Included In This Lesson
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Outline
Pathophysiology
Postpartum hemorrhage is the excessive bleeding following delivery of a baby. For vaginal delivery, excessive bleeding would be more than 500ml and for cesarean delivery, more than 1000ml. This may happen with vaginal or cesarean delivery and occurs in 1-5 out of 100 women. The hemorrhage may occur immediately after birth, or over several hours following delivery.
Etiology
Normally, the uterus continues to contract after the delivery of the baby and placenta. These contractions help close the vessels that supplied blood from the mother to the baby. When these contractions do not continue or are not strong enough, hemorrhage occurs. Sometimes, a tear in the cervix, placenta, or the blood vessels within the uterus may cause hemorrhage. Risk factors include obesity, multiple births (twins or more), many previous pregnancies, blood clotting disorders, infection, prolonged labor, or use of assistive devices such as forceps or vacuum to deliver the baby.
Desired Outcome
A patient will maintain optimal fluid balance and vital signs within normal limits
Postpartum Hemorrhage (PPH) Nursing Care Plan
Subjective Data:
- Pain in the vaginal area (if due to hematoma)
- Dizziness
Objective Data:
- Uncontrolled bleeding
- Excessive saturation of perineal pads
- Hypotension
- Tachycardia
- Low hematocrit
Nursing Interventions and Rationales
- Assess vital signs and monitor for signs of shock
- Monitor blood loss
- Site
- Type
- Amount- should be no more than 1 perineal pad per hour
- Presence of clots
- Assess for vaginal hematoma
- Monitor intake and output for 30ml – 50 ml/hr urine output; may require indwelling catheter insertion for accurate measurement
- Monitor lab values to determine the need for transfusions or signs of complications
- Administer IV fluids, medications and blood products as necessary
- Oxytocin
- Antibiotics
- Analgesics
- Fluid replacement may be necessary and, depending on the amount of blood lost and hematocrit level, a blood transfusion may be required.
- Oxytocin is sometimes given to initiate contractions that will help stop bleeding.
- Perform uterine massage to stimulate contractions following delivery
- Monitor and manage pain
- Place the patient on bed rest with legs elevated
- Prepare patient for surgery if indicated; remain on NPO status
References
- https://emedicine.medscape.com/article/275038-overview?pa=Aq2wsSmfqp4alb%2FETL19oHRhYsq4W5cKPOA2iNXh2k2NLuz5Hc6%2Fkue309oStNFA43mU9jD%2B1DtnxY47OmyybA%3D%3D#a10
- http://www.stanfordchildrens.org/en/topic/default?id=postpartum-hemorrhage-90-P02486
- https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02486
Miriam Wahrman, MSN/Ed, RNC-MNN 
Nichole Weaver, MSN/Ed, RN, CCRN 
