PPH
> 1000 ml lost or s/s hypovolemia (tachy/hypo)
ealy <24 hr
tone, trauma, tissue, thrombin
atony is leading cause- FIRST ACTION- fundal massage
late 24h-6w
usual cause is infection, subinvolution, and retain placental
risk factors
obesity, multiple births, multipara, blood clotting disorder, infection, prolonged labor, use of assistive devices (forceps/vacuums)
uterine atony cause
-PRIMARY cause of PPH
failure of uterus contraction following deliver
RISK- prolonged labor, polyhydram, multiple gestation, mag sulfate
retained placental frag
failure of placental delivery within 60m of fetus (incomplete)
RISK- previous c/s
uterine trauma cause
use of instruments such as forceps/vacuum or manual removal
Pt feels a sudden gush of blood
-assess pad, clot, last pad change before calling for help
-bladder distention: PPH or impedes decent of labor
desired outcome of PPH
maintain fluid balance/VS
-hemodynamically stable - tissue perfusion/VS
- return uterine function - effective uterine cxn/monitor bleeding
- restoration blood volume - transfuse, labs
- prevention of complications - address PPH, DIC, infection
- Psychosocial support- emotional support to family
TX PPH
- uterine massage/contraction - breast feeding
- empty bladder- straight cath
- contact provider/RRT- early activation
- advocate for pain/medication - prior express clots
- administer uterotonic medication - oxytocin, methergine (not HTN), hemabate (not asthma
- fluid replacement - as indicated
- surgical intervention - deep laceration, conservative measure (NEED informed consent)
- Bakri/Jada - tamponade/suction
- psychosocial support- reassure, clear communication
- debrief - improve their response
When doing manual exam
Nurse advocate for pain relief
