Question

Becky is a 33 year old woman. She is a G4 P3. She had a spontaneous vaginal delivery of a 4100 live female 4 hours ago following a precipitous delivery. Post-delivery, she received 10u of Pitocin IM. Her perineum is intact and she is feeling good. She breastfed her infant after delivery for 20 minutes without any issues. In the postpartum unit her fundus is firm at the umbilicus, her lochia is small to moderate. V.S. are stable. She rings her call bell and states "I feel dizzy and lightheaded". Upon entering the room, Becky is pale and there is a pool of blood on the floor. What are 4 interventions that the nurse should do? What are the risk factors for postpartum hemorrhage? What medical management should be initiated? Develop one nursing diagnosis and 3 nursing interventions for a patient experiencing a postpartum hemorrhage.

Answer 1

Answer =

Postpartum hemorrhage ( PPH ) = It is related to the amount of blood loss in excess of 500 ml following birth of the baby . It may be usefull for statistical purposes .As the effect of the blood loss is important rather than the amount of blood lost,

Clinical defination of PPH = Any amount of bleeding from or into the genital tract following birth of the baby up to the end of the puerperium which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure is called postpartum hemorrhage.

Postpartum Hemorrhage causes =

1. Atonic uterus = Atonicity of uterus is the most common cause of PPH.

2. Traumatic = Blood loss from episiotomy , or cesarian section.

3. Retained tissues .

4. Blood coagulopathy.

5. Percipitate labor.

6. Mismanaged of third stage of labor .

7. Prolonged labor.

8. Antepartum hemorrhage .

* Prevention =

- Improvement of the health status = In postpartum hemorrhage we should improve fist health status of female and improve hemoglobin of female .

- Active management of the third stage of labor for all women in labor should be a routine as it reduces PPH by 60 % .

Management of Postpartum Haemorrhage =

* The first step is to control the fundus and to note the feel of the uterus .

- Atonic uterus = - A. Massage the uterus to make it hard and express the blood clot.

- B. Methergine 0.2 mg is given intravenously .

C. Injection Oxytocin dirp is started 10 unit in 500 ml NS at the rate of 40-60 drops per minute but this female already infused with oxytocin so no need to again.

D. Injection 15 methyl PGF 2 alpha 250 mu gram IM in the deltoid muscle every 15 minute upto maximum 2mg.

E. When uterine atony is due to tocolytic drugs ,calcium gluconate 1g iv slowly should be given to neutralize the calcium blocking effect of these drugs.

F. Bimanual compression of the uterus and uterine temponade also is a good management of PPH.

* 4 Intervention with this lady =

1. To assess the amount of blood loss and to replace it.

2. To find out the cause and to take appropriate steps to rectify it.

3. To administer antibiotic ( clindamycin and metronidazole )

4. Provide the fundus massage to the patient is the good management of PPH.