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Postpartum hemorrhage (PPH) is the most significant cause of maternal deaths during or after childbirth, as it can lead to severe blood loss that can be life-threatening. It occurs at more than 10% of births and has a fatality rate of 1%. It is also estimated to account for 19.7% of all deaths related to pregnancy globally and it causes 25% of all maternal deaths. Due to the unpredictability of the problem and its rapid progression, reducing the incidence of PPH and improving maternal health outcomes becomes a challenge. PPHTraditionally, postpartum hemorrhage is defined as blood loss of 500 ml or more following a vaginal birth; this occurs in as many as 5% to 15% of postpartum women. With a cesarean birth, hemorrhage is present when there is a 1,000-ml blood loss or a 10% decrease in the hematocrit level. Although hemorrhage may occur either early (within the first 24 hours following birth) or late (from 24 hours to 6 weeks after birth), the greatest danger is in the first 24 hours because of the grossly denuded and unprotected uterine area left after detachment of the placenta. The body initially responds to a reduction in blood volume with increased heart and respiratory rates. These reactions increase the oxygen content of each erythrocyte and cause faster circulation of the remaining blood. Tachycardia is usually the first sign of inadequate blood volume. Blood flow to nonessential organs gradually stops, to make more blood available for vital organs. The four main reasons for postpartum hemorrhage are uterine atony, trauma, retained placental fragments, and the development of disseminated intravascular coagulation (DIC). These causes are generally referred to as the four T’s of PPH: tone, trauma, tissue, and thrombin. Conditions that increase the client’s risk for postpartum hemorrhage include the following:
When planning care for a client diagnosed with postpartum hemorrhage, provide measures that will restore the client most quickly to health and promote contact among her, her child, and her primary support persons. The following are nursing diagnoses associated with the management of postpartum hemorrhage:
Postpartum Hemorrhage Nursing Care PlanBelow are sample nursing care plans for the problems identified above. Deficient Fluid VolumeAs a consequence of increased circulating blood volume during pregnancy, vital signs of hypovolemic shock become relatively insensitive in pregnancy. Tachycardia does not usually develop until blood loss exceeds 1,000 ml, and blood pressure is usually maintained in the normal range. A blood loss of up to 1,500 ml will begin to manifest clinical signs, such as a rise in pulse and respiratory rate, and a slight recordable fall in systolic blood pressure. Hypovolemic clients who begin to decompensate, as evidenced by hypotension, will deteriorate extremely rapidly. Nursing Diagnosis
Evidenced by
Desired OutcomesAfter implementation of nursing interventions, the client is expected to:
Nursing Interventions
Ineffective Tissue PerfusionThe body initially responds to a reduction in blood volume with increased heart and respiratory rate. These reactions increase the oxygen content of each erythrocyte and cause faster circulation of the remaining blood. Blood flow to non-essential organs gradually stops, to make more blood available for vital organs specifically the heart and brain. This change causes the client’s skin and mucous membranes to become pale, cold, and clammy. As blood loss continues, flow to the brain decreases, resulting in mental changes. As blood flow to the kidneys decreases, they respond by conserving fluid. Nursing Diagnosis
Evidenced by
Desired OutcomesAfter implementation of nursing interventions, the client is expected to:
Nursing Interventions
Risk for InfectionPlacental fragments are more likely to be retained if the placenta does not separate cleanly from its implantation site after birth or if there is disruption of the placental scab. Clots form around these retained fragments and slough several days later, sometimes carrying the retained fragments with them. Blockage of the lochial flow because of the retained placenta or clots increases susceptibility to infection. Nursing DiagnosisRisk Factors
Evidenced by
Desired OutcomesAfter implementation of nursing interventions, the client is expected to:
Nursing Interventions
Post Partum Hemorrhage Nursing Care Plan SampleNursing Diagnosis: Fluid Volume Deficit
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