PP Hemorrhage & Hypovolemic Shock Flashcards
What is postpartum hemorrhage?
Blood loss significant enough to cause hemodynamic instability
When does primary PP hemorrhage occur?
first 24 hours of delivery
When does secondary PP hemorrhage occur?
24 hours to 12 weeks after delivery
What is the most common cause of PP hemorrhage?
uterine atony
Other causes of PP hemorrhage
trauma to birth canal, retention of fetal or placental tissue, coagulopathy or thrombin disorder
What are the risk factors of PP hemorrhage?
prolonged labor, augmented labor, history of, overdistended uterus
Additional causes of PP hemorrhage
unrepaired lacerations of birth canal, placental abruption, placental previa, magnesium sulfate administration, ruptured uterus
What is uterine atony?
uterine muscle is not contracted so bleeding occurs; fundus is soft on exam
What is the #1 cause of secondary PP hemorrhage?
subinvolution of the uterus; retained tissue of conception or infection
What is the FIRST thing you do for PP hemorrhage?
massage the fundus
What do you do after massaging the fundus in PP hemorrhage?
- IV bolus with LR and Pitocin, 2. Cytotec, Hemabate, Methergine, 3. Vital signs Q5, 4. Empty bladder
When do you NOT give methergine or hemabate?
Don’t give methergine if hypertensive; don’t give hemabate is history of asthma
How can you prevent 60% of PP hemorrhage?
active management of the third stage of labor
What is hypovolemic shock?
Volume loss
Risk factors of hypovolemic shock?
Burns, GI losses (vomiting, severe diarrhea), excessive sweating, bleeding (injury, bleeding disorders, physiologic bleeding)
Class 1 hemorrhagic shock
15% blood volume, no change in vitals
Class 2 hemorrhagic shock
15% - 30% of blood volume, tachycardic, narrowing pulse pressure, pale and cool skin, behavior changes
Class 3 hemorrhagic shock
Loss of 30% - 40% blood volume, BP drops, HR increases, diminished capillary refill, mental status worsens
Class 4 hemorrhagic shock
loss of more than 40% blood volume, limit of body’s compensation is reached, aggressive resuscitation needed
What are come compensatory mechanisms of hypovolemic shock?
Aldosterone, fluid retention, shunting, diversion of blood as an attempt to maintain organ perfusion
Signs and symptoms of shock
skin, heart, oxygen, LOC, kidney
What are three interventions for hypovolemic?
ventilation, infusion, pharmacology
Ventilation intevention
decrease O2, increase ventilation
Infusion intervention
assess GI tract for PO fluids, consider IV fluids, optimize positioning
