MCN 209 OBGYNE ROTATION

A READING ON

Postpartum
Hemorrhage
PRESENTED BY: MICAELLA MONIQUE U. LEONARDO
BSN 2M- G2
Title: Duration of labor and the risk of severe
postpartum hemorrhage: A case-control study.

Bibliography:
Nyfløt, L. T., Stray-Pedersen, B., Forsén, L., & Vangen, S.
(2017). Duration of labor and the risk of severe postpartum
hemorrhage: A case-control study. PloS one, 12(4),
e0175306. https://doi.org/10.1371/journal.pone.0175306
 Summary:
Postpartum hemorrhage (PPH) is a condition that affects 6% of
mothers all around the world where heavy bleeding can be
experienced after giving birth, it is also the leading cause of
maternal death worldwide.

Primary PPH is defined as >500 mL of blood loss within the first 24

hours after delivery, secondary PPH occurs between 24 hours and
12 weeks postpartum, while Severe postpartum hemorrhage was
defined as postpartum blood loss ≥1500 mL or need for blood
transfusion.
 Summary:
The study’s objective is to understand and investigate the
association between duration of active labor, the effect of each
stage of active labor, and the effect of duration of labor on severe
postpartum hemorrhage.

The case-study was generated from Oslo University Hospital and

Drammen Hospital in Buskerud Municipality to where participants
are women who were admitted for delivery during the time period
of January 1, 2008 to December 31, 2011.
 Summary:
It was found and observed that women who has longer duration
of labor (>12 hours), as well as have longer period of all phases of
active labor are more prone to experienced severe postpartum
hemorrhage.

Therefore, concluded that Severe postpartum hemorrhage has

been associated with prolonged active labor (duration> 12 hours).
When labor is prolonged, increased attention seems important to
decrease the risk of serious postpartum hemorrhage.
 REACTION:
Postpartum hemorrhage, also known/ called as PPH is when heavy
bleeding occurs after delivering a baby. Postpartum hemorrhage
occurs in around 1 in 100 to 5 in 100 people. It is a serious but rare
condition where the mother lose a lot of blood which can cause a
severe drop in the mother’s blood pressure, and may lead to shock
and death if not treated. It is known to be one of the leading causes of
maternal death worldwide. The most common cause of postpartum
hemorrhage is when the uterus does not contract enough after
delivery, and is more likely with a cesarean birth. It most often
happens after the placenta is delivered, but it can also happen later. It
usually occurs within 1 day after giving birth, or even 12 weeks after
delivery.
As mentioned in the referenced study, women with prolonged labor
are at greater risk for postpartum hemorrhage which can also lead to
severe PPH. Other conditions that may increase the risk also includes
Placental abruption, Placenta previa, Overdistended uterus, Multiple-
baby pregnancy, High blood pressure disorders of pregnancy, having
many previous births, Infections, Obesity, use of forceps or vacuum-
assisted delivery, as well as being Asian or Hispanic Ethnic
background. the most common symptoms of postpartum hemorrhage
are as mentioned; Uncontrolled bleeding, Decreased blood pressure,
Increased heart rate, decrease in the red blood cell count, Swelling and
pain in the vagina and nearby area if bleeding is from a hematoma,
these symptoms can occur, a day after or even 12 weeks after delivery.
It is important to visit your healthcare provider as soon as primary
bleeding is noticed to get treated immediately.
As a student nurse, our primary role as we encounter patients with
postpartum hemorrhage is to help the patient recover her strength
and to avoid complications, diagnose and intervene early or during a
hemorrhage. It will play a crucial role in the treatment of the patient
with hemorrhage data such as the amount of bleeding, the state of the
uterus, monitoring the maternal vital signs and watching for signs of
shock.

As a student nurse, specially under OBGYNE rotation, I really find the

topic postpartum hemorrhage interesting as the condition is very
familiar to my ears, but doesn’t really know what it is. Upon my
research, I learned a lot of information that I may be able to utilized as
my tool on our actual duty.
it is important that we get to understand these type of condition as it
is very dangerous to women who just recently delivered a baby when
left untreated, such as notifying the mother that when bleeding occurs
a day or 12 weeks after delivery to immediately visit the nearest
healthcare provider. It is also important that we get to give important
health teachings to the mother about the risks and symptoms that
they may encounter to avoid the risk of severe blood loss, that may
lead to death. This reading will serve its purpose especially when
exposed to the actual rotation duty where we might encounter this
type of condition. Knowing this common behavior will prepare me for
future encounters, alongside with my co-student nurses.
THANK YOU