Postpartum Haemorrhage Causes and Nursing Management
Postpartum Haemorrhage Causes and Nursing Management : Primary postpartum haemorrhage is defined as a loss of more than 500 ml of blood within 24 hours after vaginal delivery or more than 1000 ml of blood after a caesarean section.Postpartum haemorrhage can be atonic, traumatic or due to coagulation failure (tone, tissue, trauma, thrombin).
Postpartum Haemorrhage Causes
Atonic Postpartum Haemorrhage
- Retained placenta or placental parts (tissue)
- Multiple pregnancy (uterine atony due to over distension and a large placental site)
- Polyhydramnios (uterine atony due to over distension)
- Prolonged labour (uterine atony)
- Placental abruption (uterine atony and coagulation failure.
- Placenta previa
- Grand multiparity (uterine atony due to the presence of more fibrous tissue)
- Deep general anaesthesia (uterine atony due to halothane.
- Submucous fibroids
- Uterine abnormalities
- Anaemia
Traumatic Postpartum Haemorrhage
- Normal labour / precipitate labour
- Instrumental delivery
- Caesarean section
- Episiotomy
- Uterine rupture
- Uterine inversion
Coagulation Failure
- Placental abruption
- Eclampsia
- Sepsis
- Prolonged intrauterine death
- Amniotic fluid embolism
- Anti-coagulant therapy
- Preexisting coagulation problems
Postpartum Haemorrhage Nursing Management
Resuscitation is the first step in the management of an emergency. However, diagnosis and treatment should take place simultaneously.
- The first step is to insert two 14 gauge cannulae and commence intravenous crystalloids (2 liters of Hartman’s solution) and colloids (1.5 liters), till blood is available.
- Assess airway and breathing. Give oxygen by face mask at 10—15 liters/ minute.
- Crossmatch 6 units of blood. Commence transfusion as soon as possible, because the circulating volume should be restored with blood. Uncross-matched O Rhesus negative blood can be given
initially if the patient is collapsed. - Keep the patient warm.
- Take blood for baseline full blood count and coagulation screen.
- Adequate amount of blood should be transfused to restore the circulating volume.
Postpartum Haemorrhage Treatment
- Intravenous broad spectrum antibiotics.
- Resuscitation and blood transfusion if bleeding is profuse
- Ultrasound scanning to exclude retained placental tissue.
- Blood and high vaginal swab for culture and ABST if there is sepsis.
- Evacuation of retained placental tissue if present.
