ANDRES BONIFACIO COLLEGE

College Park, Dipolog City

SCHOOL OF NURSING

POSTPARTUM
HEMORRHAGE
Submitted By:
Christy M. Alumbro
Sheila Jean Enguito Submitted
To:
Jojie Keith F. Rosalem Mr. Art
DELIVERY ROOM
WARD CLASS
 Table of Contents
I. ABC Mission and Vision X. Reference

II. Nursing Mission and

Vision
III. Definition
IV. Signs & Symptoms
V. Etiology
VI. Diagnosis
VII.Treatment
VIII.Nursing Management
IX. Pathophysiology
 Andress Bonifacio College

Mision Vision
We commit to provide affordable quality A center of excellence
education with values in industry, in instruction ,
intelligence, integrity, and undertake research, technology,
relevant research and socially-responsive extension, athletics
community service using innovative and the arts.
technologies.
 School of Nursing

Mision Vision
The school of nursing shall generate competent, safe and Excellence in nursing education.
compassionate professional nurses
committed to:

a. Practice high standard of nursing care utilizing research

and evidence base practices that are culturally appropriate
and sensitive;

b. Be actively involved in local, national, global issues affecting

nursing, people’s health environment;

c. Ongoing holistic growth and development of the self and

others.
 DEFINITION
Postpartum hemorrhage is heavy
bleeding after the birth of your baby.
Losing lots of blood quickly can cause a
severe drop in your blood pressure. It may
lead to shock and death if not treated. The
most common cause of postpartum
hemorrhage is when the uterus does not
contract enough after delivery. Blood loss
of ≥500 mL for vaginal delivery and
≥1000 mL for cesarean delivery, after
completion of the 3rd stage of labor
SIGNS AND SYMPTOMS
 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 
ETIOLOG
Y
Early PPH is typically caused by at least one
of following: Tone, tissue, trauma, thrombin .

Tone (Uterine Atony)

 Failure of contraction and retraction of myometrial muscle fibers after delivery.

 Most common cause of PPH.

 Causes of uterine atony include the following:
 Overly distended uterus: Multiparity, fetal macrosomia, polyhydramnios.
 Fatigued uterus: Amnionitis, prolonged labor or rapid forceful labor, use of
tocolytics, high parity.
 Obstructed uterus: Retained placenta or fetal parts, placenta accreta, overly
distended bladder, anatomic/functional distortion of uterus.
 Other causes include previous PPH or use of general anesthesia.
ETIOLOG
Y
Tissue (Retained Products of Conception)

 Bleeding may occur from retained products,

blood clots, cotyledon or from an abnormal
placenta.
ETIOLOG
Y
Trauma (Genital Tract Trauma)

 Genital tract damage may occur spontaneously

or through manipulations used to deliver the
baby, eg. Episiotomy.
 Lacerations may be present in the cervix, vagina
or perineum.
 Extensions or lacerations at cesarean section.
 Uterine rupture or uterine inversion.
ETIOLOG
Y
Thrombin (Coagulopathy)

 Can be caused by preexisting disorders (eg.

hemophilia A, von Willebrand’s Disease, factor
XI deficiency).
 May be acquired during pregnancy [eg.
idiopathic thrombocytopenic purpura (ITP),
thrombocytopenia with preeclampsia,
disseminated intravascular coagulopathy (DIC)]
or from therapeutic anticoagulation (eg. history
of thromboembolic disease).
DIAGNOSIS
How is postpartum hemorrhage diagnosed?
 Estimate of how much blood you have lost ((this
may be done by counting the number of
saturated pads, or by weighing of packs and
sponges used to absorb blood).
 Measuring pulse and blood pressure.
 Red blood cell count.
 Clotting factors in the blood.
TREATMENT
The aim of treatment of postpartum hemorrhage is to find and stop the cause
of the bleeding as soon as possible. Treatment may include:

 External uterine massage and bimanual compression.

 Removing pieces of the placenta that remain in the uterus
 Uterine artery ligation.
 Uterine hemostatic compression suturing.
 Laparotomy. This is surgery to open the abdomen to find the cause of
bleeding.
 Tying off or sealing bleeding blood vessels. This is done using uterine
compression sutures, special gel, glue, or coils. The surgery is done
during a laparotomy.
 Hysterectomy. This is surgery to remove the uterus. In most cases, this
is a last resort.
 Medications.
TREATMENT
There are numerous medications used to treat PPH. The following uterotonic agents are
used to help the uterus contract.

