Postpartum Hemorrhage (PPH)

Introduction:

Postpartum Hemorrhage (PPH) is a serious and potentially life-threatening condition that can occur after childbirth. It is characterized by heavy bleeding from the uterus and can lead to severe blood loss and decreased cardiac output if not quickly treated. Understanding the signs, causes, and necessary interventions for PPH is critical for the health and well-being of new mothers. In this blog post, we will explore the key aspects of a postpartum hemorrhage nursing care plan, including the identification of risk factors, the implementation of appropriate interventions, and techniques to promote comfort and healing.

Definition:

According to WHO, PPH is typically described as blood loss over 500 milliliters (mL) after vaginal birth and 1000 mL after cesarean birth.

Types of Postpartum Hemorrhage

1. Primary PPH: Hemorrhage occurs within 24 hours following the birth of the baby. Examples include Third Stage Hemorrhage and True Postpartum Hemorrhage
2. Secondary PPH: Hemorrhage occurs beyond 24 hours and within puerperium, also called delayed or late puerperal hemorrhage

Causes of Primary Postpartum Hemorrhage

a. Atonic Uterus

b. Traumatic Uterus

c. Retained Tissues or Placenta

d. Blood Coagulopathy

Causes of Secondary Postpartum Hemorrhage

a. Retained bits of cotyledon or membranes

b. Infection and separation of slough over a deep cervicovaginal laceration

c. Endometritis and subinvolution of the placental site

d. Secondary hemorrhage from Cesarean Section

e. Withdrawal bleeding following estrogen therapy for suppression of lactation

f. Others include chorion epithelioma, carcinoma cervix, placental polyp, infected fibroid, fibroid polyp, etc.

Postpartum Hemorrhage Nursing Care Plan

The following outcomes should be prioritized in a postpartum hemorrhage nursing care plan:

Bleeding control and management: The nurse should keep track of the patient’s vital signs and hemoglobin levels. The nurse should also be familiar with the administration of anti-bleeding drugs such as oxytocin, ergometrine, and misoprostol.

Fluid and electrolyte balance: To avoid dehydration and electrolyte imbalances, the nurse should check the patient’s fluid intake and output, as well as their electrolyte levels.

In order to prevent infection, the nurse should check the patient’s temperature and administer wound care as needed. In order to prevent infection, the nurse should also educate the patient on good hygiene practices.

Monitoring for uterine contractions: The nurse should look for evidence of contractions in the patient’s uterus and assess the patient’s pain level.

Assisting with future pregnancy decision-making: The nurse should advise the patient about future pregnancy alternatives, such as family planning methods and the risks and advantages of future pregnancies.

Emotional assistance: The nurse should offer emotional support to the patient and family, assisting them in dealing with the physical and emotional stress of postpartum hemorrhage.

Collaboration with an interdisciplinary team: The nurse should collaborate closely with other members of the healthcare team, such as obstetricians and midwives, to provide the patient with comprehensive and coordinated care.

A postpartum hemorrhage nursing care plan is provided below:

Postpartum hemorrhage can result in various physical and emotional effects for a mother. The following are some nursing diagnoses that may apply to a mother experiencing postpartum hemorrhage:

• Deficient fluid volume related to blood loss
• Acute pain related to uterine contractions and manual interventions
• Imbalanced nutrition: less than body requirements related to blood loss and decreased food intake
• Risk for decreased cardiac output related to blood loss
• Risk for injury related to blood loss
• Risk for infection related to genital tract trauma during delivery
• Risk for decreased oxygenation related to decreased hemoglobin levels
• Anxiety related to potential harm to self and baby

These nursing diagnoses can help guide the development of a postpartum care plan that addresses the mother’s physical and emotional requirements. It’s vital to remember that each mother’s condition is unique, and nursing diagnoses may differ depending on the specific circumstances.

Nursing Diagnosis 1: Deficient fluid volume related to blood loss

Nursing Interventions

• Continuously monitor vital signs, including blood pressure, & heart rate
• Keep an eye out for indicators of fluid volume insufficiency in the patient, such as decreased urine production, dry mouth, or lightheadedness.
• Keep track of the patient’s fluid intake and output.
• Encourage oral fluid intake, as tolerated, and offer clear liquids, such as water, ice chips, and clear broths, to promote hydration.
• To restore lost fluids, administer IV fluids as directed by your healthcare professional.
• Assess for signs of fluid overload, such as crackles in the lungs, and report any changes to the physician.
• Encourage the patient to rest and conserve energy, as excessive physical activity can place additional demands on the body and reduce fluid volume.

