Warner 1

Cristina Warner

Sarah Holda

Nursing 211

13 November 2017

Pathophysiology of Postpartum Hemorrhage

Postpartum hemorrhage is defined as a blood loss greater than 500 ml for vaginal birth

and 1000 milliliters for a cesarean birth, or a decrease in hematocrit level of 10% or more, or the

need for a blood transfusion (Cunningham, 2010, p. 666) due to continued bleeding even with

the “usual treatment” (Belfort & Dildy, 2011 p. 666). Hemorrhaging within 24 hours of

childbirth is called early postpartum hemorrhage while hemorrhaging between 24 hours to 12

weeks after birth is considered late postpartum hemorrhage. Hemorrhage is one of the leading

causes of maternal morbidity and mortality along with hypertensive disorders, cardiovascular

condition, PE, and infection.

Diagnosing and treating postpartum hemorrhage utilizes the entire healthcare team to

control hemorrhage and prevent future problems like hypovolemic shock. It can also be done by

visual assessment, assessing the amount of bleeding by weighing the saturated pads, reviewing

the patient’s lab results (CBC and clotting factors), checking vital signs, skin temperature, and

firmness of fundus.

Signs and symptoms of postpartum hemorrhage include: excessive bleeding, severe

unrelieved perineal or rectal pain, a uterus that does not contract, tachycardia, decrease in BP,

cool, pale, and damp skin, low urine output, and decreasing oxygen level.
 Warner 2

Risks factors for postpartum hemorrhage include: prolonged labor, cesarean birth,

trauma, uterine atony, retained placenta in the uterus, history of previous postpartum

hemorrhage, clotting disorders, uterine inversion, and use of vacuum extractor or forceps.

Treatment for postpartum hemorrhage includes the use of Oxytocin, methylergonovine,

prostaglandins, IV fluids, and uterine massage. In rare cases blood transfusion may be

necessary. If bleeding continues or reoccurs, dilation and curettage may be required. If infection

is suspected, a broad-spectrum antibiotic may be given. Nursing care for women after

postpartum hemorrhage should include: bedrest, checking vital signs, review labs, administering

medication, assess changes in level of consciousness, location and firmness of the fundus,

assessing hourly urine output, uterine massage, notifying physician of patient’s status, and

providing emotional support for patient and family. The most significant role of the nurse is to be

able to recognize the early signs of hemorrhage and be able to intervene before it becomes a

problem.
 Warner 3

Citations:

McKinney, E. S., & Crum, K. A. (2013). Virtual clinical excursions--Obstetrics-pediatrics, for

McKinney, James, Murray, Nelson, and Ashwill: Maternal-child nursing, 4th edition:. Maryland

Heights, MO: Elsevier/Saunders.