 Oxytocin should be given after every delivery, but also additional oxytocin may be
given for hemorrhage. It may be given intravenous (IV) or intramuscular (IM). The
usual dose is 10 to 40 units. There are few side effects to oxytocin.
 Methergine 0.2mg IM may be given every 2 to 4 hours. Nausea, vomiting, and
hypertension are possible side effects. A woman with preeclampsia should not
receive methergine.
 Hemabate 250mcg IM may be given every 15 to 90 minutes. This medication can
cause nausea, vomiting, diarrhea, shivering, and bronchospasm. This medication
should not be given to women with asthma.
 Cytotec 600-1000mcg may be given sublingual (SL), vaginally, or rectally. Nausea,
vomiting, diarrhea, and shivering are all side effects. It is important to remember that
methergine and hemabate are both kept in the refrigerator.
 Tranexamic acid (TXA) is a lysine analog and antifibrinolytic agent that is also being
used in some L&D units to stop bleeding. This is given IV piggyback and must be
reconstituted before use.
TREATMENT
Replacing lost blood and fluids is important in treating
postpartum hemorrhage. You may quickly be given
IV (intravenous) fluids, blood, and blood products to
prevent shock. Oxygen may also help.

Postpartum hemorrhage can be quite serious. But

when your provider quickly finds and treats the
cause of bleeding, you often will be able to recover
fully.
NURSING MANAGMENT
Initial management includes identifying PPH, determining the cause, and
implementing appropriate interventions based on the etiology.

 Assess maternal vital signs to establish baseline data.

 Assess the amount of bleeding.
 Assess cause of trauma (tone, tissue, trauma, thrombin)
 Save all perineal pads used during bleeding and weigh them to
determine the amount of blood loss.
 Place the woman in a side lying position to make sure that no blood is
pooling underneath her.
 Assess lochia frequently to determine if the amount discharged is still
within the normal limits.
 Assess vital signs, especially the blood pressure. (BP monitoring Q5
mins, continuous monitoring of SaO2)
 massage of uterus / bimanual compression until the procedure taken
over by obstetrician
 Provide psychological care
PATHOPHYSIOLOGY
NEXT SLIDE
 Pathophysiology Mechanism Signs and Symptoms Complications Diagnosis Intervention

Tissue Thrombus Tone Trauma

Delayed Multiple General

Placental Pre- Instrumental
Incomplete pregnancy, anestheti
spontaneous abruption eclampsia Prolonged deliveries risk
delivery of poly- c applied
expulsion of labor, or _ of trauma
placenta hydramnio to
placenta very rapid
Damage to Widespread s, mother Cephalo- Women with
labor
fetoplacenta endothelial macrosom during pelvic scarred
l tissue damage y labor disproportion uteruses (e.g.
Parts of the
: fetal head/ prior C-
placenta may be
shoulder section) _
retained inside the Excessive exposure of
wider than risk of
uterine cavity after tissue factor present in
birth canal trauma
delivery the placental vascular
bed Over- Smooth Uterine
distended muscle muscle Prolonge
Retained tissue Disseminate Pre- uterus relaxation over- d 2nd Ruptured
may be felt d existing weakens persisting worked Stage of uterus
inside the uterus intravascular maternal uterine after and Labor
or seen on U/S coagulation coagulopat muscles labor fatigue
hy: (Von
Depletion Birth canal or uterine
Willebrand
of trauma, bleeding directly
Retained tissue prevent Disease)
thrombin out via vagina
the uterine wall from Inadequate uterine muscle
fully contracting and Elevated INR, PTT, PT tone after delivery
sealing off maternal
blood vessels
Impaired maternal coagulation

• Fluid resuscitation and sometimes transfusion

Postpartum Hemorrhage (PPH) • Uterine massage
• Normal delivery: blood loss > 500 ml • Removal of retained placental tissues and repair of
• Cesarian delivery: blood loss > 1000 ml genital lacerations
Clinical
• Elevated, thready pulse • Uterotonics (eg, oxytocin,
evaluation
• Low blood pressure prostaglandins, methylergonovine)
• Hypovolemia • Sometimes surgical procedures
REFERENCES
• https://www.stanfordchildrens.org/en/topic/default?id=postpartum-hemorrhage

• https://
www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P
02486

• https://nurseslabs.com/postpartum-hemorrhage/

• https://
www.stanfordchildrens.org/en/topic/default?id=postpartum-hemorrhage-90-P02486

• https://www.webmd.com/parenting/what-is-a-postpartum-hemorrhage#2-5

• https://
www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-com
plications-of-labor-and-delivery/postpartum-haemorrhage

• http://
calgaryguide.ucalgary.ca/wp-content/uploads/2014/09/Post-Partum-Hemorrhage.jpg