1. What is the normal location of the fundus two hours post vaginal delivery?

1. Umbilicus

2. What assessments are vital for the nurse to perform on the postpartum client?
1. B-breasts, U- uterus, B- bladder, B-bowel, L- Lochia, E- episiotomy, B- Bonding. also
evaluate incisions, episiotomy aNd lacerations R- redness, E-edema, E-ecchymosis, D-
drainage, A-approximation

3. What factors increase a womans risk for postpartum hemorrhage?
1. Large baby- cause distinction of uterus
2. Multiple pregnancies
3. Preeclampsia (high bp and protein in the uterine after 20th wk. of pregnancy).
4. When the placenta is too close to the cervix (placenta Previa)
5. When all or part of the placenta attaches abnormally to the myometrium (placenta
accreta)
6. If pt received Pitocin
7. Infection
8. Obesity
9. Htn
10. Anesthesia (muscle relaxes)
11. Episiotomy

4. What are the differences between early and late postpartum hemorrhage?
. Early: Occurs within the first 24 hours and is usually due to Uterine Atony
. Late: Occurs 24 hours to 6 weeks Postpartum and is usually due to Sub-Involution

5. Why is the nursing assessment vital to caring for the postpartum woman? If the nursing
assessment is done as it should be, many problems will be assessed and intervention done
before it becomes an emergency or life threatening.

6. What is uterine atony, and how does it cause postpartum hemorrhage?
1.the uterus not contracting efficiently enough or relaxing intermittently in the hours
following the birth, allowing the bleeding to become heavy. Allows the placental site to
continue bleeding

7. What are other causes of postpartum bleeding?
1.Episiotomy or vaginal/ cervix Tear
2. Uterine rupture
3. Clotting


8. How is postpartum bleeding treated?
1. Identify the cause of the bleed
2. Medications to stimulate contractions - pitocin, prostaglandin E2 dinoprostone,
methergine)
3. Massaging the fungus promotes contraction
4. Make sure pt has been voiding, a full bladder may inhibit contractions.
5. Pt might also have pieces of placenta- remove them
9. What are the indications and contraindications of common medications used to treat
postpartum hemorrhage?


1. pitocin: indications: naturally produced hormone that plays a role in uterine
contractions
2. methergine, indications: acts directly on smooth muscLe of the uterus and increases
tone, rate, and amplitude of rhythmic contractions. contra: kidney dx/ heart dx or high
bp pts.
3. Hemabate: control muscle contractions contra: active pelvic dx, breathing disorder,
heart dx, liver dx, kidney dx.