Pestano, Gia Selena L.

April 13,2020
BSN 2y2-2 NCMA 219 LEC

1. What is the most common cause of early postpartum hemorrhage? Describe the
pathophysiology of this cause of haemorrhage?
The most common cause of post-partum haemorrhage is Uterine Atony, i.e.
failure of the uterus to contract. Primary post-partum hemorrhage due to uterine atony
occurs when the relaxed myometrium fails to constrict the blood vessels that traverse its
fibers, thereby allowing hemorrhage. Since up to one-fifth of maternal cardiac output, or
1000 ml/min, enters the uteroplacental circulation at term, post-partum hemorrhage can
lead to exsanguination within a short time.
Failure of the uterus to contract may be associated with retained placenta or
placental fragments, either as disrupted portions or, more rarely, as a succenturiate
lobe. The retained material acts as a physical block against strong the uterine
contraction which is needed to constrict placental bed vessels. In most cases, however,
dysfunctional postpartum contraction is the primary reason for placental retention. It is
more likely for the placenta to be retained in cases of atonic PPH, and so the
contraction failure often becomes self-perpetuating. The reasons for this contractile
dysfunction are unknown. The exception is uterine fibroids, where the source of
distension cannot be removed by uterine contraction, and must therefore cause the
atony. However, the uterus does not even have to be distended during the third stage
for contractile dysfunction to occur. Distension prior to delivery, which occurs with
multiple pregnancy and polyhydramnios, also affects the ability of the uterus to contract
efficiently after delivery, and is thus another risk factor for atonic PPH

2. How will the nurse recognize uterine atony?

Uterine atony is prompted typically by finding of more than usual blood loss
during examination demonstrating a flaccid and enlarged uterus, which may contain a
significant amount of blood. With focal localized atony, the fundal region may be well
contracted while the lower uterine segment is dilated and atonic, which may difficult to
appreciate on abdominal examination, but may be detected on vaginal examination. A
digital exploration of the uterine cavity (if adequate anesthesia is available), or bedside
obstetric ultrasound imaging to reveal an echogenic endometrial stripe is an essential
examination, as is a timely examination with adequate lighting to exclude an obstetric
laceration.

3. What signs typically distingush postpartum hemorrhage caused by uterine atony from
hemorrhage caused by lacerations of the birth canal?
Uterine atony is caused by the relaxation of the uterus seen on the outside upon
examination. Although both are causes of haemorrhage the diagnosis for both varies.
Pestano, Gia Selena L. April 13,2020
BSN 2y2-2 NCMA 219 LEC

4. How do the signs and symptoms of a hematoma differ from those of uterine atony or
a bleeding laceration? 
Hematoma caused by uterine atony can only be halted thru the constriction of the
uterus which can be done with the massaging of the uterus or stimulating natural
oxytocin and having an order from the physician to administer oxytocin. While after
careful inspection of the vagina a laceration can be found and depending on the severity
of the laceration usualy suturing is not required.