Evaluation:

Monitoring fluid intake and output, as well as giving IV fluids, can assist prevent and treat fluid volume shortage, as well as issues associated with blood loss.

Nursing Diagnosis 2: Acute pain related to uterine contractions and manual interventions

Nursing Interventions

• Administer pain medicine, such as intravenous (IV) opioids or regional anesthetics, as directed by your healthcare professional (epidural).
• Encourage them to adopt relaxation techniques like deep breathing and progressive muscle relaxation.
• To assist the patient in coping with the discomfort, provide emotional support and encouragement.
• To ease discomfort, place the patient in a comfortable position, such as a side-lying position.

Evaluation:

Pain medication can assist lower the severity of pain, while relaxation techniques and emotional support can help the patient cope with the suffering. Changing postures might also help relieve pain.

Nursing Diagnosis 3: Imbalanced nutrition: less than body requirements related to blood loss and decreased food intake

Nursing Interventions

• Encourage the mother to eat and drink as tolerated, focusing on nutrient-dense foods and fluids to aid in her recovery from blood loss.
• If the mother is unable to consume adequate nutrients orally, provide additional nutrition, such as enteral or parenteral feeding.
• Monitor the mother’s diet and drink consumption on a regular basis to ensure she is achieving her nutritional needs.
• Provide healthy nutrition education: Teach the mother about good nutrition and how it can help her recover from blood loss.
• Provide small, regular meals: Provide small, frequent meals to the mother to help prevent decreased appetite and enhance nutrient intake.
• Assess for symptoms of anemia: Assess the mother for symptoms of anemia, such as fatigue, weakness, and pallor, and report any changes to the healthcare provider.

Nursing Diagnosis 4: Risk for decreased cardiac output related to blood loss

Nursing Interventions

1. Continuous monitoring of vital signs, including blood pressure, heart rate, and oxygen saturation levels, to assess for changes in cardiac output.
2. Administration of fluids and/or blood products, as prescribed, to replace lost blood volume and maintain cardiac output.
3. Monitoring of fluid and electrolyte balance, including sodium, potassium, and fluid intake and output, to prevent imbalances that can affect cardiac function.
4. Close collaboration with the interdisciplinary team, including the physician and blood bank, to ensure timely and appropriate treatment for blood loss.
5. Administering medications, such as vasopressors, to increase blood pressure and improve cardiac output, as prescribed.
6. Assessing the patient’s response to treatments, including monitoring of vital signs, urine output, and level of consciousness, to evaluate the effectiveness of interventions.
7. Encouraging the patient to rest and conserve energy, as excessive physical activity can place additional demands on the heart and decrease cardiac output.
8. Providing emotional support and addressing any fears or concerns the patient may have about their condition and treatment.
9. Maintaining a quiet and calm environment to reduce stress and minimize additional demands on the heart.
10. Educating the patient and family about the importance of maintaining fluid and electrolyte balance and the risks and benefits of treatments, to promote understanding and participation in the patient’s care.

Evaluation:

The goal of the nursing diagnostic “Risk for decreased cardiac output related to blood loss” in a patient with PPH is to prevent and manage the potential decrease in cardiac output that can occur due to blood loss. The purpose of nursing interventions is to keep blood volume and heart function normal, while also monitoring the patient’s reaction to therapies and offering support and education to the patient and family.

Nursing Diagnosis 5: Risk for Tissue injury related to blood loss

Nursing Interventions

• Monitor vital signs: Regularly assess the mother’s blood pressure, pulse, and respiratory rate to monitor for changes that may indicate a decrease in blood pressure and increased risk for injury.
• Administer IV fluids: Administer IV fluids to maintain fluid volume and prevent injury related to low blood pressure.
• Administer oxygen: Provide supplemental oxygen as needed to maintain oxygenation levels and prevent injury related to hypoxia.
• Administer medications: Administer medications, such as vasopressors, as ordered by the healthcare provider to increase blood pressure and prevent injury related to low blood pressure.
• Assess for signs of shock: Assess the mother for signs of shock, such as decreased urine output, pale and cool skin, and restlessness, and report any changes to the healthcare provider.
• Encourage deep breathing and leg exercises: Encourage the mother to perform deep breathing and leg exercises to improve circulation and prevent blood clots, which can increase the risk of injury.
• Monitor laboratory values: Regularly monitor laboratory values, such as hemoglobin and hematocrit levels, to assess the mother’s overall blood volume and monitor for changes that may increase the risk of injury.

