Pathophysiology
The most common cause of PPH
failure of the uterus to contract and retract after birth (Uterine Atony)
A potentially life-threatening complication that can occur after both vaginal and cesarean births
Postpartum hemorrhage (PPH)
The first line drug for uterine atony
Oxytocin
How long after delivery is a patient at greatest risk for postpartum hemorrhage?
The first 24 hours after delivery
What is the first intervention to perform when uterine atony is present?
Fundal massage
______ refers to incomplete involution of the uterus or failure to return to its normal size and condition after birth
Subinvolution
Blood loss that occurs within 24 hours of birth is termed
primary (immediate or early) postpartum hemorrhage
Medication given to control postpartum hemorrhage that is contraindicated in patients with hypertension.
Methylergonovine maleate (Methergine)
Assisted delivery causes a greater risk for PPH. What does an assisted delivery involve?
The use of instruments (forceps,vacuum) to help get the baby out.
What is the most common cause of subinvolution?
Retained placenta fragments
This is a sign of uterine atony
Boggy uterus
Blood loss that occurs 24 hours to 12 weeks after birth is termed
delayed (late) postpartum hemorrhage
Medication given to control postpartum hemorrhage that is contraindicated in patients with asthma
Carboprost (Hemabate)
The Fifth "T"
Traction placed on the umbilical cord to expel the placenta can result in cord detachment from the placenta or uterine inversion, resulting in a massive hemorrhage.
How is QBL measured after delivery?
By weighing peripads, chux pads, and sponges
One gram of weight equals roughly one milliliter (mL) of blood loss (1 g = 1 mL)
_____ helps to prevent PPH immediately after birth by providing hemostasis
Thrombosis (formation of a blood clot)
PPH is defined as a blood loss greater than ____ mL after vaginal birth or more than ____ mL after a cesarean birth.
500 mL , 1000 mL
Or any amount of bleeding that places the birthing parent in hemodynamic jeopardy.
Postpartum hemorrhage is best managed by using a stepwise progressive approach. The two first line treatments include? (non-pharmacological and pharmacological)
Manual massage (fundal massage) and pharmacological therapies (oxytocin; pitocin)
Which risk factor is when the uterus is enlarged due to too much amniotic fluid or a large baby?
Overdistended Uterus
A firm fundus with increased HR and decreased BP without any peri pad saturation is an indication of?
Hematoma
A helpful way to remember the causes of postpartum hemorrhage is by using the 4 Ts. What are the 4 Ts?
Tone, Tissue, Trauma, Thrombin
Two important vital signs that are important to monitor when observing for postpartum hemorrhage
Heart rate and Blood pressure
** Daily double** The RN is caring for a woman experiencing postpartum hemorrhage two hours after an induced vaginal delivery at 36 weeks 2 days for severe pregnancy induced hypertension. The fundus is boggy and firms with massage. The patient has an IV infusion of lactated ringers running. What is the best intervention for this patient?
Start IV oxytocin infusion
Risk factors for uterine atony.
What are: Prior PPH, Chorioamnionitis, Fibroids, Labor induction or augmentation, Therapeutic use of magnesium sulfate, Uterine overdistention (macrosomia, multiple gestation, polyhydramnios), Uterine inversion, Previous blood transfusion for PPH
What are two options that can be used to help treat PPH when fundal massage and medications fail to contract the uterus?
Jada System and Bakri Balloon (Uterine Balloon Tamponade)