PP Hemorrhage & Hypovolemic Shock

Question 1

What is postpartum hemorrhage?

Answer 1

Blood loss significant enough to cause hemodynamic instability

Question 2

When does primary PP hemorrhage occur?

Answer 2

first 24 hours of delivery

Question 3

When does secondary PP hemorrhage occur?

Answer 3

24 hours to 12 weeks after delivery

Question 4

What is the most common cause of PP hemorrhage?

Answer 4

uterine atony

Question 5

Other causes of PP hemorrhage

Answer 5

trauma to birth canal, retention of fetal or placental tissue, coagulopathy or thrombin disorder

Question 6

What are the risk factors of PP hemorrhage?

Answer 6

prolonged labor, augmented labor, history of, overdistended uterus

Question 7

Additional causes of PP hemorrhage

Answer 7

unrepaired lacerations of birth canal, placental abruption, placental previa, magnesium sulfate administration, ruptured uterus

Question 8

What is uterine atony?

Answer 8

uterine muscle is not contracted so bleeding occurs; fundus is soft on exam

Question 9

What is the #1 cause of secondary PP hemorrhage?

Answer 9

subinvolution of the uterus; retained tissue of conception or infection

Question 10

What is the FIRST thing you do for PP hemorrhage?

Answer 10

massage the fundus

Question 11

What do you do after massaging the fundus in PP hemorrhage?

Answer 11

1. IV bolus with LR and Pitocin, 2. Cytotec, Hemabate, Methergine, 3. Vital signs Q5, 4. Empty bladder

Question 12

When do you NOT give methergine or hemabate?

Answer 12

Don’t give methergine if hypertensive; don’t give hemabate is history of asthma

Question 13

How can you prevent 60% of PP hemorrhage?

Answer 13

active management of the third stage of labor

Question 14

What is hypovolemic shock?

Answer 14

Volume loss

Question 15

Risk factors of hypovolemic shock?

Answer 15

Burns, GI losses (vomiting, severe diarrhea), excessive sweating, bleeding (injury, bleeding disorders, physiologic bleeding)

Question 16

Class 1 hemorrhagic shock

Answer 16

15% blood volume, no change in vitals

Question 17

Class 2 hemorrhagic shock

Answer 17

15% - 30% of blood volume, tachycardic, narrowing pulse pressure, pale and cool skin, behavior changes

Question 18

Class 3 hemorrhagic shock

Answer 18

Loss of 30% - 40% blood volume, BP drops, HR increases, diminished capillary refill, mental status worsens

Question 19

Class 4 hemorrhagic shock

Answer 19

loss of more than 40% blood volume, limit of body’s compensation is reached, aggressive resuscitation needed

Question 20

What are come compensatory mechanisms of hypovolemic shock?

Answer 20

Aldosterone, fluid retention, shunting, diversion of blood as an attempt to maintain organ perfusion

Question 21

Signs and symptoms of shock

Answer 21

skin, heart, oxygen, LOC, kidney

Question 22

What are three interventions for hypovolemic?

Answer 22

ventilation, infusion, pharmacology

Question 23

Ventilation intevention

Answer 23

decrease O2, increase ventilation

Question 24

Infusion intervention

Answer 24

assess GI tract for PO fluids, consider IV fluids, optimize positioning

Question 25

Pharmacology interventions

Answer 25

avoid IM injections, oxygen administration, stop bleeding, vasoactive medications