Postpartum Complications and Care

Postpartum Complications and Infections

Trauma-Related Postpartum Hemorrhage

• Definition: Postpartum hemorrhage caused by trauma, typically involving lacerations or an episiotomy (surgical incision to the perineum), but can also occur to the vaginal wall or cervix.
• Assessment Findings:
  • Fundus is firm, midline, and appropriate for the postpartum day (e.g., not boggy).
  • Despite a normal fundal assessment, there is heavy or excessive bleeding.
    • Heavy bleeding: Saturating a pad in less than 2 hours (reported on page 464 of the book).
    • Excessive bleeding: Saturating a pad in less than 15 minutes (reported on page 464 of the book).
• Nursing Action: Call the doctor immediately. There is nothing a nurse can do for a firm fundus with excessive bleeding; massaging a firm fundus is ineffective and pointless ("beating a dead horse"). The issue is internal bleeding, not uterine atony.
• Bleeding Characteristics: Presents as a continuous trickle of bright red blood, resembling a