A nurse is caring for a client who is experiencing a postpartum hemorrhage
What is postpartum hemorrhage?Postpartum hemorrhage is more bleeding than normal after the birth of a baby. About 1 in 100 to 5 in 100 women have postpartum hemorrhage. It's more likely with a cesarean birth. It most often happens after the placenta is delivered, but it can also happen later. Show
What causes postpartum hemorrhage?Once a baby is delivered, the uterus normally contracts and pushes out the placenta. After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta stay attached, bleeding is also likely. Postpartum hemorrhage may also be caused by:
Who is at risk for postpartum hemorrhage?Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk include:
What are the symptoms of postpartum hemorrhage?These are the most common symptoms of postpartum hemorrhage:
The symptoms of postpartum hemorrhage may look like other health conditions. Always see your healthcare provider for a diagnosis. How is postpartum hemorrhage diagnosed?Your healthcare provider will review your health history and do a physical exam. Lab tests often help with the diagnosis. Other tests may include:
How is postpartum hemorrhage treated?The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as soon as possible. Treatment may include:
Replacing lost blood and fluids is important in treating postpartum hemorrhage. You may quickly be given IV (intravenous) fluids, blood, and blood products to prevent shock. Oxygen may also help. Postpartum hemorrhage can be quite serious. But when your provider quickly finds and treats the cause of bleeding, you often will be able to recover fully. What are possible complications of postpartum hemorrhage?Losing lots of blood quickly can cause a severe drop in your blood pressure. This may lead to shock and death if not treated. What can I do to prevent postpartum hemorrhage?It’s important to know before delivery what puts you at risk for postpartum hemorrhage. It's important to have emergency care available in case it is needed at the time of delivery and after birth. Early care can reduce the amount of blood loss. When should I call my healthcare provider?Most cases of postpartum hemorrhage occur at delivery or soon after. But you may bleed heavily after you go home from the hospital. Talk with your healthcare provider about the symptoms of postpartum hemorrhage and what to watch for. During your hospital stay or once you get home, call your healthcare provider right away if you have any of the following:
Key points about postpartum hemorrhage
Next stepsTips to help you get the most from a visit to your healthcare provider:
What management is required for a client experiencing a postpartum hemorrhage?External uterine massage and bimanual compression are generally used as first-line treatments. These compression techniques encourage uterine contractions that counteract atony and assist with expulsion of retained placenta or clots. Aortic compression is another compression technique that has been used for severe PPH.
What nursing interventions should be performed after palpating a fundus?(5) Nursing interventions. (a) Palpate the fundus frequently to determine continued muscle tone. (b) Massage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle). (c) Monitor patient's vital signs every 15 minutes until stable.
What is the priority nursing intervention for a client with severe preeclampsia?Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother's safety and deliver a healthy newborn as close to a full term as possible.
What drug is administered if conventional therapies are unsuccessful in resolving postpartum hemorrhage?If intravenous oxytocin is unavailable, or if the bleeding does not respond to oxytocin, the use of intramuscular ergometrine, oxytocin–ergometrine fixed dose, or a prostaglandin drug (including sublingual misoprostol, 800 μg) is recommended.
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