Etiology:

4T’s

 Tone: uterine atony

 Tissue: retained placenta
 Trauma: lacerations, uterine rupture
 clotting: coagulopathy
What causes Atony of the Uterus?

 Prolonged labor
 Very rapid labor
 Overdistention of the uterus, or excessive enlargement of the uterus
 The use of oxytocin (Pitocin) or other drugs or general anesthesia during labor
 Induced labor

Risk Factors:

 Conditions that distend the uterus beyond average capacity. Multiple gestations, hydramnios, a
large baby, and the presence of uterine myomas predispose to postpartum hemorrhage
 Conditions that could have caused cervical or uterine lacerations. A woman who underwent
operative birth or rapid birth could develop lacerations that would cause bleeding
 Conditions with varied placental site attachment. Placenta previa and abruption placenta also
cause heavy maternal bleeding
 Uterus could not contract readily. Conditions such as deep anesthesia during cesarean delivery,
advanced maternal age, and high parity could cause the uterus not to contract and therefore
result in bleeding.

Nursing Assessment:
  Assess the amount of bleeding
 Maternal vital signs to establish baseline data
 Signs of shock
 Condition of the uterus

Nursing Diagnosis:

 Deficient fluid volume related to excessive bleeding after birth

Outcome Evaluation:

 If the uterus suddenly relaxes, there will be an abrupt gush of blood vaginally from the placental
site. This can occur immediately after birth but is more likely to occur gradually, over the first
postpartum hour, as the uterus slowly loses its tone
 If the loss of blood is extremely copious, a woman will quickly begin to exhibit symptoms of
hypovolemic shock such as a falling blood pressure; a rapid, weak, or thread pulse; increased
and shallow respirations; pale, clammy skin; and increasing anxiety.
 If the blood loss is unnoticed seepage, there is little change in pulse and blood pressure at first
because of circulatory compensation. Suddenly, however, the system is able to compensate no
more, and the pulse rate rises rapidly and becomes weak.
 Blood pressure then drops abruptly. With slow bleeding, a woman develops these symptoms
over a period of hours; the end result of continued seepage, however, can be as life threatening
as a sudden profuse loss of blood
 It is difficult to estimate the amount of blood a postpartum woman is losing because it is difficult
to estimate the amount of blood