Postpartum Hemorrhage Study Guide
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Questions and Answers

What is the primary goal of resuscitative measures in the management of atonic postpartum hemorrhage?

  • To restore blood volume and correct hypovolemic shock (correct)
  • To reduce anxiety
  • To inspect the placenta for completeness
  • To administer pain relief

    • Uterine packing is universally recommended for managing atonic postpartum hemorrhage.

    False

    What is the definition of secondary postpartum hemorrhage?

    Bleeding from the genital tract that occurs after 24 hours of delivery until the end of the puerperal period.

    To relieve anxiety in patients with postpartum conditions, it is essential to explain her ______ and management.

    <p>condition</p> Signup and view all the answers

    Match the following measures with their respective management steps for atonic postpartum hemorrhage:

    <p>Massage of uterus = Step II Inspection of placenta = Step I Use of oxytocic drugs = Step III Bimanual compression = Step V</p> Signup and view all the answers

    Which of the following is NOT a clinical picture of secondary postpartum hemorrhage?

    <p>Normal uterine involution</p> Signup and view all the answers

    The pulse and blood pressure of a postpartum patient should be checked every 30 minutes.

    <p>False</p> Signup and view all the answers

    What is the recommended action if an atonic uterus is identified?

    <p>Inform the obstetrician and massage the uterus.</p> Signup and view all the answers

    Vaginal bleeding in secondary postpartum hemorrhage may be in the form of excessive or prolonged red ______.

    <p>lochia</p> Signup and view all the answers

    Which method is used to assess risk factors in a postpartum patient's history?

    <p>Observation of the mother</p> Signup and view all the answers

    What is a common cause of partial placental separation?

    <p>Improper management of the third stage of labor</p> Signup and view all the answers

    Secondary postpartum hemorrhage occurs within the first 24 hours after childbirth.

    <p>False</p> Signup and view all the answers

    List one contributing factor to uterine inertia.

    <p>Prolonged labor</p> Signup and view all the answers

    The primary postpartum hemorrhage occurs during the first _______ hours postpartum.

    <p>24</p> Signup and view all the answers

    Which of the following is NOT a symptom of excessive blood loss?

    <p>Increased appetite</p> Signup and view all the answers

    Match the conditions with their corresponding causes:

    <p>Uterine inertia = Atonic postpartum hemorrhage Retained placenta = Mechanical interference with retraction Trauma in genital tract = Postpartum hemorrhage Coagulation defects = Hypofibrinogenemia</p> Signup and view all the answers

    The presence of placenta in the lower uterine segment can make the suprapubic region boggy.

    <p>True</p> Signup and view all the answers

    What is a recommended management step to prevent postpartum hemorrhage?

    <p>Active management of the third stage of labor</p> Signup and view all the answers

    Immediate replacement of _______ loss is essential in managing postpartum hemorrhage.

    <p>blood</p> Signup and view all the answers

    Which of the following is a complication of postpartum hemorrhage?

    <p>Puerperal anemia</p> Signup and view all the answers

    A full bladder can reflexively inhibit uterine contractions.

    <p>True</p> Signup and view all the answers

    What is a common cause of retained placenta?

    <p>Uterine inertia</p> Signup and view all the answers

    One of the factors contributing to uterine atony is _______ multiparity.

    <p>grand</p> Signup and view all the answers

    Which drug is commonly administered intravenously to manage postpartum hemorrhage?

    <p>Oxytocin</p> Signup and view all the answers

    What is the most common cause of postpartum hemorrhage (PPH)?

    <p>Uterine atony</p> Signup and view all the answers

    Secondary postpartum hemorrhage occurs within the first 24 hours after delivery.

    <p>False</p> Signup and view all the answers

    What is considered excessive bleeding from the genital tract following a cesarean section?

    <p>More than 1000 ml</p> Signup and view all the answers

    The primary mechanism for immediate hemostasis after delivery is myometrial __________.

    <p>contraction</p> Signup and view all the answers

    Match the following classifications of postpartum hemorrhage with their definitions:

    <p>Third Stage Hemorrhage = Excessive bleeding before or during expulsion of the placenta Primary Postpartum Hemorrhage = Excessive bleeding within the first 24 hours after delivery Secondary Postpartum Hemorrhage = Excessive bleeding more than 24 hours after delivery True Postpartum Hemorrhage = Includes both primary and secondary types</p> Signup and view all the answers

    Which of the following is not a source of third stage hemorrhage?

    <p>Blood clotting defects</p> Signup and view all the answers

    Atonic postpartum hemorrhage is a type of traumatic hemorrhage.

    <p>False</p> Signup and view all the answers

    What percentage of postpartum hemorrhage is attributed to atonic causes?

