Postpartum hemorrhage

early PPH

heorrhage within the first 24 hours postpartum

1000mL

excessive bleeding is more than:

500mL

blood loss after birth should be less than

late PPH

hemorrhage after 24 hours

four Ts

1. tone

2. tissue

3. trauma

4. thrombin

four factors/causes of PPH

uterine atony

most common cause of PPH

Macrosomia

big baby, often seen in diabetic mothers

4500 grams

macrosomia babies weigh over:

overstretching of the uterus and not going to retract

how can polyhydramnios cause abnormality of uterine tone

Past fourr babies, the uterus is overworked, tired, and cannot contract

How does high parity cause abnormality in uterine tone?

the uterus can be contracting for days and gets tired.

How does prolonged labour cause tone abnormalities?

1. polyhydramnios

2. multiple gestation

3. macrosomia

4. rapid labour

5. prolonged labour

6. high parity

causes for uterine atony:

if there are missing parts of the membranes then there could be some left behind. Anything left behind stops the uterus from clamping down.

why is it important that the placenta is intact when it is delivered?

The placenta will not separate like normal and will hang on causing great bleeding.

How does an invasive placenta cause PPH?

women over 35

invasive placentas are seen more in:

1. birth by c-section

2. hysterectomy

if placenta is invasive, what happens next? [2]

placenta previa

placenta attaches either totally across or near the internal oss of the cervix

uterine inversion

pulling on the cord before the placenta separates. Will see a grey-blue mass sticking out of the vagina

uterine surgery or after c-section

uterine rupture is seen when?

instrumental births

lacerations are typically caused by

precipitous births

when baby is more quickly and the head is not controlled on the way out. Pops out, can have tearing

1. lacerations of cervix, vagina, perineu,

2. hematoma

3. uterine inversion

4. uterine rupture

examples of trauma that can cause PPH [4]

1. hemophilia A

2. Von-willebrands

pre-existing conditions that cause clotting factor deficiencies. Should know about conditions prior to birth. [2]

the cause

treatment for PPH depends on

firm up

when you massage the fundus, it should

IV oxytocin and misoprostol

if PPH is related to a problem with uterine tone, the first treatment will be:

misoprostol

Prostaglandin analogue that causes uterus to cla,p down and vasoconstrict

Ergometrine

A smoothmuscle contractor that makes the whole uterus just clamp right down

After oxytocin and misoprostol are not sufficient

When would ergometrine be given?

Bakri balloon

balloon filled with sterile water than occludes bleeding by applying pressure. Stays in place for 24 hours

every 5 minutes

how often to assess having PPH

1. S+S of shock

2. vitals

3. o2 sats

4. LOC

5. color

6. intake and output (blood included)

what to monitor when Bakri balloon is in [6]

give general to relax muscles and replace it into the pelvic cavity as quick as possible. May require meds to clamp it down.

how to replace uterine inversion:

the incision is low in the uterus, that area is weakened

why would c-section oms ave weakened area in uterus?

1. cannot give birth vaginally

2. advise getting pregnant again

after several c-sections, what are moms advised for future?

fetal heart drops

first sign of uterine rupture

uterine rupture from weakened area

Multiple c-section moms are more at risk for:

1. bright red bleeding

2. tenderness and pain in ruptured area

3. her heart rate increases

Signs of uterine rupture: [3]

1. trial of labour after c-section (TOLAC)

2. vaginal birth after caesarian (VBAC)

trying for vaginal delivery after c-section

Dilation and cutterage (D+C)

OR procedure for manual removal of pieces of placenta

at the birth of the anterior shoulder of the baby

When do women get injection of oxytocin?

Dissiminated intravascular coagulation (DIC)

Clotting is not able to keep up with bleeding.

bleeding from gums, IV sites, folet catheter sites, lochia has tiny red dots or clots.

signs of DIC:

1. bleeding too much

2. stillbirth and not realize

3. miscarriage and not all products are evacuated

Causes of DIC

placental abruption

When the placenta decides to separate from uterine wall before birth

emergency C-section

placenta abruption next steps:

–Massage fundus

–Expel clots

–Ensure empty bladder

–Replace fluid ; IV

–Administer medications

–Assist with suturing

–Prepare for OR

nursing care for post partum hemorrhage [8]