![]() ![]() ![]() Trauma includes vaginal, cervical, or perineal lacerations. In a postpartum patient, a narrowing of the pulse pressure (the difference between the systolic and diastolic blood pressure) may be a sign of compensated hemorrhage and an early sign of a serious problem. A full bladder can also prevent the uterus from contracting (see Figure 17-1). Overstretching may cause a lack of efficiency of the smooth muscle cells to contract. Extreme uterine distention (e.g., multifetal gestations, hydramnios) can cause uterine atony. Mechanical factors that contribute to the inability of muscles to contract include retained placental fragments or large blood clots. Uterine atony is the most common cause of early postpartum hemorrhage and occurs during the first hours after birth. Without this contraction, the vessels at the placental implantation site cannot close and begin to heal. Uterine atony (hypotonic uterus) is the inability of the myometrium muscle (middle muscle, which has interlacing “figure eight” fibers) of the uterus to contract and stay contracted around the open blood vessels. Inserting an indwelling (Foley) catheter to assess kidney function and urinary output.Providing oxygen to increase saturation of red blood cells (with a pulse oximeter used to assess blood oxygen saturation).Starting intravenous fluids to maintain circulating volume.Recognizing the specific cause (where the blood is coming from).The management for hypovolemic shock (reduced blood volume) resulting from postpartum hemorrhage includes: A collaborative effort by the health care team is necessary to provide prompt care. As the blood loss continues, blood flow to the brain decreases and the woman becomes restless, confused, anxious, and lethargic. A decrease in blood volume causes the woman’s skin and mucous membranes to become pale, cold, and moist (clammy). These reactions increase the oxygen content of circulating erythrocytes (red blood cells). The body responds to hypovolemia (reduced blood volume) with increased heart and respiratory rates. Women at greatest risk for postpartum hemorrhage include those who have labor induction or augmentation, multiple fetuses (twins, etc.), macrosomia, preeclampsia, operative deliveries, and chorioamnionitis. Coagulation defects and infection can also result in postpartum hemorrhage (Rice-Simpson, 2010). Late postpartum hemorrhage (secondary postpartum hemorrhage) is caused by retained placental fragments or subinvolution. The most common causes of early postpartum hemorrhage are uterine atony and laceration. Many problems can occur during the postpartum period, but most problems fall into the following five categories: Before discharge, the nurse teaches preventive measures to avoid common postpartum complications. Consequently, hospital-based nurses are challenged to perform a risk assessment and attempt to recognize subtle signs of complications that may require a delay in discharge. Women are often discharged after childbirth before clinical signs of puerperal infection and other postpartum disorders are evident. Shortened inpatient (postpartum) stays are common in maternity care. Thrombophlebitis (thrŏm-bō-fle˘ BĪ-tŭs, p. Compare postpartum blues with postpartum psychosis.Įndometritis (e˘n-dō-me˘ -TRĪ-tĭs, p. Discuss the nursing care of a woman who has an infected episiotomy.Ĩ. Describe predisposing factors for infections of the reproductive system.ħ. List four common sites for puerperal infection.Ħ. Explain the nursing care of a woman who has a thromboembolism.ĥ. Describe the dangers that deep vein thrombosis presents.ĥ. Identify nursing interventions in the care of the woman with postpartum hemorrhage.Ĥ. ![]() Summarize major causes of postpartum hemorrhage.ģ. ![]()
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