Postpartum Hemorrhage

Definitions & Diagnosis

100

What is a postpartum hemorrhage?

 Significant blood loss after giving birth

200

It may be difficult to accurately measure blood loss. List 2 other ways the healthcare team can identify if a postpartum hemorrhage is occurring. 

- Lab values (>10% loss of hematocrit)

- Vital signs

- Physical assessment (pale, bruising) 

- etc.  

300

True or False: Postpartum hemorrhage is the 2nd most common reason for maternal morbidity and death around the world. 

False, PPH is the leading cause of maternal morbidity/death universally. 

400

What is the difference between postpartum hemorrhage and expected blood loss for vaginal and c-section deliveries?

Considered a postpartum hemorrhage if:

a. > 1000mL loss for both

b. > 500mL loss after vaginal delivery; > 1000mL loss after c-section

c. > 600 mL loss after vaginal delivery; >1200mL for c-section

d. > 800 mL loss after vaginal delivery; > 1000mL loss after c-section

b. > 500mL loss after vaginal delivery; > 1000mL loss after c-section 

500

• In our patient scenario, the mother had a prolonged 2nd stage of labour, an assisted vaginal birth, a 3rd degree laceration, and the baby was 41 weeks 2 days gestation. Was she at a low, medium, or high risk for PPH?

High Risk

The 4 T's

100

What does the 4 T’s stand for?

Tissue, Tone, Trauma, Thrombin

200

When does early PPH vs late PPH occur? 

Early PPH occurs within 24 hours following birth. Late PPH occurs between 24 hrs and 12 weeks postpartum. 

300

What is the primary cause of postpartum hemorrhage?

Uterine atony (lack of uterine tone)

400

What is expected uterine involution for the first 48 hours after birth?

At umbilicus, then 1cm/day, should be at suprapubic bone by day 10

500

List 3 possible causes of uterine atony.

• Fatigue from long labour

• Prolonged oxytocin use/ labour induction

• Repeat distension (2+ pregnancies, twins)

• Improperly draining bladder

  • Physically displaces the uterus and may keep the cervix propped open

Interventions

100

What is the purpose of a fundal massage? 

To help the smooth muscles (myometrium) of the uterus contract 

200

What medications can be used to treat postpartum hemorrhage? List at least 3. 

• Crystalloid IV fluids & Blood products to maintain adequate circulating blood volume
• Oxytocin to boost contractions and treat uterine atony
• Misoprostol Carbopost, Ergonovine or Calcium chloride 10% to induce contractions if oxytocin ineffective within 4 minutes
• Tranexamic acid is given as prophylactic in high PPH risk or during active PPH to prevent the breakdown of clots

300

What is bimanual uterine compression? And who can perform it?

• Apply one hand to the abdomen with downward pressure while the other makes a fist inside the uterus, in order to manually compress/add pressure to the uterus to stop bleeding

• Only a physician can perform bimanual uterine compression
  
  
  

400

What is a Bahkri balloon?

A bahkri balloon is an inflatable balloon on a catheter that can be inserted into the uterus to tamponade the bleeding from the inside.

500

What pharmacological intervention can the RN perform independently, without a doctor’s order, if they identify a postpartum hemorrhage? 

Initiate IV infusion of oxytocin in normal saline (30 IU of oxytocin in 500 mL NS) for uterine atony/PPH while awaiting orders from the primary care provider.