Question

The nurse notices a postpartum patient's lochia is very heavy. Describe how you would assess vaginal bleeding, signs and symptoms of postpartum hemorrhage, and any interventions that the nurse might anticipate.

Answer 1

Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 1 to 5 percent of women have postpartum hemorrhage and it is more likely with a cesarean birth. Hemorrhage most commonly occurs after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well.

Once a baby is delivered, the uterus normally continues to contract (tightening of uterine muscles) and expels the placenta. After the placenta is delivered, these contractions help compress the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, called uterine atony, these blood vessels bleed freely and hemorrhage occurs. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta remain attached, bleeding is also likely.

The following are the most common symptoms of postpartum hemorrhage. However, each woman may experience symptoms differently. Symptoms may include:

• Uncontrolled bleeding

• Decreased blood pressure

• Increased heart rate

• Decrease in the red blood cell count (hematocrit)

• Swelling and pain in tissues in the vaginal and perineal area, if bleeding is due to a hematoma

Nurses also need to intervene early or during the course of a hemorrhage to help the patient regain her strength and vitality. The data that the nurse would give would be essential in the care of the patient with hemorrhage

Nursing Assessment

• Assess the amount of bleeding.
• Assess maternal vital signs to establish baseline data.
• Assess for signs of shock.
• Assess the condition of the uterus

Nursing Interventions

• Save all perineal pads used during bleeding and weigh them to determine the amount of blood loss.
• Place the woman in a side lying position to make sure that no blood is pooling underneath her.
• Assess lochia frequently to determine if the amount discharged is still within the normal limits.
• Assess vital signs, especially the blood pressure

Evaluation

• Maternal blood pressure is higher than 100/60 mmHg.
• Pulse rate is within the normal range of 60-100 beats per minute.
• Flow of lochia is less than a saturated pad per hour.

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