I.

-Introduction

Postpartum hemorrhage is a condition when a woman, who had just gone labor and delivery, is experiencing heavy
bleeding after giving birth. It is a very serious case but occurs rarely. It happens just within 1 day of birth or up to 12
weeks after birth. The first few signs and symptoms of postpartum hemorrhage are heavy vaginal bleeding, drop in
blood pressure, signs of shock (blurring vision, chills, clammy skins, fast heart rate), nausea, pale skin, swelling and
pain on the vagina or perineum. The risk factors for postpartum hemorrhage are uterine atony, uterine inversion,
uterine rupture, placental abruption, placenta accrete, placenta previa, retained placenta, C-section deliveries,
lacerations, prolonged labor, DIC condition, infections, obesity, preeclampsia or gestational hypertension.
Postpartum haemorrhage has two types, early postpartum haemorrhage whereby it happens within just 24 hours
after delivery; and late postpartum haemorrhage which occurs between 24 hours to 6 weeks after delivery. There is
also two classifications of postpartum postpartum haemorrhage: primary haemorrhage is where a woman loses 500-
1000 ml of blood, and secondary postpartum haemorrhage is when the woman experiences abnormal or heavy
vaginal bleeding between 24 hours to 12 weeks after birth.

II. Objectives
 Knowledge:
o Identify the chief complaints of a patient experiencing postpartum haemorrhage
o Classify the needs of the mother
o Understand the development of postpartum haemorrhage cases
 Skills:
o Elaborate nursing interventions to prevent further complications of postpartum haemorrhage
o Create a nursing diagnosis to prepare future issues
o Identify the signs and symptoms of postpartum haemorrhage cases
III. Nursing Health History
 Biographic data:
 Name: Mrs. Eve
 Age: 29-years-old
 Sex: Female
 Marital status: Married
 Occupation: N/A
 Source of information: the patient
 Final diagnosis (if admitted in the hospital): Atonic Postpartum Hemorrhage
 Chief complaint:
 Increased vaginal bleeding after delivery
 History of present illness:
 Two days after discharge, her vaginal bleeding has been increasing and her pads were very
soaked
 Few days after, her vaginal bleeding was bright red and she did not feel good and felt sick to
her stomach
 Her head was spinning and felt lower abdominal cramps
 Vaginal bleeding occurred at the 6th day after delivery and has been increasing
 Obstetric history:
 G: 3
 T: 1
 P: 0
 A: 2
 L: 1
 Menstrual bleeding for 7 days (menorrhagia)
 Past medical history:
 Received antenatal care
 Iron deficiency anemia due to menorrhagia
 No known allergies
  Has anemia prophylaxis
IV. Physical Examination
 Vital signs:
 Pulse: 100 bpm
 BP: 110/76 mmHg
 Respiratory rate: 22 cpm
 02 saturation: 93%
 General assessment:
 When talking to the patient, she responds intelligently but is lethargic
 Hospital gown is soaked with blood
 Perineal pads filled with blood
 Presence of blood on bed linens
 Assessment of the abdomen:
 Boggy uterus at 2 cm below the umbilicus
 Signs of pain in lower abdomen and area around vaginal
V. Symptoms Manifested
 Symptoms manifested by the patient:
 Heavy vaginal bleeding
 Feeling confused or dizzy
 Swelling and pain in lower abdomen or perineum
 Nauseated
 Other possible signs and symptoms:
 Pale skin
 Low BP or signs of shock:
 Blurry vision
 Chills
 Clammy skin
 Fast HR
 Sleepy/weak
VI. Pathophysiology

Precipitating factors: Predisposing factors:

 Multiple births  Menorrhagia

 History of miscarriages  Anemia

Delivery of the fetus

Uterine
Uterus contracts down to given Placenta separates from contractions are
the reduction in volume. uterine interface. not strong enough.

