Postpartum Hemorrhage & Uterine Changes

what is postpartum hemorrhage?

excessive blood loss in a woman after childbirth

what is primary postpartum hemorrhage?

within the first 24 hours after childbirth

what is secondary (delayed) postpartum hemorrhage?

occurs 24 hours to 6 weeks after childbirth

what is the mean blood loss with vaginal delivery?

500 cc

what is the blood loss with hemorrhage from vaginal delivery?

more than 1000 cc

what is the mean blood loss for a c section?

1000cc

what is the blood loss with hemorrhage with a c section?

more than 1500 cc 

what are prenatal risk factors for postpartum hemorrhage?

history of hemorrhage, pre-eclampsia, problems with placenta, obesity, nulliparity and multiparity, previous c-section, multiple gestation

what are intrapartum risk factors for hemorrhage?

interventions, prolonged labor, large fetus, chorioamnionitis, still birth

what is chorioamnionitis?

bacteria infection of the membranes and fluid surrounding fetus

what are the interventions are intrapartum risk factors for postpartum hemorrhage?

augmented labor, forceps or vacuum delivery, episiotomy, c section 

what are the 4 T’s of post partum hemorrhage?

tone, tissue, trauma, thrombin

what tone are we looking at in the 4 T’s?

uterine tone

what tissue are we looking at in the 4 T’s?

retained tissue such as placental

what trauma are we looking at in the 4 T’s?

lacerations and uterine rupture

what thrombin are we looking at in the 4 T’s?

bleeding disorders

what causes 70% of postpartum hemorrhage?

uterine atony

what can cause uterine atony?

uterus is not responding to oxytocin or lower level of it

what is retained placenta?

delay of placenta delivery 

what are risk factors for placenta retention?

prior C/S scar, most have now risk factors

what does traction on the umbilical cord cause?

tear and inversion of uterus

how is postpartum hemorrhage diagnosed?

physical exam, imaging and blood test s

what does treatment for postpartum hemorrhage based on?

severity of the bleeding 

what are treatment options for postpartum hemorrhage?

fluids, oxygen and resuscitation

bimanual uterine massage

trauma/surgical repair

meds

where is the fundus of contracted uterus?

immediately after placental expulsion it is at the umbilicus

where is the uterus 1 week postpartum?

descends into the cavity of the pelvis

what happens to the uterus 9 days postpartum?

regain previous non pregnant size 

when does menstruation begin?

without nursing 6-8 weeks, with nursing after it is concluded

what may cause pain of the uterus after delivery?

puerperal uterus tends to remain tonically contracted