Postpartum haemorrhage is defined as severe bleeding that occurs immediately after labour. However let us take a good look at the causes of postpartum haemorrhage and its risk factors.
Causes / Risk Factors for Postpartum Haemorrhage
- Multiparity
- Retained product of conception.
- Polyhydramnios causing over-distension of uterine muscles.
- Prolonged labour resulting in uterine inertia.
- Precipitate labour.
- Multiple pregnancy causing over-distension of uterine muscles
- Big baby
- Ante-partum haemorrhage.
- Previous history of postpartum haemorrhage or retained product of placenta.
- Full bladder.
- Placenta previa
- Placenta abrutio
- General anaesthesia.
- Mismanagement of third stage of labour.
- Unknown ateiology.
- Pre-eclampsia.
- Blood clothing disorder.
- Laceration of the genital tract.
- Mechanical factors e.g hurrying the third stage of labour.
Read Also: Causes Of Prolonged Labour In Pregnancy
Nursing Management of a Patient With Postpartum Haemorrhage
Call for medical aid;
- If the cause is what you can manage, treat it before the doctor arrives
- Find out the cause before the doctor arrives.
Resuscitate the Mother;
- Give prescribed intravenous infusion.
- Apply non-pneumatic anti-shock garment (NASG) which helps to promote venous return to the central part of the body organ
Stop the Bleeding;
- Rub up contraction by lightly massaging the uterusabdominally
- Give uterotonic drug to sustain the contraction.
- Put the baby to breast.
Empty the Bladder;
- if the bladder is full encourage her to void.
- Pass urethral catheter if she cannot pass urine on her own.
Empty the Uterus;
- Deliver the placenta when the uterus is well contracted
- Remove blood clots
Position;
- Encourage mother to assume any comfortable position, probably dorsal or lithotomy position.
- Lift her legs to allow blood drain from them into the central circulation.
- Do not raise the foot of the bed to avoid pooling of blood in the uterus.
Psychological Care;
- Reassure the woman and her support persons.
- Explain her condition to her and the family.
- Encourage her to ask questions and answer them tactfully.
- Give prescribed sedatives if need be.
Observations;
- Check the vital signs ¼ hourly for early signs of shock.
- Maintain intake and out put chart
- Keep all soiled linens and pads to asses the amount of blood loss.
- Record all observations and care given for continuity of care.
Investigation
Encourage blood test if not previously done to include the following;
- Blood group
- Packed cell volume
- Haemoglobin level
- Rhesus factor to know if there is need to administer immunoglobin
- Platelet count/fibrinogen level.
Blood transfusion
- Transfuse blood if need be
- Monitor vital signs closely before, during and after blood transfusion.
- Monitor blood transfusion to avoid any form of complication.
- If transfusion reaction occurs stop the blood and alert the doctor.
General nursing care;
- Help her in the performance of activities of daily living.
- Maintain asepsis when caring for her.
- Help her to maintain good personal hygiene.
- Help her in oral toileting.
- Give her bed bath if she cannot go to the bathroom.
Nutrition
- Encourage adequate nutrition rich in protein and carbohydrates.
- Encourage fruits and vegetables.
- Encourage copious intake of fluid
- If she can’t take food orally, give intravenous fluid replacement.
Advise on discharge;
Advise her on the following;
- To take her prescribed drugs
- To return for follow up care as scheduled.
- To book early in her next pregnancy and emphasize on the need to book in a well-equipped hospital.
- Adequate nutrition.
- Maintenance of adequate personal and environmental hygiene.
- Moderate exercise.
- To report to the hospital before the appointment date if any emergency situation occurs.
Prevention of Postpartum Haemorrhage by the Midwife
- Identify women of higher risk factor for postpartum haemorrhage antenatally.
- Women with high risk should be encouraged to book early in a well equipped hospital.
- Lift the foot of the bed and administer analgesia if she has a strong urge to bear down before the cervix is fully dilated.
- Encourage women to be involved in their birth preparedness and complication readiness plan.
- Encourage every mother to be delivered by a skilled care provider who can provide postpartum haemorrhage prevention care.
- Stress on the importance of breast feeding and implement it immediately after delivery of the baby.
- Closely monitor all women post delivery to exclude abnormal bleeding.
- Correct anaemia during antenatal period.
- The bladder should be emptied on to two hours during labour.
- During second stage of labour, she should be asked to breathe out the head of the baby in between contraction.
- Transfer all at risk patients to facilities that can manage this condition.
- Encourage her to perform post natal exercises to help in restoring the myometrium and the pelvic floor muscle tone, there by making them suitable for the next pregnancy.
- Encourage mothers to space out child bearing to allow the uterus to have enough time to recover from previous birth stress.
- Deliver shoulder in anterior-posterior position to avoid perineal tear.
- Give uterotonic drugs immediately after delivery of baby.
Complications of Postpartum Haemorrhage
- Shock
- Anemia
- Death
- Infections
- Renal failure
- Liver damage.
We hope this information was helpful. Feel free to ask your questions in the comment section below