Postpartum Hemorrhage
What are some signs and symptoms of postpartum hemorrhage?
-uncontrolled bleeding
-decreased BP
-increased HR
-decrease in hematocrit
What are some signs and symptoms of placental abruption?
-vaginal bleeding that is painful
-rigid abdomen
-back pain
-uterine pain
-uterine tenderness or rigidity
-painful contractions
What is the 1st sign of hemorrhagic shock?
Tachycardia
What is shoulder dystocia?
An obstetric emergency where the fetal head does not lead to the delivery of the shoulders
The shoulders are stuck at the pelvis and does not allow the fetus to pass through the birth canal
What are some reasons for a c-section?
-elective(w/out medical indication)
-scheduled(labor and birth contraindicated, malpresentation, repeat c-section, HIV high viral load of the mother, active herpes outbreak)
-unplanned(protracted labor, non-reassuring fetal status, urgent vs emergent)
What is the first thing you should do as nurse when you suspect postpartum hemorrhage?
Check the fundus to see if it's boggy.
If it boggy and not firm, massage the fundus.
What is the difference between placental abruption and placenta previa?
Placental abruption is when the placenta detaches from the uterus prematurely(medical emergency) with or without bleeding
Placenta previa is when the placenta is near or covers the cervical opening. There is bright red vaginal bleeding, but without pain
What is a late sign of hemorrhagic shock?
Low BP
What is the 1st and 2nd biggest risks to the fetus caused by shoulder dystocia?
1st is hypoxia
2nd is nerve damage
What is the difference between and urgent and emergent c-section?
Urgent: variability and late decels
Emergent: huge decels and fetal bradycardia
What are some causes of postpartum hemorrhage?
-uterine atony
-retained placenta
-lacerations
-hematoma
-uterine inversion
-subinvolution
How is placental abruption managed and treated?
-bedrest
-side lying position
-VS fetal and mom
-continuous EFM
-16 or 18G IV
-labs
-foley
-be aware for DIC
-C-section
Why does blood pressure decrease when a patient is in hemorrhagic shock?
Due to the rapid loss of blood
What are some risk factors for shoulder dystocia?
-maternal obesity
-maternal diabetes
-protracted labor
-fetal macrosomia
-hx of shoulder dystocia
What are some maternal risks for a c-section?
-infection
-blood clots
-reaction to anesthesia
-surgical injury
-blood loss
Why is knowing the volume of blood lost during labor important?
-hemorrhage risk
-may need blood transfusion
-may lead to hemorrhagic shock
What are some causes of placental abruption?
-HTN
-trauma
-twins
Describe what the following for look like if a patient is in hemorrhagic shock?
Respirations?
Pulse?
BP?
Urinary output?
Mental status?
Respirations: increased
Pulse: increased HR, bounding pulses
BP: low
Skin: cool and pale
Urinary output: low
Mental status: altered
What are some maternal and fetal complications of shoulder dystocia?
Maternal
-postpartum hemorrhage
-3rd and 4th degree perineal tears
Fetal
-hypoxia
-nerve damage
-fracture of humerus or clavicle
-intracranial hemorrhage
-cervical spine injury
What are some fetal risks for a c-section?
-low birth weight
-respiratory problems
-low APGAR scores
-fetal injury
What are the medications that should be given within 1 minute of birth?
What are the contraindications, if any?
-Pitocin(1st line)
-Misoprostol
-Methergine
-Hemabate
True or false
Placental abruption has a reassuring FHR and placenta previa has a non-reassuring FHR and abnormal maternal vitals?
False
What are the nursing interventions for hemorrhagic shock?
-large bore IV x2
-fluid resuscitation(blood products/fluids)
-transfusion protocol
-continuous monitoring
-ensure open airway(O2)
-prepare for surgery
What do you do for shoulder dystocia?
Hint: HELPEER
H: call for Help
E: evaluate for Episiotomy
L: Legs->McRoberts Maneuver
P: external Pressure->suprapubic
E: Enter: rotational maneuvers
R: Remove the posterior arm
R: Roll the patient to her hands and knees
List nursing care things for before, during, and after a c-section
Before
-VS
-pain meds, drug allergies
-EFM
-foley
-consent forms
-test dose of anesthesia
-CBC, type and cross
During
-VS
-monitor incision site
-weigh estimate blood loss
-initiate skin to skin
-count tools
After
-VS
-monitor incision site
-monitor for bleeding
-monitor urine output
-monitor for infection
-ambulate patient
-monitor for DVT