Basics of PPH
How much blood loss defines PPH after a vaginal delivery?
> 500mL
What is the most common cause of PPH?
Uterine atony (Tone)
What should the nurse palpate to assess for uterine tone?
The fundus
What maternal vital sign change is often the first sign of hemorrhage?
Increased heart rate
What is a sentinel event?
Unexpected occurrence involving death, serious physical or psychological injury, or the risk thereof
How much blood loss defines PPH after a cesarean section?
> 1000 mL
Which "T" involves retained placenta or membranes?
Tissue
What does a "boggy" uterus indicate?
Uterine atony
What happens to blood pressure in severe hemorrhage?
It decreases (hypotension)
What is PPH considered a sentinel event?
It can cause maternal death if not recognized and treated
What time frame defines primary PPH?
Within 24 hours of delivery
Your patient has heavy bleeding after delivery, but her uterus feels firm. Which of the 4 T's should you suspect?
Trauma
What is the nurse's first action when PPH is suspected?
Massage the fundus
Name one maternal complication caused by untreated PPH.
Hypovolemic shock, organ failure, or death
Name one stakeholder in a PPH sentinel event.
Nurse, patient, OB, family, administration
What time frame defines secondary PPH?
24 hours to 12 weeks postpartum
Which "T" refers to coagulation problems like DIC?
Thrombin
Name one medication used to treat uterine atony.
Oxytocin (Pitocin), Methergine (Methylergonovine), Carboprost (Hemabate)
Name one patient-related risk factor for PPH
High BMI, multiple gestation, prolonged labor, preeclampsia
Name one quality improvement strategy to prevent PPH.
PPH risk assessment tool, emergency cart, simulation training
What organization defines sentinel events and tracks PPH-related deaths?
The Joint Commission
Give one example of a condition that increases risk for uterine atony.
Overdistended uterus, prolonged labor, multiple gestation
Besides fundal massage, name two immediate nursing interventions for PPH.
Call for help, monitor vitals, start IV fluids, administer meds, quantify blood loss
Name one newborn or family-related consequence of maternal postpartum hemorrhage.
Neonatal stress, maternal death affecting the family, loss of bonding
What collaborative team effort is essential to reduce PPH deaths?
Interprofessional communication and rapid response teamwork