Early Postpartum Hemorrhage Nursing Care Plan & Management

Notes

Description
  1. Early postpartum hemorrhage is defined as blood loss of 500 mL or more during the first 24 hours after delivery.
  2. Post partum hemorrhage is the leading cause of maternal death worldwide and a common cause of excessive blood loss during the early postpartum period.
  3. Approximately 5% of women experience some type of postdelivery hemorrhage.
Etiology
  1. Major causes of postpartum hemorrhage are uterine atony (responsible for at least 80% of all early postpartum hemorrhages); laceration of cervix, vagina, or perineum; and retained placental fragments.
  2. Predisposing factors include hypotonic contractions, overdistended uterus, multiparity, large newborn, forceps delivery, and cesarean delivery.
Pathophysiology
  • The uterus is unable to contract effectively and maintain hemostasis.
Assessment Findings

Clinical manifestations include:

  1. Vaginal bleeding.
  2. Hypotonic uterus.
  3. Excessive blood loss, which may produce hypotension, thread pulse, pallor, restlessness, dyspnea, and chills.

Nursing Management

1. Assist with appropriate treatment to prevent complications.

  • Determine the presence of uterine firmness and location and amount of vaginal bleeding immediately after delivery.
  • Measure and record serial maternal vital signs after delivery- every 5 to 15 minutes until stable; increase or decrease the frequency of assessment relative to baseline and amount of bleeding.
  • Notify the practitioner of abnormal assessment findings.
  • Massage the fundus gently, taking care to support the uterus with the hand just above the symphysis pubis.
  • Administer medications as prescribed.
  • Keep an accurate pad count (100 mL per saturated pad).
  • Assess condition of skin, urine output, and level of consciousness.

2. Provide physical and emotional support.

3. Provide client and family education.

Exam

Nursing Care Plan