POSTPARTUM HEMORRHAGE / UTERINE ATONY

INVOLUTION

Which term describes the process whereby the reproductive organs return to their nonpregnant state, involving the sealing of the placental site and reduction of the uterus to its pre-pregnancy size, and during which a woman is at risk of hemorrhage until the process is complete?

ACTIVE MANAGEMENT OF THE THIRD STAGE (AMTSL)

Which practice is used routinely to reduce the risk of postpartum hemorrhage through three steps, administration of uterotonics (e.g., oxytocin) to contract the uterus, early cord clamping, and controlled traction on the cord with uterine counter-pressure to deliver the placenta?

MECHANICAL HEMOSTASIS

Which postpartum process involves rapid uterine contraction that “pinches” the vessels at the placental site to stop bleeding?

CHEMICAL HEMOSTASIS

Which postpartum process involves thrombin converting fibrinogen to fibrin, forming clots that permanently seal the uterine sinuses?

POST-PARTUM HEMORRHAGE

Which condition is characterized by blood loss of 500 ml or more after vaginal birth (or 1000 ml after cesarean section), can occur early (within the first 24 hours) or late (24 hours to 6 weeks postpartum), and poses significant danger in the first 24 hours due to the unprotected uterine surface after placental detachment?

MULTIPLE GESTATION, HYDRAMNIOS, LARGE BABY (>9 LB), UTERINE MYOMAS

Which condition/s increases the risk of postpartum hemorrhage due to overdistension of the uterus, causing it to become lax and weakening the pelvic muscles?

OPERATIVE BIRTH AND RAPID BIRTH

Which condition/s increase the risk of postpartum hemorrhage due to cervical or uterine trauma, where scar tissue is less flexible than intact uterine walls?

PLACENTA PREVIA, PLACENTA ACCRETA, RETAINED PLACENTAL FRAGMENTS, PREMATURE SEPARATION OF PLACENTA

Which placental condition/s are risk factors for postpartum hemorrhage due to improper attachment or abnormal site of the placenta?

DEEP ANESTHESIA, INDUCED OR ASSISTED LABOR WITH OXYTOCIN, PREVIOUS UTERINE SURGERY, PROLONGED/DIFFICULT LABOR, MATERNAL AGE, CHORIOAMNIONITIS/ENDOMETRITIS, ANEMIA, HISTORY OF PPH, PROLONGED MAGNESIUM SULFATE OR TOCOLYTIC USE

Which increases the risk of postpartum hemorrhage because the uterus is unable to contract effectively?

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

Which condition increases the risk of postpartum hemorrhage due to systemic activation of blood coagulation, leading to microvascular thrombi and impaired clotting?

UTERINE ATONY

Which postpartum condition involves the failure of the uterus to contract after delivery and affects uterine involution?

FUNDAL MASSAGE

Which therapeutic intervention helps control postpartum hemorrhage by stimulating uterine contraction and promoting uterine tone and consistency?

CARBOPROST TROMETHAMINE

Which drug stimulates the myometrium to contract similarly to labor contractions and can be repeated every 15 to 90 minutes up to 8 doses?

METHYLERGONOVINE MALEATE

Which uterotonic acts directly on smooth muscle, increasing the tone, rate, and amplitude of rhythmic uterine contractions, and may be repeated every 2–4 hours up to 5 doses?

MISOPROSTOL

Which prostaglandin analogue binds to myometrial cells to cause strong contractions and is administered rectally if other methods are ineffective?

DIARRHEA AND NAUSEA

Which side effects are commonly assessed for after administration of prostaglandins such as misoprostol or carboprost tromethamine, and may require antiemetic therapy?

THEY MAY INCREASE BLOOD PRESSURE

Why must uterotonic medications such as methylergonovine and prostaglandins be used cautiously in women with hypertension?

ELEVATE THE WOMAN’S LOWER EXTREMITIES

Which intervention helps improve blood return to the heart in a woman experiencing uterine atony by using gravity?

TO ENSURE HER BLADDER IS EMPTYING AND AVOID INTERFERING WITH UTERINE CONTRACTIONS

Why should a woman with uterine atony be assisted to use the bedpan or bathroom every 4 hours?

ADMINISTER OXYGEN BY FACE MASK AT 10–12 L/MIN

Which action helps increase blood oxygen levels in a woman with uterine atony?

TO ALLOW ADEQUATE BLOOD FLOW TO THE BRAIN AND KIDNEYS

Why is the woman positioned supine (flat) during uterine atony management?

BIMANUAL COMPRESSION

Which procedure involves one hand on the abdomen and one hand in the vagina to compress the uterus and stimulate contraction?

BALLOON TAMPONADE

Which intervention uses a balloon catheter inflated with sterile water to apply pressure on the bleeding site, reducing blood flow and promoting clotting?

STABILIZE BALLOON PLACEMENT AND PREVENT INFECTION

What is the purpose of vaginal packing after balloon tamponade?

REPLACES BLOOD LOSS AND REQUIRES CROSSMATCHING BEFORE TRANSFUSION

Why is blood replacement important in postpartum hemorrhage management?

IRON THERAPY

Which intervention promotes hemoglobin production and improves oxygen-carrying capacity of red blood cells after postpartum hemorrhage?

