Postpartum Hemorrhage
The 4Ts.
What are tone, tissue, trauma and thrombin disorders?
Infection of the endometrium, myometrium, or parametrial tissue decidua (uterine lining).
What is endometritis?
Firm uterus with continued bleeding.
What is a s/s of a perineal laceration?
When lochia progresses to alba and then returns to rubra and uterus does not decrease in size or descend.
What is subinvolution?
Symptoms disappear WITHOUT medical intervention.
What is postpartum blues?
Heavy bleeding with clots and a boggy uterus that does not respond to interventions could indicate this.
What is retained or abnormal placenta?
Tender breast that are warm to touch causing patient to feel malaise, swelling/hardness, burning while breastfeeding, wedge-shaped redness and fever of 101 or greater.
What is mastitis?
This may be vulvar, vaginal, cervical or retroperitoneal.
What is a hematoma?
10% decrease in hgb/hct
saturation of peripad in 15 minutes
boggy fundus even after massage
tachycardia (late sign)
decrease in BP (late sign)
What is primary postpartum hemorrhage?
Can occur up to 12 months after delivery.
What is postpartum depression?
This one of the 4Ts requires the nurse to assist the uterus to contract, monitor bleeding, maintain fluid balance, monitor vital signs and labs, administer O2 and keep patient warm.
What is tone (uterine atomy)?
To help prevent this, the nurse should: assist the patient to void within a few hours of birth and catheterize them if they are unable to; remind the patient to void every 3-4 hours, measure voiding for first 24 hours, change peripads every 3-4 hours, encourage 2L of water per day, and encourage foods that increase urine acidity: cranberry juice, apricots, and plums.
What is urinary tract infection?
This one of the 4Ts includes lacerations and hematomas.
What is trauma?
This complication is divided into 4 categories:
Asymptomatic type
Bleeding type
Massive bleeding type
Organ failure type
What is disseminated intravascular coagulation (DIC)?
Requires psychiatric interventions and mother is unable to care for herself or her baby.
What is postpartum depression?
The amount of blood loss used to define hemorrhages for vaginal and cesarean deliveries.
What is 500mL and 1000mL, respectively?
The following sites could result in this if not properly assessed and monitored:
cesarean incision
episiotomy
perineal laceration
What is a wound infection?
Steady trickle of unclotted, bright red blood.
What is a s/s of a laceration?
Hypoxia that results from: acute lung injury, transient pulmonary hypertension, hypotension, cardiac arrest or coagulopathy which can lead to rapid death.
What is anaphylactoid syndrome of pregnancy or amniotic fluid embolism?
Should receive patient education regarding postpartum blues, depression, and psychosis.
Who are the patient and their support person or significant other?
Postpartum hemorrhage patients are treated with this two-pronged approach.
What is:
1) resuscitation and management of the hemorrhage
2) identification and management of the underlying cause
The appropriate way to assess a wound for infection.
What is REEDA?
Firm uterus, sudden onset of painful perineal pressure, bulging area under the skin and difficulty voiding or sitting.
What are s/s of a hematoma?
A patient who shows s/s of DIC, oozing from IV sites, nosebleeds, petechiae, bleeding gums, hypotension, signs of shock, abnormal clotting lab values is suffering from this.
What is a thrombine disorder?
Women who have or have a family history of bipolar disorder or affective disorder are at higher risk for this.
What is postpartum psychosis?