Postpartum Hemorrhage Nursing Care Plan & Management

Postpartum hemorrhage (PPH) is one of the fastest ways a stable delivery turns into a crisis. It drives the majority of the 14 million obstetric hemorrhage cases that occur each year, and it kills quickly when it goes unrecognized. Know the risk factors, catch the early signs, and move fast.

What Is Postpartum Hemorrhage?

PPH is blood loss over 500 mL in a vaginal delivery, or over 1,000 mL in a cesarean delivery, within 24 hours.

Pathophysiology

The main causes bleed through different mechanisms. In uterine atony, the uterus stops contracting and the open placental sites keep bleeding. Lacerations bleed directly. Retained placental fragments keep the uterus from clamping down and can cause massive bleeding.

Risk Factors

Watch for these in any postpartum woman:

• Anything that overdistends the uterus: multiple gestation, hydramnios, a large baby, uterine myomas.
• Anything that sets up cervical or uterine lacerations: operative birth or rapid birth.
• Abnormal placental attachment: placenta previa, abruptio placentae.
• A uterus that will not contract: deep anesthesia during cesarean delivery, advanced maternal age, high parity.
• Inadequate coagulation: disseminated intravascular coagulation.

Signs and Symptoms

• Heavy vaginal bleeding: over 500 mL in a vaginal delivery or over 1,000 mL in a cesarean delivery.
• Tense, rigid uterus, which can point to concealed bleeding on top of what you see.

Medical Interventions

• Pitocin to restore and maintain uterine tone when the uterus will not contract.
• Carboprost tromethamine, a prostaglandin derivative, for sustained uterine contractions.
• Blood transfusion after type and crossmatch to replace the loss.
• Oxygen at 4 L/min via face mask if the woman is in respiratory distress.

Surgical Management

• Suturing to control bleeding from severe uterine atony.
• Hysterectomy as a last resort to save the mother's life.

Nursing Management

Assessment

• Quantify the bleeding.
• Get baseline maternal vital signs.
• Watch for signs of shock.
• Assess uterine tone and position.

Nursing Diagnosis

• Deficient fluid volume related to excessive bleeding after birth.

Interventions

• Save and weigh all perineal pads to quantify blood loss.
• Position the woman side lying so blood does not pool unseen beneath her.
• Assess lochia frequently against normal limits.
• Monitor vital signs, especially blood pressure.

Evaluation

• Blood pressure stays above 100/60 mmHg.
• Pulse rate stays within 60-100 beats per minute.
• Lochia flow is less than one saturated pad per hour.