Postpartum Haemorrhage Causes and Nursing Management

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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.
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