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Module 5 - Hemorrhag


What is the #1 cause of maternal mortality worldwide? Postpartum Hemorrhage
Past definition of postpartum hemorrhage blood loss >500 cc vaginally;blood loss > 1000cc C/S
Current definition of postpartum hemorrhage Any amount causing hemodynamic instability Drop in Hct by > 10% Loss of > 15% total blood volume
Excessive blood loss in first 24 hours post birth is _________ hemorrhage. Evidenced by _______ _______,___________,____________ and _______ _________ Early. Uterine atony, lacerations, hematomas and placental fragments.
Excessive blood loss after the first 24 hours post birth (up to 6 wks post birth)is ________ hemorrhage. Evidenced by _________ ________ ________ & ____________. Late. Retained placental fragments & subinvolution.
Causes of postpartum hemorrhage are the 4 "T's" - name them. 1. Tone - uterine muscle atony (50%) 2. Tissue placental or endometrial. 3. Trauma - C/S or genital tract 4. Thrombosis - coagulation
Pathophysiology of postpartum hemorrhage is determined by the __________ of blood loss. amount
Moderate blood loss may result in _____________. Lab test would show a ______ ___________ anemia lowered hct/hgb
Severe blood loss may result in __________ __________ or ____________. Pulse would be __________&_______. BP would be_________, Respirations would be _________&_____ , Skin would be ________, urine output would ________ and LOC would ____________. hypovolemic shock or death. tachycardic &weak pulse. hypotensive BP, rapid & shallow respirations. clammy skin,decreased urine output (oliguria) LOC would change.
True or False. A woman with no identifiable risk factors may hemorrhage after child birth. True
Predisposing factors for Atony include : overdistention of uterus, bladder distention, prolonged labor, oxytocin use, Multiparity, anesthesia or tocolysis, prolonged 3rd stage, preeclampsia, operative birth, retained placenta, placenta priva
How does the nurse manage Atony? Massage fundus, express clots AFTER fundus is firm. Pad count, increase IV, O2 at 2-3 liter, reposition.
Once bleeding stops how often should the nurse reassess ? q 5-15 minutes if bleeding stopps
Who performs a bimanual compression? Medical doctor
What is needed for Atony management ? 1. Bloodwork for Hct/Hgb 2. Uterine stimulants 3. IV fluids / possibly blood 4. Catheterization to monitor U/O 5. Provide adequate rest. 6. Hysterectomy as last resort.
_________ is an IV Med for Atony of uterus. It may cause ___________. Oxytocin @ 50 mu/min rapid IV infusion will cause hypotension.
Name 3 IM meds for Atony of uterus Methergine (contraindicated with HTN) Ergotrate Hemabate
Cytotec(rectal)and Prostin E2(vaginal) are suppository for _______________ uterine atony Prostin E2 is contraindicated if woman is hypotensive
Which Atony Medication should not be used if the woman is hypertensive ? Methergine
A side effect of prostaglandins is __,____&____ nausea, vomit, diarrhea.
A pp Laceration is a tear that involves the _______, _____,______,_____,or ______. cervix, vagina, perineum, rectum or urethra
name 5 Predisposing factors for a laceration Nulliparity Epidural anesthesia Precipitous birth Macrosomia Instrumental delivery
S&S of laceration Persistent, excessive bright red bleeding in presence of firmly contracted uterus.
A 4th degree perineal tear in volves the ______. rectum
Management of laceration may include what 3 things? Return to OR for surgical repair or ligation. Fluid and/or blood replacement. Antibiotics.
Bleeding into soft tissue due to injury to blood vessel is called a _____________ Hematoma
Name the predisposing factors for a hematoma Preeclampsia Pudendal anesthesia First full-term birth Precipitous labor Prolonged 2nd stage Macrosomia Instrumental delivery Hx vulvar varicosities
if you see Discolored bulging, tense, shiny mass Complaints of severe pain, pressure Firm fundus Normal lochia May see S&S hypovolemic shock if severe - you should think of what ? Hematoma
True or False Hematoma's are always visable false -May be visible or hidden
Treatment for small hematoma Ice x 12 hours sitz bath
Treatment for large hematoma Surgical incision and evacuation of clots Ligation bleeding vessels Fluid/blood replacement Antibiotics may be prescribed
Causes Early PP Hemorrhage Retained placental fragments Uterine inversion Uterine rupture Abnormal placental implantation Accreta Increta Percreta Coagulation disorders
When Pieces of placenta fail to separate Become necrosed and get Slough off causing sudden bleeding it results in ________________ due to ______________. Late PP Hemorrhage due to Retained Placental Fragments
How do we avoid Late PP Hemorrhage due to Retained Fragments- Placenta carefully examined after birth Manual removal if necessary
If bleeding occurs, Late PP Hemorrhage what actions does the nurse support? administer IV oxytocin, IM methergine, IM prostaglandins Replace fluid/blood if needed Request Ultrasound to check for remaining fragments Request Exploration of uterus and removal of fragments Administer Antibiotics to prevent infection
Created by: CCBCMDNursing218