Nursing Care Plan - Postpartum Hemorrhage

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Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more than 500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood loss. In cesarean births the average blood loss rises to 800-1000 mL. There is a greater risk of hemorrhage in the first 24 hours after the birth, called primary postpartum hemorrhage. A secondary hemorrhage occurs after the first 24 hours of birth. In the majority of cases the cause of hemorrhage is uterine atony, meaning that the uterus is not contracting enough to control the bleeding at the placental site. Other reasons for a hemorrhage would include retained placental fragments (possibly including a placenta accreta), trauma of some form, like a cervical laceration, uterine inversion or even uterine rupture, and clotting disorders.

Common Signs and Symptoms:

• uncontrolled bleeding
• decreased blood pressure
• increased heart rate
• decrease in the red blood cell count (hematocrit)
• swelling and pain in tissues in the vaginal and perineal area

Conditions that may increase the risk for postpartum hemorrhage include the following:

• placental abruption - the early detachment of the placenta from the uterus.
• placenta previa - the placenta covers or is near the cervical opening.
• overdistended uterus - excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).
• multiple pregnancy - more than one placenta and overdistention of the uterus.
• pregnancy-induced hypertension (PIH) - high blood pressure of pregnancy.
• having many previous births
• prolonged labor
• infection
• obesity
• medications to induce labor
• medications to stop contractions (for preterm labor)
• use of forceps or vacuum-assisted delivery
• general anesthesia

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