Post Partum Hemorrhage

What is the leading cause of maternal morbidity and morality in the US

Post Partum Hemorrhage (PPH)

Criteria for PPH

blood loss >500 in vaginal

bloss loss >1000 in c-section

Hct decrease 10%

1st signs of PPH

• Maternal HR >110 BPM

• 15% drop in BP

• O2 less than 95%

How is blood loss quantified

Carefully weights the placenta basin and all bloody items

• Pads, linens, clothing

1 mL = 1 gram in fluid volume

Causes of PPH

• Lack of Uterine Tone (atony)

• Genital Trauma

• Retained placental fragments

• Infection

• Coagulation defects

Risk factors for PPH (uterine atony)

• Uterine Overdistension

• Prolonged labor

• Hx of uterine atony/PPH

• Trauma during birth

• Labor induction (oxytocin)

• Chorioamnionitis

• High Parity

• Retained fragments of placenta

• Anesthesia/Analgesia

  • Magnesium Sulfate

  • Nifedipine

Hallmark sign of Uterine Atony

Soft, boggy uterus filled with clots and blood

How will the feel upon palpation if the cause is trauma?

Firm and midline

Conditions that cause issues relating to maternal coagulation

• idiopatic thrombocytopenia

• HELLP syndrome

• Disseminated intravascular coagulation

• Von Willebrand disease

Treatment of Von Willebrand disease

• Desmopressin

• Plasma transfusion

• antihemophiliac factor

Signs of shock

• Restless

• Anxiety

• Pale

• Cool

• Clammy

• increase pulse

• tachypnea

• shaking

• low BP

Why is a full bladder and excessive amniotic fluid risk factors?

Cause uterine distention that interferes with contractions

S/S of hemorrhage

• Heavy bleeding

  • Large clots

  • >1 pad an hour

• Dizzy/lightheaded

• Boggy uterus

• High HR, Low BP

• Hypovolemia

How often is the fundus location and condition checked for the first post partum hour?

q 15 mins

Nursing Interventions

• MASSAGE THE FUNDUS!!!

• “I need a little help in here”

• Monitor Vitals

• Time it takes to saturate pad

• Assess LOC - (Restless?)

• Establish IV access with 2 large-bore needle (18 G or larger)

• Admin Oxytocic drugs

• Distended Bladder?

  • Foley Cath

• O2 @ 10-12 L/min

• Blood transfusion

• Fluid Replacement

• Methergine and Hemabate

How to Massage fundus

• Place one hand just above the symphysis pubis

• Place one hand on top of the fundus

• Only massage the fundus when it is not firm

• Apply slight downward pressure

Important safety consideration for PPH

If this happens while pt is out of bed MAKE SURE YOU RETURN THEM TO BED!!!