POSTPARTUM BLEEDING

 Any blood loss from the uterus greater than 500 mL

o EARLY - Within the first 24 hours
o LATE - Anytime after the first 24 hours
 Leading cause of maternal mortality

1. EARLY POSTPARTUM HEMORRHAGE - b leeding within 1st 24 hrs.

CAUSES OF EARLY POSTPARTAL HEMORRHAGE

Uterine atony
Lacerations
Disseminated intravascular coagulation
Hematoma

Uterine Atony - boggy or relaxed uterus & profuse bleeding

• Predisposing factor - overstretched uterus
• Management:
a. Massage the uterus
b. Modified trendelenberg
c. IV fast drip/ oxytocin IV drip
d. Breast feeding – post pit gland will release oxytocin so uterus will contract.

Lacerations = well contracted uterus + bleeding

• assess perineum for laceration

• degree of laceration
1. Cervical
2. Perineal
CLASSIFICATION OF PERINEAL LACERATION
1ST DEGREE - Vaginal skin & mucus membrane
2ND DEGREE - 1st degree + muscles of vagina
3RD DEGREE - 2nd degree + external sphincter of rectum
4TH DEGREE - 3rd degree + mucus membrane of rectum
Management: Episiorrhapy
3. Vaginal

Disseminated intravascular coagulation - Deficiency in clotting ability caused by vascular injury.

Management: Blood transfusion

LATE POSTPARTUM HEMORRHAGE

Subinvolution

• retained placental fragments leads to subinvolution – incomplete return of the uterus to its
prepregnant size and shape
Management :
• Dilatation and Curettage (D&C) except placenta increta, percreta
Acreta – attached placenta to myometrium.
Increta – deeper attachment of placenta to myometrium
Percreta – invasion of placenta to perimetrium
• manual extraction of fragments
• massaging of uterus.

NURSING MANAGEMENT

ASSESSMENT

• Excessive uterine bleeding during the first hour following delivery and during the postpartum
period
• Blood loss greater than 500 mL
• Signs of hypovolemic shock (Cold skin, confusion, pallor, anxiety, decrease in urine output,
general weakness, tachypnea, falling unconscious, moist skin and increased sweating)
• Signs of bleeding from unrepaired laceration
• Signs of bleeding from uterine atony

NURSING CARE – early

• Monitor vital signs, check the fundus and lochia every hour
• Monitor level of consciousness
• Keep the bladder empty
• Anticipate ↑ Pitocin IV infusion or administration of ergot prep. IM
• Estimate blood loss by pad count
• Monitor I & O

NURSING CARE – late

• Anticipate hospitalization
• Type and cross match blood
• Anticipate Pitocin IV infusion or administration of ergot prep. IM
• Admin antibiotic
• Keep warm and be alert to any s/sx of shock
• D&C
• Prepare for surgery