Definitions
What is the definition of postpartum hemorrhage (PPH)?
Answer: Blood loss greater than 500 mL after vaginal delivery or greater than 1000 mL after cesarean delivery
TRUE or FALSE: It is fine to give Pitocin after baby is delivered
Answer: FALSE - it needs to be given after placenta delivered. Given too early can cause the uterus to contract down and not release the placenta
How will the uterus feel if patient is having a hemorrhage?
Answer: Boggy
What is first line treatment for postpartum hemorrhage?
Answer: Fundal Massage
When do you give a mother who just gave birth Pitocin?
Answer: Right after the placenta is delivered
What is uterine atony?
Answer: When the uterus fails to contract effectively after childbirth
Name the most common cause of early postpartum hemorrhage
Answer: Uterine Atony
Aside from visual bleeding, what are other signs the patient could exhibit if starting to hemorrhage?
Answer: decreased level of consciousness, fatigue, and/or valor
How do you determine blood loss in a postpartum patient?
Answer: Weight the pads and any under buttock pads to get an accurate weight
Uterus is slightly boggy, 2U, and deviated to the left. What is your next step?
Answer: Have her empty her bladder
Where is the fundus?
Answer: The top portion of the uterus, which should be firm and at or near the level of the umbilicus after delivery.
Which patient is most at risk for PPH?
A. G1P0, 40 wks, vaginal delivery, 6lb 2 oz baby
B. G1P0, 40wks, C-section, 7lb 3oz baby
C. G2P2, 39 wks, C-section, 5lb 2 oz baby
D. G2P0, 39 weeks, Vaginal delivery, 10lb 6 oz baby
Answer: D - large baby (macrosomia)
What vital sign changes might indicate postpartum hemorrhage?
Answer: Decreased blood pressure and Increased Heart Rate
How often should you check vital signs with a patient who is hemorrhaging?
Answer: Every 15 minutes minimum
What does G4P2 mean?
Answer: Patient has been pregnant 4 times with 2 live births
TRUE or FALSE: Women with no identifiable risk factors may hemorrhage after childbirth
Answer: TRUE
What time frame is considered an early postpartum hemorrhage?
Answer: Within in the first 24 hours after childbirth
What is the first-line medication used to treat uterine atony?
Answer: Oxytocin (Pitocin)
What labs should be monitored after a PPH?
Answer: Hemoglobin and Hematocrit and PT/PTT
What is lochia?
Answer: vaginal discharge that occurs after childbirth, consisting of blood, mucus, and uterine tissue
What is the most common cause of later postpartum hemorrhage?
Answer: Retained placental fragments
If a patient is experiencing heavy bleeding and needs to get up to bathroom, what do you do?
Answer: Offer a bedpan. They may be dizzy/lightheaded and getting up could be dangerous
When evaluating the patient who is bleeding, what are the 4 "T"s?
Tone, Trauma, Tissue, and Thrombin
Aside from uterine massage, what are next steps for a patient with PPH?
Answer: Get help! Uterine stimulants and IV fluid replacement