Postpartum Hemorrhage (PPH)

• From delivery up to 6wks postpartum

• SVD Spontaneous vaginal delivery: greater than 500ml (considered PPH)

o Estimated blood loss

o Quantitative blood loss(weighing everything)

• CS C-Section: greater than 1000ml

Two main reasons for PPH

• Full bladder

• Retained placenta

What you will assess when you walk into a patient’s room for PPH

1. Assess Fundus

-should always be right at umbilicus

If it feels like your cheek: boggy; (massage it) Don’t stop unless it firms up

2. Call for help

3. Call Dr.

4. Meds

5. VS and O2 stat

6. Weigh under pads (add this amount of blood loss to what she lost at delivery

7. Change under pads

8. Empty bladder (foley)

9. Start 2

nd IV; may need to give patient blood

o Once you start to feel the fundus firm up you can stop massaging

o Only thing that can misplace the fundus is a full bladder

• The uterus has to contract to stop bleeding

Meds (all usually standing orders)

• Pitocin: usually IV sometimes IM every patient after they deliver will get this drug

(immediately)

o If there is a fetus in the uterus; has to be on pump and is piggybacked

o If not given wide open

• Methergine: given IM; if patient has HTN CANNOT be given this drug

• Hemabate: given IM; CANNOT give if patient has asthma (can cause explosive diarrhea)

• Cytotec: rectally; given 800-1000 mcg

*Methergine and Hemabate: work within 2-3 minutes

If all of this doesn’t work then back to the OR

• Should be dark brown

• Firm w/ Bright red blood- laceration

• After delivery check every 15 minutes x 4

• Every 30 minutes x 4