Chapter 23
Nursing Care of the Woman and Family Experiencing Postpartum Complications
Postpartum Hemorrhage
← Loss of more than 500mL of blood following vaginal childbirth or loss of more than 1000mL following cesarean birth
← Early postpartum hemorrhage
▪ >500 ml in first 24 hrs (blood loss often underestimated)
← Late or delayed
▪ >500 cc after first 24 hrs.
← Decrease in hematocrit of 10% or more since admission pr the need for blood transfusion
Etiology:
← Early postpartum hemorrhage:
o Uterine Atony
o Trauma to the birth canal
← Late postpartum hemorrhage
o Retained placental fragments
o Subinvolution or infection
Predisposing Factors
← Overdistention of the uterus (multiple gestation, large infant, hydramnios, uterine fibroids)
← Multiparity (5 or more)
← Maternal age over 30 years
← Precipitate labor
← Prolonged labor
← Use of assistive devices (forceps, vacuum extractor)
← Cesarean birth
← Manual removal of the placenta
← Previous postpartum hemorrhage
← Placenta previa or accreta, PROM, and retained placental fragments
← Drugs: oxytocin, prostaglandins, tocolytics or magnesium sulfate
← General anesthesia
← Chorioamnionitis
← Endometritis
← Clotting disorders
← Previous postpartum hemorrhage or uterine surgery
← Fetal death
← Disseminated intravascular coagulation
← Early postpartum hemorrhage: 4 main causes:
o Uterine Atony
o Lacerations
o Retained placental fragments
o Disseminated intravascular coagulation
← Late postpartum hemorrhage
o Subinvolution
o Perineal Hematomas
o Puerperal Infection
o Thrombophlebitis
o Mastitis
o Urinary System Disorders
o Cardivascular system Disorders
o Psychological complications of Puerperium
Early Postpartum Hemorrhage
Uterine atony
▪ Relaxation of the uterus
▪ Failure of the...