Nursing Diagnosis 6: Risk for infection related to genital tract trauma during delivery

Interventions

• Monitor the patient’s temperature and any signs of infection, such as redness or discharge.
• Administer antibiotics as ordered by the healthcare provider to prevent or treat the infection.
• Encourage the patient to maintain good hygiene practices, such as frequent handwashing.
• Instruct the patient to report any signs of infection to the healthcare provider.

Evaluation:

Monitoring for signs of infection and administering antibiotics can help prevent or treat an infection, while good hygiene practices can help prevent the spread of infection.

Nursing Diagnosis 7: Risk for decreased oxygenation related to decreased hemoglobin levels:

Nursing Intervention

• Monitor the patient’s oxygen saturation levels and blood pressure.
• Administer oxygen as ordered by the healthcare provider.
• Administer IV fluids and blood products as ordered by the healthcare provider to maintain fluid volume and hemoglobin levels.
• Monitor the patient for signs of decreased oxygenation, such as shortness of breath or changes in skin color.

Evaluation:

Monitoring for signs of decreased oxygenation and administering oxygen and fluids can help maintain oxygen saturation levels and prevent complications related to decreased hemoglobin levels.

Nursing Diagnosis 8: Anxiety related to potential harm to self and baby

Nursing Interventions

• Encourage the patient to express their concerns and fears.
• Provide reassurance and education about the delivery process and potential outcomes.
• Offer relaxation techniques, such as deep breathing or progressive muscle relaxation.
• Provide support from a significant other or support person, if requested.

Evaluation:

Allowing the patient to express their concerns and providing education can help reduce anxiety, while relaxation techniques and support from loved ones can help the patient cope with stress.

Frequently Asked Questions:

What are the common signs of postpartum hemorrhage?

Common signs of postpartum hemorrhage include heavy vaginal bleeding, a rapidly increasing heart rate, low blood pressure, weakness or dizziness, and the need for a blood transfusion.

How should I care for a postpartum woman who is bleeding?

A postpartum woman who is bleeding should be transported to a hospital immediately for medical evaluation and treatment. In the meantime, it is important to keep the woman lying down, elevate her legs, and monitor her vital signs.

How can I prevent postpartum hemorrhage?

There are several steps that can be taken to reduce the risk of postpartum hemorrhage, including adequate prenatal care, timely identification and management of obstetrical risk factors, and prompt recognition and treatment of bleeding after delivery.

What are the risk factors for postpartum hemorrhage?

Risk factors for postpartum hemorrhage include a history of heavy menstrual periods, previous postpartum hemorrhage, multiple gestations, advanced maternal age, and obstetrical complications such as uterine atony or tears in the birth canal.

What are the types of nursing care that may be necessary for a postpartum woman with heavy bleeding?

Nursing care for a postpartum woman with heavy bleeding may include monitoring vital signs, administering IV fluids, administering medications to manage bleeding, providing emotional support, and collaborating with the interdisciplinary team to provide timely and appropriate care.

How often should I assume that a postpartum woman is losing blood and when should I seek medical attention?

Any vaginal bleeding after delivery, especially if it is heavy or accompanied by other signs of postpartum hemorrhage, should be considered a medical emergency and prompt medical attention should be sought.

What are some steps that I can take to reduce the risk of further bleeding after delivering a baby?

Steps that can be taken to reduce the risk of further bleeding after delivering a baby include maintaining proper hydration, avoiding excessive physical activity, and following the physician’s instructions for postpartum care and medications.

What can I do to promote comfort and healing after a postpartum hemorrhage?

Promoting comfort and healing after a postpartum hemorrhage may include taking pain medications as prescribed, resting, avoiding excessive physical activity, and maintaining proper hydration.

Are there any medications that can be given to help reduce the amount of bleeding after delivery?

Yes, there are medications that can be given to help reduce the amount of bleeding after delivery, including uterotonics, such as oxytocin, and antifibrinolytics, such as tranexamic acid.

Can anything be done to speed up the healing process after a postpartum hemorrhage?

In addition, to prompt and appropriate medical treatment, the healing process after a postpartum hemorrhage can be supported by maintaining proper hydration, resting, avoiding excessive physical activity, and following the physician’s instructions for postpartum care and medications.

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