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1he Coal of LreaLmenL ls Lo correcL Lhe underlylng cause whlle aLLempLlng Lo conLrol Lhe hemorrhage and reduce
lL's effecLs on Lhe woman



















Woman is suspected to experience postpartum hemorrhage (Blood loss oI more
than 500 ml), Soaked Perineal pads with blood (2 or more every hour)
EARLY ASSESSMENT and
RECOGNITION
a. Occurrence
b. Condition/ Placement oI the Uterus
c. Characteristics oI lochia
d. Characteristics oI pain
e. Other signs and symptoms


8leedlng occurs wlLhln 24 hours of dellvery 8leedlng occurs afLer Lhe 24 hours afLer dellvery
up Lo 6week posLparLum perlod















Early postpartum
hemorrhage
Late postpartum hemorrhage
-boggy Iundus and high,
moderate to heavy
lochia (when a perineal
pad Iills up with blood
in less than 1 hour), no
pain present,
tachycardia,
hypotension and other
signs oI hypovolemic
shock iI blood loss is
severe.
-normal condition and
placement oI uterus,
heavy bleeding (2 or
more perineal pads Iills
up with blood in less
than 1 hour), bright red
in color, bleeding
continues in a steady
trickle or Ilow, constant
pain, bruising may be
apparent.
- normal condition and
placement oI uterus, normal
characteristics oI lochia,
pressure and severe pain at
the site (perineal
hematoma), deep pain
unrelieved by comIort
measures or medications
(deep pelvic hematoma),
swelling and dark red or
purple discoloration oI
perineum, accompanied by
instability oI BP, pulse, hgb
and hct.
1 and 5 Multiparity, Intrauterine
inIection, Previous uterine
surgery, Prolonged or diIIicult
labor, Hx oI postpartum
hemorrhage, use oI tocolytics
during labor, overdistention oI
uterus.
2 and 3. Episiotomy,
Macrosomia, Precipitous labor,
Traumatic delivery, Use oI
Iorceps or vacuum extraction Ior
delivery.
4.Abruptio placentae, placenta
accrete, prolonged third stage
labor
Uterine Atony
Laceration Hematoma
-slightly boggy Iundus but oIten Iirm when
massaged, intermittent clots on perineal
pads, pain is intermittent or heavier than
normal cramping, portions oI maternal
surIace oI placenta are missing
-Iirm Iundus when palpated but
Ioggy short time later, Initially
lochia Ilow normal, and
increases over what is expected,
pain may be absent or there
may be constant cramping,
backache may be present,
dizziness, lightheadedness,
Iatigue, Iever and other signs oI
inIection may be present.
Retained
placental
Fragments
Uterine
Subinvolution
Elevated Serum HCG,
ULTRASOUND will
reveal evidence

Decreased in HGb
and Hct level.
lf uLerlne aLony Lhen lf hemaLoma ls presenL
lf laceraLlon ls Lhe cause



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Fundal massage
Drug therapy
(Oxytocic Agents)
BIMANUAL
COMPRESSION
UTERINE
PACKING or
UTERINE
ARTERIAL
EMBOLIZATION
OR LIGATION
TOTAL
HYSTERECTOMY
is the last option.
Applying pressure to
the lacerated area
until sent to OR/DR
SURGICAL REPAIR OF
THE LACERATION IS
THE ONLY OPTION.
SUTURING!!!
For large hematomas
, SURGICAL
INCISION, WITH
DRAINAGE AND
EVACUATION OF
CLOTS AND
LIGATION OF THE
BLEEDING
VESSEL may be
required.
Small hematomas
usually require no
additional treatment
other than
application oI ice
and analgesics to
control pain.
Drug therapy
(Oxytocic Agents)
Prepare woman Ior
SURGERY!
DILATATION AND
CURRETTAGE
Follow up to the physician must be emphasized, Health
teaching is crucial, EMOTIONAL Support is needed ,
Continuity oI care is a must!

GOAL and EXPECTED OUTCOME OF

NURSING MANAGEMENT:
a. The woman will demonstrate
evidence oI Iluid balance, will
remain Iree oI injury, will exhibit
signs oI adequate tissue perIusion.





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1WC WA?S
II the woman experiencing postpartum
hemorrhage is assessed and managed
properly, identiIied and treated the
underlying cause correctly, there is
cooperation oI the patient, coordination oI
the members oI the health care team
FOLLOW UP TREATMENT by patient,
POSITIVE ATTITUDE then;
II the patient is not managed correctly, No
treatment is done, Not identiIied the cause
early, then,

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