Question

Mrs. X, 36 year old women with obstetrical score G8P7 got admitted to the labor room in her active phase of labor at 39 weeks of gestation. She had a previous history of PPH. During this pregnancy she developed GDM. Labor progressed quickly as she is a grand multipara and a baby boy of 4 kg weight was delivered vaginally with vacuum assistance. She has an episiotomy too. Placental delivery followed in another 10 minutes. Patient already on oxytocin drip with 20 units diluted in RL solution timed at a rate of 125 ml/min. 20 minutes after delivery, Ms. X, passed large clots.

ASSESSMENT

1. What are the possible risk factors of PPH you would identify from the case study? List them.

2. Based on the observed risk factors and h/o of PPH, what immediate examination and interventions would you plan and why?

DIAGNOSIS

History:

On admission, the mother was in 39 weeks of gestation already in the active phase of labor. This is her 8th Gravida and already has 7 living children. Her past obstetrical history from the green card revealed severe PPH in the previous pregnancy 2 years back. In the current pregnancy she is diagnosed with GDM. As she was a grand multipara, the labor progressed quickly and she delivered a baby boy weighing 4 kg by assisted vaginal delivery (Vacuum) with episiotomy.

Examination:

Exactly 20 minutes after the delivery, it was observed that the Mrs. X, passed large clots with her BP going down steadily 100/60, pulse is 90 beats /min. But the patient hasn’t developed shock yet but likely to develop if not intervened immediately.

4. Based on this clinical scenario, frame the nursing diagnosis and your plan of care?

5. What would be the health education you would like to give to this patient?

Mrs. X, 36 year old women with obstetrical score G8P7 got admitted to the labor room in her active phase of labor at 39 weeks of gestation. She had a previous history of PPH. During this pregnancy she developed GDM. Labor progressed quickly as she is a grand multipara and a baby boy of 4 kg weight was delivered vaginally with vacuum assistance. She has an episiotomy too. Placental delivery followed in another 10 minutes. Patient already on oxytocin drip with 20 units diluted in RL solution timed at a rate of 125 ml/min. 20 minutes after delivery, Ms. X, passed large clots.

ASSESSMENT

1. What are the possible risk factors of PPH you would identify from the case study? List them.

2. Based on the observed risk factors and h/o of PPH, what immediate examination and interventions would you plan and why?

DIAGNOSIS

History:

On admission, the mother was in 39 weeks of gestation already in the active phase of labor. This is her 8th Gravida and already has 7 living children. Her past obstetrical history from the green card revealed severe PPH in the previous pregnancy 2 years back. In the current pregnancy she is diagnosed with GDM. As she was a grand multipara, the labor progressed quickly and she delivered a baby boy weighing 4 kg by assisted vaginal delivery (Vacuum) with episiotomy.

Examination:

Exactly 20 minutes after the delivery, it was observed that the Mrs. X, passed large clots with her BP going down steadily 100/60, pulse is 90 beats /min. But the patient hasn’t developed shock yet but likely to develop if not intervened immediately.

4. Based on this clinical scenario, frame the nursing diagnosis and your plan of care?

5. What would be the health education you would like to give to this patient?

Answer 1

Answer 1) Risk factors for PPH in this patient are grand multipara, large baby (4 kg), vacuum-assisted delivery, previous history of PPH, patient on oxytocin drip

.Answer 2)

Examination in this patient for PPH

Examination of placenta- To check for complete removal of placenta

Examination of v-a-g-i-n-a to check for vaginal tear.

Management of PPH

Manual removal of clots

Repair of the episiotomy incision

Inj oxytocin stat - to cause contraction of uterus which will reduce the bleeding

Balloon tamponade

If all above fails, then uterine artery embolization is done.

Answer 4) Nursing diagnosis - PPH

Plan of care of the patient:-

Once the PPH is controlled, the hemoglobin level of the patient will be checked. Based on the Hb level, the patient will be given blood transfusion or haematinics.

The patient will be given IV fluids to make up for the lost blood.

The patient will be examined for the repeat episode of bleeding

Care of episiotomy wound will be done.

Answer 4) Health education to the patient:-

To opt for sterilization or other methods of contraception

To consume iron-rich vegetables

Exclusive breast feeding the child for 6 months