EMBOLIZATION

Which procedure is used in severe bleeding to block pelvic or uterine blood vessels using a catheter with embolic agents?

UTERINE ARTERY LIGATION AND HYSTERECTOM

Which interventions are considered last-resort surgical management for uterine atony?

COMPRESSION → TAMPONADE → BLOOD → SURGERY

What is the correct sequence of interventions for managing uterine atony quickly?

LACERATIONS

Which postpartum condition involves tears of the birth canal that can lead to infection or hemorrhage and occurs most often in difficult or rapid labor, primigravidas, delivery of a large infant (>9 lb), or when instruments such as forceps or vacuum are used?

CERVICAL LACERATIONS

Which type of birth canal tear is usually found on the sides of the cervix near the branches of the uterine artery, can cause arterial bleeding with bright red blood gushing from the vaginal opening, and may lead to significant blood loss?

PERINEAL LACERATIONS

Which type of birth canal tear occurs in the perineum, the area between the vagina and rectum, and is more likely when the woman is in the lithotomy position during birth?

VAGINAL LACERATIONS

Which type of birth canal tear is a wound in the tissues of the vagina and is generally easier to locate and assess compared to cervical lacerations?

FIRST DEGREE

Which degree of perineal laceration involves only the skin of the perineum and vaginal opening, requires few or no stitches, and heals quickly with minimal discomfort?

SECOND DEGREE

Which perineal laceration involves skin and muscle (fascia), requires layer-by-layer suturing, causes moderate discomfort, and heals in a few weeks?

THIRD DEGREE

Which laceration involves vaginal tissue, perineal skin, and perineal muscles extending to the anal sphincter?

FOURTH DEGREE

Which perineal laceration extends through vaginal tissue, perineal skin, perineal muscles, and anal sphincter, causing severe pain and high risk of anal incontinence?

PERIURETHRAL TEAR

Which type of tear occurs near the top of the vagina close to the urethra, does not involve muscles, heals quickly, and may cause burning during urination?

EPISIORRHAPHY

What is the surgical repair of vulvar or perineal injuries, done by suturing the vaginal mucosa, muscle layer, and skin layer?

HIGH-FLUID DIET AND STOOL SOFTENERS

Which care measures help protect perineal sutures after episiorrhaphy?

HARD TIPS COULD OPEN SUTURES NEAR OR INCLUDING THE RECTAL SPHINCTER

Why should enemas or rectal suppositories be avoided in 3rd and 4th-degree lacerations?

RETAINED PLACENTA

Which postpartum condition occurs when part or all of the placenta is not delivered, preventing full uterine contraction and causing bleeding?

PLACENTA ACCRETA

Which type of retained placenta grows too deeply into the uterine wall and can cause severe postpartum hemorrhage if removed?

ABRUPT, HEAVY VAGINAL BLEEDING AND UTERUS NOT FULLY CONTRACTED

Which sign is commonly seen in a woman with retained placenta?

INSPECTING THE PLACENTA FOR COMPLETE COTYLEDONS

After birth, how can retained placental tissue be identified by inspection?

ULTRASOUND

Which imaging method can detect retained placental tissue in the uterus?

HCG BLOOD TEST

Which blood test may indicate the presence of remaining placental tissue after delivery?

STOP BLEEDING AND ALLOW UTERINE CONTRACTION

What is the main reason for removing retained placental fragments after birth?

D&C (DILATION AND CURETTAGE)

Which procedure involves dilating the cervix and scraping the uterine lining to remove retained tissue?

TO REMOVE RETAINED OR ABNORMAL TISSUE

What is the purpose of performing D&C for retained placenta?

METHOTREXATE

Which medication may be prescribed to destroy retained placental fragments by slowing or stopping cell growth?

BECAUSE HEMORRHAGE MAY BE DELAYED, LOCHIA CAN CHANGE BACK TO RUBRA

Why should the client monitor changes in lochia after retained placenta removal?

BALLOON OCCLUSION AND EMBOLIZATION OF THE INTERNAL ILIAC ARTERIES

Which interventions may be used for placenta accreta to minimize blood loss?

HYSTERECTOMY

Which surgical procedure may be performed as a last resort in cases of severe retained placenta or placenta accreta

NORMAL HEMOSTASIS

Which process strengthens the initial platelet plug at a bleeding site by producing a firm, fixed structure with fibrin threads?

THROMBIN

Which enzyme activates fibrinolysin, digests excess fibrin threads, and produces fibrin degradation products (FDPs) to prevent over-clotting?

DIC

Which condition is characterized by systemic activation of blood coagulation, leading to fibrin deposition in organs, microvascular thrombi, and multiple organ dysfunction?

PLATELETS AND FIBRIN ARE USED EXCESSIVELY AT BLEEDING SITES, LEAVING THE REST OF THE BODY DEFICIENT

What happens in DIC that causes systemic bleeding defects?

HEPARIN

Which anticoagulant prevents formation of new clots and extension of existing clots in DIC management?

TO REPLACE LOST PLATELETS AND ENSURE NEW PLATELETS ARE NOT CONSUMED BY ONGOING COAGULATION

Why are platelets transfused after heparin therapy or bleeding in DIC?

BONE MARROW

Where are platelets (thrombocytes) formed in the body?