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.
Normally, the uterus continues to contract after the delivery of the baby and placenta. These contractions actually 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 the 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 delivery the baby.
Patient will maintain optimal fluid balance and vital signs within normal limits
Assess vital signs and monitor for signs of shock
Decreased fluid volume will cause blood pressure to drop and patient will go into shock
Monitor blood loss
Amount of blood loss and presence of blood clots can help determine treatment.
Assess for vaginal hematoma
If bleeding is due to vaginal hematoma, rest and application of an ice pack may be sufficient treatment
Monitor intake and output for 30ml – 50 ml/hr urine output; may require indwelling catheter insertion for accurate measurement
Decreased urine output may be a sign of hematomas that put pressure on the urethra, or may be a late sign of hypovolemic shock.
Monitor lab values to determine need for transfusions or signs of complications
Watch hematocrit and clotting levels to know if blood transfusion is necessary and for signs and severity of DIC.
Administer IV fluids, medications and blood products as necessary
Perform uterine massage to stimulate contractions following delivery
Begin fundal massage and educate patient on how to massage abdomen to stimulate contractions. These contractions may help stop bleeding.
Monitor and manage pain
Continued, unrelieved pain may be due to hematomas or lacerations within the vagina
Place patient on bed rest with legs elevated
Rest and elevation of legs helps venous return and slows bleeding
Prepare patient for surgery if indicated; remain on NPO status
If bleeding can’t be managed otherwise, surgery may be required
Create Your Free Account