Postpartal hemorrhage is usually defined as the loss of more than 500 ml of blood during or after delivery. It is
one of the leading causes of maternal mortality. Hemorrhage may occur early, within the first 24 hr after delivery, or
late, up to 28 days postpartum (the end of the puerperium).
CLIENT ASSESSMENT DATA BASE
May report excessive fatigue
Blood loss at delivery generally 400–500 ml (vaginal delivery), 600–800 ml (cesarean delivery), although research
suggests that blood loss is often underestimated
History of chronic anemia, congenital/incidental coagulation defects, idiopathic thrombocytopenia purpura
May be anxious, fearful, apprehensive
Labor may have been prolonged/augmented or induced, precipitous/traumatic; use of forceps/vacuum extractor,
general anesthesia, tocolytic therapy.
Difficult or manual delivery of placenta.
Examination of placenta following birth may have revealed missing placental fragments, tears, or evidence of torn
Vaginal birth after cesarean (VABC).
Previous postpartal hemorrhage, PIH, uterine or cervical tumors, grand multiparity
Ongoing/excess aspirin ingestion
Early Postpartal Hemorrhage (Up to 24 Hr Following Delivery)
Changes in BP and pulse (may not occur until blood loss is significant)
Delayed capillary refill
Pallor; cold/clammy skin
Dark, venous bleeding from uterus externally evident (retained placenta)
May have excessive vaginal bleeding, or oozing from cesarean incision or episiotomy; oozing from IV catheter, sites of
intramuscular injections, or urinary catheter; bleeding gums (signs of disseminated intravascular coagulation
Profuse hemorrhage or symptoms of shock out of proportion to the amount of blood lost (inversion of uterus)
Difficulty voiding may reflect hematoma of the upper portion of the vagina.
Bladder distension (urinary retention).
Painful burning/tearing sensations (lacerations), severe vulvar/vaginal/pelvic/back pain (hematoma formation), lateral