A Reading on

Post-Partum Hemorrhage

In Partial Fulfillment of the

Requirements in MCN 209- RLE

OBGYNE ROTATION

Submitted to:

Milagrosa Candida Caburnay, RN, MN.

Clinical Instructor

Submitted by:

Micaella Monique U. Leonardo, StN.

BSN 2M- GROUP 2

January 25, 2021

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. 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. Both cases of significant postpartum hemorrhage (n = 859) and a random sample
of controls (n = 1755) were included in the research population. 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.