generally caused by
retained
placental fragments or bleeding disorders.
ASSESSMENT FINDINGS
Signs of impending shock include
changes in skin
temperature and color
and altered level of
consciousness.
NURSING MANAGEMENT
POSTPARTUM HEMORRHAGE
Prevent excessive blood loss and resulting complications.
a. Massage the uterus, facilitate voiding, and report
blood loss.
b. Monitor blood pressure and pulse rate every 5 to
15 minutes.
c. Prepare for intravenous infusion, oxytocin, and
blood transfusion, if needed.
d. Administer medications and oxygen as prescribed
(other slide-)
e. Measure and record fluid intake and output.
f. Be prepared for a possible dilatation and curettage
(D & C).
Assist the client and family to deal with physical and
emotional stresses of postpartum complications.
TREATMENT OF POSTPARTUM HEMMORHAGE
treatment: Fundal massage
route/dose:
notes:
1st line in theraphy
TREATMENT OF POSTPARTUM HEMMORHAGE
treatment: oxytocin/pitocin
route/dose:
notes:
- 10-40 U in 1L NS infused at 200-500 ml/hr
- Drug of Choice; Give After Baby/Placenta Delivered;
If IV Unavailable, may use 10U IM
TREATMENT OF POSTPARTUM HEMMORHAGE
treatment: Prostaglandin F2a (Hemabate)
route/dose:
notes:
-0.25mg IM q15min (Max 2mg or 8 doses)
-Contraindicated in Asthma; Can Cause N/V/D
TREATMENT OF POSTPARTUM HEMMORHAGE
treatment: Misoprostal (Cytotec)
route/dose:
notes:
- 800 – 1000mcg PR xl
- Can Cause Fever & Tachycardia
TREATMENT OF POSTPARTUM HEMMORHAGE
treatment: Methylergonivine (Methergine)
route/dose:
notes:
0.20mg IM q2 – 4hrs
- Avoid in Pts with HTN (i.e. Preeclampsia)
TREATMENT OF POSTPARTUM HEMMORHAGE
treatment: TXA
route/dose:
notes:
-1g IV over 10min
-Equivocal Evidence
Lacerations 3 typoes
a. Cervical lacerations
b. Vaginal lacerations
c. Perineal lacerations
FOUR MAIN CAUSES OF POSTPARTUM
HEMORRHAGE
Uterine Atony
2. Lacerations
Retained Placental Fragments
4. Disseminated Intravascular Coagulation
Disseminated Intravascular Coagulation
Disseminated intravascular coagulation (DIC) is a
rare but serious condition that causes abnormal
blood clotting throughout the body’s blood vessels.
Conditions That Distend the Uterus Beyond Average
Capacity
Multiple gestation
* Hydramnios (excessive amount of amniotic fluid)
* Large baby (more than 9 lb.)
* Presence of uterine myomas (fibroid tumors)
Conditions that Could Have Caused Cervical or Uterine
Lacerations
Operative birth
* Rapid Birth
Conditions With Varied Placental Site or Attachment
Placenta previa
* Placenta accrete
* Premature separation of placenta
* Retained placental fragments
Why retained placenta does cause postpartum
hemorrhage?
Because piece of tissue or clot prevent
effective myometrial contraction and
retraction, which is normally needed to
compress the blood vessels at the site of
detached placenta.
Conditions That Leave the Uterus Unable to Contract
Readily
Deep anesthesia or analgesia
* Labor initiated or assisted with an oxytocin agent
* Maternal age greater than 30 years
* High parity
* Previous uterine surgery
* Prolonged and difficult labor
* Possible chorioamnionitis
* Secondary maternal illness (e.g. anemia)
* Prior history of postpartum hemorrhage
* Endometritis
Prolonged use of magnesium sulfate or other tocolytic
therapy.