Uterine atony/postpartum
hemorrhage. Persistent blood loss. Blood vessels bleed more.
VII. Diagnostic and Laboratory

Patient’s results Normal value Significance

Hemoglobin 2.1 g/uL 13.7-17.5 g/dL 2.1 g/uL is 0.21 g/dL. This
means that our patient is
now experiencing very low
levels of haemoglobin
which means that there is
also low levels of oxygen
circulating around the
body as haemoglobin
carries O2. This may also be
an indication of anemia.
Platelets 110 k/uL 161-347 k/uL Low levels of platelet
count is an indication that
the body cannot form
clots. This may be a sign of
bleeding disorders.
Active partial 40 seconds 25-37 seconds Prolonged activated
thromboplastin time partial thromboplastin
time can be an indication
that clotting of the patient
will take longer to occur
than normal.
Prothrombin time 15 seconds 11-17 seconds Normal
Fibrinogen 200 mg/dL 177-466 mg/dL Normal

VIII. Medical and Surgical Management

1) Oxytocin (Pitocin) – prevents excessive postpartum bleeding by contracting the uterus, it is given right after
birth
2) Misoprostol (Cytotec) – a prostaglandin that increases uterine tone and decreases postpartum bleeding
3) Methylergonovine maleate (Methergine) – helps control uterine bleeding
4) Carboprost tromethamine (Hemabate) – treats severe bleeding after childbirth, causes the uterine to
contract
5) Uterotonics – (ecbolic) are pharmacological agents that induces contractions, or increases the tone of the
uterus
6) Balloon tamponade – is inserted inside the uterus, and filled with fluid to compress the bleeding vessels and
stop bleeding
7) Uterine compression sutures – two to three rows of these sutures are used to completely envelope and
compress the uterus
8) Arterial ligation – controls postpartum haemorrhage from laceration of the uterine artery or branches of
utero-ovarian artery, it also helps control the bleeding.
9) Selective arterial embolization
10) Hysterectomy – (total or subtotal hysterectomy) is when the uterus is removed to save the life of a mother
who is bleeding persistently after childbirth

IX. Drug Study

Drug Name Classification Indication and Side Effects and Special Nursing
and Mechanism contraindications Adverse Effects Precautions responsibilities
of Action
Generic Name: Classifications: Indications:  Mild fever Special Monitor frequency,
Carboprost A sterile solution For severe bleeding after  Chills precaution to duration, and
form of childbirth.  Numbness patients with intensity of
Dosage: 1 gm prostaglandin  Tingly feeling asthma, contractions, and its
 Contraindications:  Nausea hypertension, interval. Notify
Route: IVTT Actions:  Severe  Diarrhea cardiovascular, physician in
Binds to the cardiovascular,  Cough renal, or contractions are
prostaglandin E2 renal, and  Headache hepatic absent for more
receptor, hepatic disease  Breast pain disease, than 1 minute.
producing  PID  Menstrual anemia,
myometrial  Hypersensitivity type of pain jaundice, Monitor vital signs
contractions,  Anemia  Ringing in the diabetes, or
causing the  Diabetes ears epileptic Auscultate for
induction of  Hard arteries episodes breath sounds
labor or  Asthma (wheezing and
expulsion of sensation of chest
placenta tightness can
indicate
hypersensitivity)

Assess for nausea,

vomiting, and
diarrhea

Monitor amount
and type of vaginal
discharge
Generic Name: Classifications: Indications:  Nausea Caution to Monitor vital signs
Tranexamic acid Antifibrinolytics For heavy menstrual  Diarrhea patients using before
to improve blood bleeding and short term  Stomach pain combination administering drug
Dosage: 1 gm clotting prevention in patients  Vomiting hormonal
Actions: with hemophillia and  Chills fever contraception, Monitor neurologic
Route: IVTT Slows down the menorrhagia  Severe overweight status
breakdown of headache patients,
blood clots, to Contraindications:  Back or joint smokers, and Assess for
help prevent  Hypersensitivity pain patients over thromboembolic
prolonged  Intracranial  Muscle pain 35-years-old complications
bleeding bleeding  Muscle
 History of stiffness Monitor platelet
venous or  Runny nose count, clotting
arterial factors
thromboemboli
sm Instruct patient to
 Renal notify healthcare
impairment physician if bleeding
recurs or
thromboembolic
symptoms develop

