POSTPARTUM

HEMORRHAGE
COLEEN AUBREY V. TAN
 WHAT IS POSTPARTUM
HEMORRHAGE?

Postpartum hemorrhage is traditionally defined as blood loss greater than

500mL for vaginal delivery or greater than 1000mL for cesarean delivery
It is the most common cause of maternal death worldwide. Up to 25% of all
pregnancy-related deaths are directly attributable to hemorrhage

Primary/early postpartum hemorrhage occurs within the first 24 hours after

delivery
Secondary/late postpartum hemorrhage occurs between 24 hours and 6
weeks postpartum
Classification according to severity:
Mild: 750 – 1250 ml
Moderate: 1250 – 1750 ml
Severe: 2500 ml
 CASE SCENARIO
Patient J.K., a 35 year-old, G2P2, is admitted to the emergency
department with heavy vaginal bleeding. Two weeks earlier, she’d
delivered an infant by a repeat Cesarean section. Nursing
assessment reveals a temperature of 38.8° C; heart rate of 140
beats/minute; and blood pressure of 88/42 mmHg. Her only notable
medical history is dietary-controlled gestational diabetes mellitus
(GDM), which occurred during both pregnancies. She’s now
presenting with a secondary postpartum hemorrhage.
 ETIOLOGY/FACTORS
ETIOLOGY/FACTORS

Uterine Atony
Lacerations
Uterine rupture
Perineal Lacerations
Retained Placental Fragments
Disseminated Intravascular Coagulation (DIC)
Perineal Hematoma
 SYMPTOMATOLOGY

Uncontrolled bleeding
Decreased blood pressure
Increased heart rate
Decrease in the red blood cell count (hematocrit)
Swelling and pain in tissues in the vaginal and
perineal area, if bleeding is due to a hematoma
PP PP
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NURSING
DIAGNOSIS
Actual:
Deficient Fluid Volume- (Related to excessive blood loss
after birth)
Ineffective Tissue Perfusion- (Related to hypovolemia)
Risk:
Risk For Infection- (Related to decreased hemoglobin,
invasive procedures, stasis of body fluids, or traumatized
tissues)
NURSING
NURSING
INTERVENTIONS
INTERVENTIONS (DEFICIENT FLUID VOLUME)
1. Assess the location of the uterus and degree of the
contractility of the uterus/ Massage boggy uterus using one
hand and place the second hand above the symphysis pubis
2. Monitor vital signs
3. Assess fundus, perineum, and bleeding. Evaluate blood loss
by weighing peri pads
4. Review the records and note certain conditions such as
retained placental fragments, any laceration, abruptio
placenta, etc.
5. Observe for reports of persistent perineal pain or feeling of
vaginal fullness. Apply counterpressure on labial or perineal
lacerations
6. Measure a 24-hour intake and output. Observe for signs of
voiding difficulty.
7. Maintain a bed rest with an elevation of the legs by 20-30°
and trunk horizontal.
8. Administer oxytocin as ordered
NURSING
NURSING
INTERVENTIONS (INEFFECTIVE TISSUE PERFUSION)
INTERVENTIONS
1. Assess the location of the uterus and degree of the contractility
of the uterus/ Massage boggy uterus using one hand and place the
second hand above the symphysis pubis
2. Monitor the vital signs 
3. Assess fundus, perineum, and bleeding. Evaluate blood loss by
weighing peri pads
4. Insert Foley catheter as ordered. Monitor hourly intake and output
(to evaluate fluid balance)
5. Monitor restlessness, anxiety or changes in level of
consciousness
6. Administer humidified oxygen at 8-12 L/min via facemask as
ordered  
7. Assess client for abdominal pain, rigidity, increasing abdominal
girth, vulvar or vulvovaginal hematomas
8. Assess client’s skin color, temperature, moisture, turgor, and
capillary refill (Hypovvolemia results in shunting of blood away
from the peripheral circulation to the brain and vital organs)
9. Administer oxytocin as ordered
NURSING
NURSING
INTERVENTIONS
INTERVENTIONS (RISK FOR INFECTION)
1. Monitor rate of uterine involution and nature and the amount
of lochial discharge.
2. Observe for signs of fever, chills, body malaise, anorexia,
pelvic pain or uterine tenderness.
3. Check the episiotomy site and abdominal wound (for
cesarean) for signs of edema, erythema, separation of wound
edges, purulent drainage.
4. Teach and demonstrate proper hand-washing and self-care
techniques. Review appropriate handling and disposal of
contaminated materials
5. Review WBC count, hemoglobin and hematocrit levels
(Increased white blood cell count indicates an infection.
Anemia often accompanies infection, delays wound healing,
and weaken the immune system)
6. Administer iron supplement as indicated (To correct anemia.
And possibly improves wound healing.)
7. Administer IV antibiotics as ordered
NURSING
NURSING EVALUATION
EVALUATION
Patient has a blood pressure of ≥100/60 mmHg, pulse
rate between 60-90 bpm, and a urine output of >30 cc/hr
Patient remained alert and oriented
Patient has a lochia flow of less than one saturated
perineal pad per hour
Patient exhibited improvement in the fluid balance as
evidenced by a good capillary refill, adequate urine
output, and skin turgor
Patient stated understanding of individual causative/risk
factors
Patient displayed normal range of
hematocrit/hemoglobin level and white blood cell count 
Patient displayed a lochia free odor.