Physiology
Two 18 gauge IV's, cross matched for blood products, patient teaching on increased risk for PPH, notify anesthesia team and blood bank, have the PPH cart readily available near bedside.
What is the nursing interventions in treatment of PPH? If the patient has increased risk factors, the nurse should prepare with these interventions in order to be ready for an emergency.
Given as 600 to 1000 mcg rectally
What is cytotec (misoprostol)? No listed contraindications.
The blood component that increases 25% in pregnancy.
What is red blood cell mass?
Typically employed after other conservative measures have failed, this PPH intervention works by applying temporary, uniform pressure to the lower uterine segment while allowing for continued monitoring of blood loss. May be left in place for up to 24 hours and monitors ongoing bleeding.
What is the Bakri balloon?
When the muscular wall of the uterus tears during pregnancy or childbirth. Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present. Disability or death of the mother or baby may result.
What is uterine rupture?
Previous postpartum hemorrhage, coagulation disorders, previous caesarean deliveries, fibroids, prolonged labor or use of induction methods, chorioamnionitis, maternal obesity
Blood component that increases 40% in pregnancy.
What is plasma volume? This causes the patient to appear to be anemic because of the increased hemodiluation.
Allows for accurate measurement of blood loss. Is the most accurate to monitor blood loss and ensures quick response to hemorrhage.
What is quantitive blood loss (QBL)?
The placenta separates from the uterus during the antepartum or intrapartum period. This can cause massive amounts of blood loss.
What is placental abruption?
Cause that may be "hidden" but can lead to significant EBL with c/o pressure / pain. Single source not usually able to be identified. Increased risk with operative delivery-use of forceps or vaccum
What is genital tract hematoma? May be treated with I&D, drain placement, incisional suture, vaginal packing, or management by interventional radiology.
The placenta is attached to the front of the uterus instead of the back portion.
What is anterior placenta? This increases risk of PPH especially if the patient is delivered by caesarean delivery.
Assessing fundal tone and vaginal bleeding. Should be done after vaginal delivery and caesarean delivery.
What is fundal massage?
What blood loss constitutes hemorrhage or vaginal deliveries in Cesarean delivery?
What is >1000 cc EBL?
A medication used to treat or prevent excessive blood loss from trauma, childbirth and heredity conditions. Death due to postpartum bleeding was reduced in women using this medication.
What is TXA (Tranexamic acid)?
Ruled out by careful assessment of lower genital tract. Can be located external or internal vaginal areas.
What are lacerations?
Tissue, Tone, Trauma and Thrombotic disorders
What are the four T's for PPH assessment?
Large bore IV's, iv and blood tubing, sterile speculums, sterile petroleum jelly, blood draw supplies, sterile gauze, 500 normal saline bag of fluids, sterile gloves
What is in the postpartum hemorrhage cart?
A condition that causes tiny blood clots and areas of bleeding throughout the body simultaneously; severe infections, surgery, or complications of pregnancy are conditions that can lead to DIC.
What is DIC (Disseminated intravascular coagulation)?