Question

What are the risk factors for postpartum hemorrhage?

What are the causes of uterine atony?

What uterotonic drugs are used to manage postpartum hemorrhage?

What are the noninvasive assessments of circulatory status in postpartum patients who are bleeding?

Of the four nursing diagnoses for postpartum hemorrhage (deficient fluid volume, ineffective tissue perfusion, anxiety, and infection) place them in priority order and list the four priority nursing interventions for each one.

What is the possible result of unmanaged postpartum hemorrhage and what are the emergency interventions if this occurs?

Answer 1

Risk factors for post partum haemorrhage

Before birth:

• Placenta previa, abnormal placentation
• Placental abruption
• Previous caesarean section, uterine surgery
• Twins or triplets
• Pre eclampsia
• Anemia
• Fibroids
• Blood clotting disorders
• Use of anticoagulants
• BMI>35

After birth:

• Induction and augmentation of labour
• Delivery by Caesarean section
• Long labour more than 12 hours
• Delay in delivery of placenta

Uterine atony or loss of uterine tone is the leading cause of post partum haemorrhage.The causes are:

• Overdistension of uterus
• Prolonged labour
• Intra amniotic infection
• Multiple gestations
• Polyhydramnios (excess amniotic fluid in the amniotic sac)
• Fetal macrosomia (newborn much larger than average)
• Halogenated anesthetics

Magnesium sulfate treatment of pre eclampsia.

Uterotonic Drugs used for the management of postpartum haemorrhage are:

Oxytocin is the first choice for the treatment and prophylaxis of uterine atony

Ergot alkaloids are the second line of medication. These include ergonovine and methylergonovine. These are not used in case of hypertensive patients.

15 methyl prostaglandin F 2 alpha can be used to treat refractory cases.

Misoprostol another prostaglandin is also used.