    <p>80%</p> Signup and view all the answers

    Study Notes

    Postpartum Hemorrhage (PPH)

    • PPH is a leading cause of maternal mortality, especially in developing countries.
    • Defined as excessive bleeding from the genital tract:

      • 500ml after vaginal delivery

      • 1000ml after cesarean section

      • Any bleeding affecting the mother's condition after delivery, regardless of the amount.

    Causes of PPH

    • Uterine Atony (80%): The most common cause.
      • Myometrial contraction (occlusion of uterine blood vessels) is impaired.
      • Factors contributing to uterine atony include prolonged labor, excessive uterine distension, weakened uterine musculature (fibroids, anemia, malnutrition, etc.), grand multiparity, full bladder, fear, pain, antepartum hemorrhage, anesthesia or sedatives, and shock.
    • Extra-Uterine: Traumatic bleeding (e.g., lacerations).
    • Blood Clotting Defects: Hypofibrinogenemia/DIC (associated with obstetric disorders like placental abruption, retained dead fetus, amniotic fluid embolism, severe pre-eclampsia, and sepsis).

    Classification of PPH

    • Third Stage Hemorrhage: Occurs during or before placental expulsion.
      • Causes: Traumatic (lacerations), or placental issues (partial separation/retained placenta).
        • Partial separation: poor third stage management, uterine inertia, placental anomalies (accreta, succenturiata).
        • Complete retention: poor third stage management, uterine inertia, unconscious patient, membrane adhesions.
      • Diagnosis: Flabby uterus, trickle of blood, soft/hard fundus (depending on cause), boggy suprapubic region (membrane adhesions).
      • Management: Bladder emptying, blood replacement, oxytocin, uterine massage/manual placental removal.
    • True Postpartum Hemorrhage: Occurs after placental expulsion within 24 hours.
      • Primary PPH: Within first 24 hours.
      • Secondary PPH: After 24 hours.

    Causes of Primary PPH

    • Uterine Atony:
    • Mechanical Interference: Retained placenta/membranes, placenta succenturiata.
    • Trauma: Genital tract lacerations.
    • Coagulation Defects: Acquired or congenital.

    Clinical picture of PPH (general signs of excessive blood loss):

    • Thirst, dyspnea, restlessness, rapid pulse, subnormal temp, low blood pressure, sweating, tachypnea, pallor, sunken eyes, dimness of vision, fainting, or coma.

    Complications of PPH

    • Hemorrhagic shock
    • Puerperal anemia
    • Puerperal sepsis
    • Venous thrombosis and pulmonary embolism
    • Sheehan's syndrome (pituitary damage)
    • Recurrence in subsequent pregnancies

    Prevention of PPH

    • Identify and manage high-risk patients:
      • Anemia, nutritional deficiencies, uterine over-distention, multiparity, fibroids, previous PPH, antepartum hemorrhage, IUFD, PIH, diabetes, etc.
      • Active management of third stage of labor & fourth stage (first 2 hours postpartum). Essential to avoid uterine atony.
    • Necessary routine measures: blood grouping/typing, hospital deliveries.
    • Proper management of labor stages: avoid prolonged labor, trauma, bladder issues.

    Management of PPH (Atonic)

    • Resuscitative measures: fluid/plasma replacement, monitoring
    • Control bleeding measures:
      • Inspect placenta (completeness), catheterization.
      • Massage uterus.
      • Oxytocics (IV/infusion).
      • Explore genital tract and uterus for lacerations/retained tissue, and remove clots.
      • Bimanual uterine compression.
      • Uterine packing (controversial).
      • Surgical measures (ligation/hysterectomy).

    Traumatic PPH

    • Predisposing factors: instrumental delivery, malposition/presentation, excessive manipulation, large fetus.
    • Sites of trauma: cervix, vagina, vulva.
    • Management: stitches/packing based on site.

    Secondary PPH

    • Bleeding after 24 hours.
    • Causes: retained placental parts, subinvolution, inversion, estrogen withdrawal, sloughing tissue, new growths.
    • Diagnosis: Variable bleeding, subinvolution, sepsis, speculum/bimanual exam, ultrasound.
    • Management: general treatment, removal of retained tissue, ligation if needed, biopsy.

    Nursing Management of PPH

    • Assessment: risk factors, vital signs, bleeding characteristics, amount, lab work.
    • Interventions (atony): inform physician, assess uterine tone, massage uterus, observe mother, administer oxytocics, bladder emptying, placenta examination, reassurance.
    • Interventions (trauma): pressure to site, assessment, equipment preparation, intervention (stitches).

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    Description

    This quiz explores the essential aspects of postpartum hemorrhage (PPH), including causes, definitions, and risk factors associated with maternal mortality. Test your knowledge on uterine atony and other contributing factors to help improve maternal health outcomes. Prepare to understand the critical implications of PPH in clinical practice.

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