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PostPartum Hemorrhage CAREPLANS


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POSTPARTAL HEMORRHAGE 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 General Findings Activity/Rest May report excessive fatigue Circulation 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 Ego Integrity May be anxious, fearful, apprehensive Sexuality 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 blood vessels. Vaginal birth after cesarean (VABC). Teaching/Learning Previous postpartal hemorrhage, PIH, uterine or cervical tumors, grand multiparity Ongoing/excess aspirin ingestion Early Postpartal Hemorrhage (Up to 24 Hr Following Delivery) Circulation 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 [DIC]) Profuse hemorrhage or symptoms of shock out of proportion to the amount of blood lost (inversion of uterus) Elimination Difficulty voiding may reflect hematoma of the upper portion of the vagina.
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Bladder distension (urinary retention). Pain/Discomfort Painful burning/tearing sensations (lacerations), severe vulvar/vaginal/pelvic/back pain (hematoma formation), lateral uterine pain, flank pain (hematoma into the broad ligament), abdominal tenderness (uterine atony, retained placental fragments), severe uterine and abdominal pain (uterine inversion) Safety Lacerations of the birth canal: Persistent trickle of bright red blood (may be profuse) with firm, well-contracted uterus; visible tears in labia majora/labia minora, from vaginal introitus to perineum; extended tears from episiotomy, extension of episiotomy into vaginal vault, or tears in cervix Hematomas: Unilateral, tense, fluctuant, bulging mass at vaginal introitus or encompassing labia majora; firm, painful to touch; unilateral bluish or reddish discoloration of skin of perineum or buttocks; (abdominal hematoma following cesarean delivery may be asymptomatic except for changes in vital signs) Sexuality Uterus: Soft, boggy, or enlarging, difficult to palpate; bright red bleeding from vagina (slow or profuse); large clots expressed on massage of uterus (uterine atony)
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