Postpartum hemorrhage (PPH) is a serious complication that can occur during childbirth. It’s important for nurses to recognize the signs and symptoms of post-delivery bleeding so they can help prevent it. A patient experiencing postpartum hemorrhage may have blood loss that exceeds 500 mL within 24 hours following delivery, or between 1000–1500 mL over several days. If left untreated, PPH can result in maternal death or permanent disability so it’s vital to be on the lookout for this condition when caring for newborns and mothers after childbirth.”
Postpartum Hemorrhage Nursing Intervention
1 Assessment of patient for symptoms of postpartum hemorrhage
- Determine the patient’s pain level and document it on the patient’s chart.
- Perform a physical assessment of the patient, including:
- Assessment of the fundus (size) by palpation and percussion; note if there is any tenderness or decrease in fetal movement.
- Take vital signs (temperature, pulse rate, respiration, blood pressure).
2 Medical diagnosis
Postpartum hemorrhage is bleeding that occurs after childbirth.
- Postpartum uterine atony is when the uterus does not contract properly after birth, causing excessive bleeding.
- Postpartum uterine rupture occurs when the uterus tears open during labor or delivery. This can be life-threatening because it allows the baby’s placenta to bleed inside your body and put pressure on major blood vessels going through your pelvis. If a tear extends into your bladder or bowel, it can also lead to complications requiring surgery. Most uterine ruptures involve women who have had cesarean sections (C-sections) before and are under general anesthesia during this birth as well.* Postpartum hemorrhage from retained placenta happens when part of your placenta remains in your uterus after birth.* Placenta accreta happens when there is an abnormal attachment between the placenta and the wall of your uterus during pregnancy.* Placenta increta happens when there are abnormal attachments between both layers of tissue that make up your womb (uterus).
3 Assess vital signs and cardiac rhythm, if necessary
Vital signs include blood pressure, pulse, respiratory rate, temperature and oxygen saturation. You should assess vital signs every 4 hours if the patient is stable. If the patient is unstable or has a cardiac arrhythmia that requires frequent monitoring, measure vital signs every 2 hours.
The postpartum period presents unique challenges in ensuring your patients are safe; however, with careful planning and preparation you can successfully manage any situation that may arise during this time of transition!
4 Insert urinary catheter and begin intravenous therapy.
- Insert urinary catheter and begin intravenous therapy.
- After the placenta is delivered, the nurse must insert a urinary catheter into the patient’s bladder to prevent her from urinating uncontrollably (incontinence). The nurse will also administer intravenous (IV) fluids to replace lost blood through transfusion.
5 Initiate resuscitation procedure.
Check for response to treatment.
Check for signs of shock.
Check for signs of hypovolemic shock.
Check for signs of cardiac arrest.
Check for signs of respiratory arrest.
Check for signs of hypoxia (oxygen deprivation). Check that the patient’s oxygen saturation levels are within normal limits (94-100 percent), or if they have a device that measures these levels, verify their accuracy by comparing them with the patient’s actual blood oxygen level readings from an oximeter attached instrumentation such as pulse oximeter or noninvasive blood pressure monitor (NIBPM) device which will provide continuous readouts of heart rate, rhythm and arterial pressure . If necessary contact physician immediately so corrective measures can be taken before it becomes severe enough to cause damage to vital organs like brain function , kidneys etc..
6 Administer indicated medications in appropriate dosage per doctors order.
You will administer the following medications in an appropriate dosage per doctors order:
- Drug Name: Heparin (drug of choice for prophylaxis against thromboembolism)
- Route of administration: subcutaneous infusion, usually 100 units/hour for 24 hours. If patient exhibits signs of bleeding go to next drug.
7 Provide supportive care for patient and family, including emotional support to family.
Provide supportive care for patient and family, including emotional support to family.
- Be aware of the patient’s feelings and behavior, and how she or he is coping with the diagnosis and treatment. Listen carefully to what the patient says.
- Encourage family members or significant others to share their experiences, thoughts, and concerns about the illness. Ask them if there are any questions that they have about the condition or its management; answer these questions as completely as you can. If a question cannot be answered immediately, be sure to relay its nature later so that another staff member will be able to address it (e.g., “John asked me about your condition; I told him we would have more information for him after your next test results are reviewed”).
8 Assess patients response to treatment and interventions.
Monitor patients response to treatment and interventions.
Assess patients response to treatment and interventions. If the patient is not responding to treatment, you should evaluate the following:
- Are there signs of shock?
- Is there hypovolemic shock?
9 Be alert to signs of potential problems from postpartum hemorrhage!
- Be alert for bleeding. All women should be taught to recognize the signs of blood loss and shock, so that they can seek help at the first sign of a problem.
- Be alert for signs of shock (pallor, clammy skin, cool extremities). If you suspect that a patient is in shock, give oxygen and ask someone else to call 911.
- Be alert for signs of infection (fever, chills). If a woman has any reason to think that she might have an infection after delivery—for example, if she had surgery or received injections during labor—she should call her doctor right away if she develops fever chills or another symptom within three days after delivery.
- Be alert for hypovolemic shock (drop in blood pressure). In this type of shock, there isn’t enough fluid volume in the body due to bleeding out from injury or severe burns; it tends not to occur as often as other types because there aren’t many external wounds postpartum.
It is important to note that postpartum hemorrhage can be life threatening and should be treated immediately if you suspect your patient may have a problem with it.