Assess lochia for color amount and clots 1 gm 1 ml no

Assess lochia for color, amount, and clots (1
gm = 1 mL)
 No more than 1 pad/hour, no large clots
 Continuous trickle of bright red blood = bleeding laceration
o Assess vital signs, including pain
o Apply ice pack to perineum
o Sensation and movement if regional
anesthesia given
o Fullness of bladder/catheter care
 Full bladder prevents uterine contractions
 Hemorrhage
 Lacerations
o Uncontrolled tear of the tissues of an around the vagina
 First degree
o Superficial vaginal mucosa or perineal skin
 Second degree
o First degree plus deeper tissue of the
perineum
 Third degree
o Adds the anal sphincter
 Fourth degree
o Extends through to the rectum
 Nursing Care for Episiotomy and Lacerations
o Ice
 For first 12--24 hours
o Warm sitz baths
 Can start sitz bath after 12 hours
o Mild analgesia
o Perineal spray bottle
 Prevents infection
 To squirt the area while voiding
 The perineal pad should be changed after each
elimination and may be changed in between
 Wipe front to back
o Avoid constipation
 Uterotonics
o Oxytocin (Pitocin)
o Methylergonovine (Metherine)
o Carboprost (Hemabate)
o Misoprostol (Cytotec)
High Risk Deliveries
 Abnormal Labor
o Dystocia
 Abnormal or difficult labor
o There is a problem with the 5 “Ps” of labor
o For any abnormalities, always monitor fetal heart rate
o Problems with the powers of labor

 Hypertonic labor/Hypertonic Uterine Dysfunction
 Frequent, painful, uncoordinated contractions
 Contractions are frequent but ineffective in promoting dilation and
effacement
 Uterus remains tense between contractions
 Reduced blood to placenta/fetus
 Treatment
 Relaxation
 Administration of pain medications
 Terbutaline (Brethine)
 Hypotonic labor/Hypotonic Uterine Dysfunction
 Uterine contractions are insufficient to promote more cervical dilation and
effacement
 Usually occurs in the active phase of labor
 Treatment
 Hydrate
 Amniotomy
 Augment with oxytocin (Pitocin)
 C-section
 Inadequate Expulsive Forces
 Occurs in the second stage of labor when the woman is not able to push
or bear down
 Causes
 Woman is tired or may not feel the urge to push
 Fetal dystocia
 Excessive fetal size (macrosomia) or malpresentation
 Pelvic dystocia
 Abnormal pelvic shape
 Treatment
 Sit woman upright
 Augment with oxytocin
 Use of assistive devices
 Forceps
 Curved blades that are used to gently guide/pull the
fetal head out of the vagina
 Vacuum
 Suction cup device which provides gentle suction to
help deliver the head
 Applied over the posterior fontanel
 C-section
o Problems with the fetus
 Fetal size
 Fetal position and presentation
o Problems with the pelvis and soft tissue
o Abnormal duration
 Precipitous Birth
 Labor less than three hours

 At risk for postpartum hemorrhage related to uterine atony or lacerations
 Risk Factors
 Grand multiparity
 History
