Question

Case Study, Chapter 1, Bess Gaskell: Immediate Postpartum Hemorrhage Morgan Logan is a 37-year-old single mother of five who just delivered her sixth baby. She did not know she was pregnant because she was busy working and caring for her five young children at home. Additionally, she is moderately obese and thought she was just putting on more weight. Morgan did not seek medical care until her last trimester. Her labor was uneventful, but at delivery, the doctor was concerned that there may have been a small piece of the placenta that retained. He encouraged the nurses in the postpartum unit to keep a close eye on Morgan and alert him of any significant issues regarding her postpartum stay. Four hours after arriving on the maternity floor, Morgan felt “a huge gush of blood when she stood up.” She passed a clot the size of an orange. The nurse massaged her fundus and called the doctor immediately. The hemorrhage was controlled, and no further issues were noted. The day after delivery, Morgan remained perplexed as to why she began to hemorrhage. She blames herself and her busy lifestyle and is feeling terrible about putting herself, the family, and—most importantly—her newborn at risk. (Learning Objectives #1 and #6)

1. Morgan asks the nurse what she could have done differently, or what she could do in the future, to prevent a postpartum hemorrhage. How should the nurse answer Morgan’s questions about postpartum hemorrhage and preventative measures?

2.Identify some ways that the postpartum nurse can help Morgan most effectively cope with her current hospital experience.

Answer 1

Answer to Question No. 1

Postpartum hemorrhage is caused due to trauma, placental abnormalities or retained placenta, uterine atony and coagulopathy. The risk factors also include multiple pregnancies, maternal obesity, labor induction, older age, and non-use of oxytocin for prophylaxis.

The retention of small piece of placenta is the cause for the hemorrhage in Morgan’s case. The prevention of postpartum hemorrhage includes the active management of third stage of labor, use of misoprostol. Use of oxytocin after delivery is the most effective to prevent or reduce hemorrhage.

Also the nurse should educate Morgan about seeking medical attention during pregnancy to watch over other symptoms such as obesity, anemia that can cause postpartum hemorrhage.

Answer to Question No. 2

The postpartum hemorrhage can be treated by the following:

• Uterine massage helps in contraction of the uterus and reduces bleeding.
• Administration of intravenous Oxytocin or Ergotamine helps uterus to contract for longer time.
• Manual removal of the placenta using appropriate analgesia.
• Replacement of the lost blood and fluids is essential to prevent shock.
• In more serious cases Laparotomy or Hysterectomy may be required.
• Postpartum hemorrhage can be serious if not detected and treated accordingly.