16 Questions
What happens to blood volume during pregnancy?
It increases
What is a common site of concealed bleeding in postpartum hemorrhage?
Broad ligament
What is the approximate amount of blood loss before clinical signs of hemorrhage appear?
1800-2100 ml
What is a key response to postpartum hemorrhage in obstetrical settings?
Implementing evidence-based protocols
Why are rapid response teams initiated in some obstetrical settings?
To respond to postpartum hemorrhage
What percentage of cardiac output perfuses the placenta at term?
20%
What is the normal mechanism for hemostasis after placental expulsion?
Contraction of the uterine muscles
What can cause significant blood loss in the postpartum period?
Both A and B
What is the time frame for late postpartum hemorrhage?
From 24 hours to 6 weeks after birth
What is the leading cause of early postpartum hemorrhage?
Uterine tone and reproductive tract trauma
What percentage of maternal deaths is attributed to postpartum hemorrhage in the United States?
One sixth
How often does a woman die from postpartum hemorrhage worldwide?
Every four minutes
What is the traditional definition of postpartum hemorrhage?
A blood loss of greater than 500 ml
What is the average blood loss in a normal vaginal birth?
Greater than 500 ml
How accurate are clinical estimates of blood loss at childbirth?
They tend to underestimate actual blood loss by up to 50%
Why is it difficult to estimate blood loss at childbirth?
Because blood mixes with amniotic fluid and is obscured as it oozes onto sterile drapes or is sponged away
Study Notes
Postpartum Hemorrhage
- Postpartum hemorrhage (PPH) is classified into two types: early (primary) and late (secondary) PPH.
- Early PPH occurs within the first 24 hours after childbirth, while late PPH occurs from 24 hours to 6 weeks after birth.
- Early PPH is more common and is often caused by issues of uterine tone and reproductive tract trauma.
- Late PPH is more likely associated with retained placental tissue.
Maternal Mortality and Morbidity
- PPH is a significant cause of maternal mortality and morbidity, accounting for approximately one-sixth of maternal deaths in the United States.
- Worldwide, an estimated 140,000 women die from PPH, with one death occurring every four minutes.
Definition of Postpartum Hemorrhage
- The traditional definition of PPH is a blood loss of greater than 500 ml following childbirth.
- However, this definition is being questioned, as the average blood loss in a normal vaginal birth is actually greater than 500 ml.
- Average blood loss after cesarean childbirth exceeds 1000 ml, and after repeat cesarean birth, it exceeds 1500 ml.
Clinical Estimation of Blood Loss
- Clinical estimation of blood loss at childbirth may be difficult because blood mixes with amniotic fluid and is obscured by sterile drapes or sponged away.
- Clinical estimates tend to underestimate actual blood loss by up to 50%.
- Healthcare providers overestimate low volumes of loss and significantly underestimate excessive blood loss.
Clinical Signs of Hemorrhage
- The clinical signs of hemorrhage, such as decreased blood pressure, increasing pulse, widening pulse pressure, thirst, restlessness, and decreasing urinary output, do not appear until as much as 1800 ml to 2100 ml of blood has been lost.
- The signs of hemorrhage become apparent shortly before the woman becomes hemodynamically unstable.
Management of Postpartum Hemorrhage
- Systems are needed in every obstetrical setting to enable nurses to respond quickly to implement certain actions independently based on evidence-based protocols.
- Rapid response teams have been initiated for obstetric emergencies, such as PPH, similar to a call for coding someone experiencing a cardiac arrest.
Learn about postpartum hemorrhage, its classification into early and late, and the causes of each. Understand the importance of timely care for postpartum hemorrhage.
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