NUR 254 Exam 2 | Child Bearing
and Child Caring Families| Latest
2024
Early postpartum haemorrhage
occurs within 24 hours of birth
Most common cause of early PPH
uterine atony
- uterus fails to contract after delivery
Risk factors for early PPH
Macrosomia: over distends uterus
Multiple gestation: over distends uterus
Polyhydramnios- to much amniotic fluid: over distends uterus
Chorioamnionitis: uterus infection
Prolonged labor: slow cervical change (overworked, can't clam
down)
Use of magnesium sulfate: relaxes the uterus (smooth muscle)
Use of oxytocin (pitocin) (8-10+ hours) can turn off for 15 mins
due to short half life
Other causes for early PPH
Unrepaired lacerations or perineum or vaginal canal: vault or
cervix (uterus is firm, not related to uterus) message won't help,
keep track of amount and notify MD. Monitor for
continuous trickle of blood.
, Hematomas of perineal area or vagina pt complains of
unrelieved pain or pressure. May or may not be able to
see. Can be caused by forceps or vacuum delivery: long labor,
need uterus to clamp down.
S/S:
Discoloration of perineum
Perineal pain/ pressure & rectal pressure
Edema
May need surgical intervention: hysterectomy
Medications for PPH
Used to contract uterus
oxytocin (Pitocin) 20 U in 1000mL (1L) of LR or NS (bolus)
Methylergonovine maleate (methergine) Check BP
-contraindicated in HTN, preeclampsia, cardiac disease
Prostaglandins
Dinoprostone (prostin E2) vaginally, rectally
-contraindicated in hypotension, asthma, HTN
Cytotec (misoprostol) rectally, sublingual or PO x1
-contraindicated in none
Carboprost Hemabate IM or intrauterine q15-90min up to 8
doses
S/E: N/V and uncontrollable diarrhea
Contraindicated in severe asthma & HTN
Late postpartum hemorrage
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