Change patient’s
position slowly to
avoid orthostatic
hypotension
Generic Name: Classifications: Indications:  Genital Verbalize if Ensure patient is not
Cefazolin Cephalosporin Respiratory tract itching patient has any allergic to the drug
antibiotics, and infections, UTIs, biliary  White allergy to drug
Dosage: 2 gm works by killing tract infections, bone and patches or its Perform culture and
bacteria joint infections, genital around components. sensitivity tests
Route: IV infections, septicaemia, mouth before
Actions: endocarditis  Loss of History of administering
Frequency and A bactericidal appetite kidney, liver or
timing: Once a day agent that acts Contraindications:  Heartburn stomach MIO rates and
by inhibition of  Hypersensitivity  Gas disease. patterns
bacterial cell wall  Impaired renal  Nausea
synthesis function  Vomiting Medication Report onset of
 Diarrhea passes into diarrhea
breastmilk.
Generic Name: Iron Classifications: Indications:  Nausea Take iron Advise patient to
tablets An oral Pregnant women or  Vomiting supplements take medications an
supplement that patients with anemia  Stomach with food to hour before meals
consists of discomfort avoid GI for effective
ferrous sulfate, Contraindications:  Heartburn disturbances absorption
ferrous  Iron  Loss of
 gluconate, and metabolism appetite Should not be Educate patient that
ferric citrate disorder  Constipation taken with these tablets may
 Overload of  Diarrhea milk, calcium, produce dark or
Actions: iron in blood  Black or dark and antacids black stools, but it is
To treat and  Blood disorders stool totally normal
prevent low  Stomach ulcer  Stained teeth
blood levels of  Gastritis
iron cause by
anemia or
pregnancy

X. Nursing Care Plan

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: Risk for Short-term goal: Monitor vital signs Increased HR, After
Vaginal bleeding hypovolemic After 6 hours of of patient every quick and shallow implementing all
increases and shock secondary nursing 15 minutes. breathing, and the nursing
vaginal pads were to postpartum interventions, cool and clammy interventions, the
very soaked. Felt haemorrhage. there will be a skin are some patient would
sick to her decrease in primary signs of refrain from too
stomach. patient’s blood loss shock. much blood loss,
and she would not balance fluid
Objective: feel nauseated. Ensure that an IV For administration volume, attain
HR: 100 bpm line is prepped. of blood, IV fluids, normal vital signs,
BP: 110/76 mmHg Long-term goal: and necessary and is no longer at
RR: 22 cpm After 24 hours of medications to risk for
Hospital gown is implementing prevent shock. hypovolemic
soaked with nursing shock.
blood, perineal interventions, the Provide proper To ensure that the
pads and bed patient would not oxygen patient would not
linens covered in be at risk for administration. be oxygen-
blood. developing deficient.
complications of
postpartum Provide emotional To decrease stress
haemorrhage support to the levels, to calm her
patient. down and make
her feel at-ease.

XI. Discharge Plan and Health Teachings

 Diet:
o Instruct the client to have healthy and balanced meals
o Keep hydrated during the day
 Medications:
o Take medications prescribed by the doctor at specified time of the day
o Do not skip the medications
o Continue taking antenatal vitamins
o Do not forget to take iron supplements
 Lifestyle:
o Get plenty of rest
o Have schedules for relaxation time
o Exercise minimally, take short walks
o Avoid unhealthy snacks and unhealthy habits
o Take time to bond with your newborn
 When to call the doctor:
o If heavy bleeding persists
 Follow up check ups:
o Are done every week