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Topics: Blood, Childbirth, Obstetrics Pages: 18 (4589 words) Published: October 2, 2014
Objectives:
1. To be able to apply in practice the knowledge acquired in providing nursing care for a client with uterine atony. 2. To learn and improve our knowledge in giving nursing care to patient with postpartal hemorrhage. 3. To come up with health teaching necessary for patient with postpartal hemorrhage. Case Scenario:

Mrs. Angela Simons, 36 years old, G8 P7, was rushed to the hospital because of active labor. She had a prolonged and difficult labor. During the first hour of her postpartum, she stated that "I was experiencing an excessive vaginal bleeding". Upon assessment, Mrs. Simons' vitals signs: T= 35.6 ; Heart rate= 130 bpm ; Respiratory Rate= 25 bpm ; BP= 80/40 mmHg, and vaginal bleeding of approximately 250 ml. She was diagnosed by the doctor of having uterine atony. As the nurse assigned to Mrs. Simons, what are your nursing interventions?

Mini Lecture
Postpartum Hemorrhage
Hemorrhage, one of the most important causes of maternal mortality associated with childbearing, poses a possible threat throughout pregnancy and is a major potential danger I in the immediate postpartal period. Traditionally, postpartal hemorrhage has been defined as any blood loss from the uterus greater than 500 ml within a 24 hour period. The greatest danger of hemorrhage is in the first 24 hours because of the grossly denuded and unprotected area left after detachment of the placenta

Uterine Atony
Uterine atony, or the relaxation of the uterus, is the most frequent cause of postpartal hemorrhage. The uterus must remain in a contracted state after birth to allow the open vessels at the placental site to seal. The myometrium fails to contract and the uterus fills with blood because of the lack of pressure on the open vessels of the placental site. It is a condition in which the muscles of a woman's uterus lose their tone and their ability to contract after child birth. Severe hemorrhaging and low blood pressure can result, presenting a number of additional health problems. Women who spend several hours in labor, deliver large or multiple babies, or have had several pregnancies in the past are at the highest risk of developing this problem. Healthcare professionals usually take precautions to prevent the condition during labor, though complications can still occur. A woman's uterine muscles usually contract to stop bleeding after the baby and the placenta are delivered. The muscles work to constrict exposed blood vessels, stopping the flow of blood and repairing uterine walls. Unrestricted blood vessels can release huge amounts of blood, leading to severe hemorrhages and hypotension.

Factors that predispose to poor uterine tone and inability to maintain a contracted state are: * Conditions that distend the uterus beyond average capacity: 1. Multiple gestation
2. Hydramnios (excessive amount of amniotic fluid)
3. Large baby (more than 9 lbs.)
4. Presence of uterine myomas (fibroid tumors)
* Conditions that leave the uterus unable to contract readily: 1. Deep anesthesia or analgesia
2. Labor initiated or assisted with oxytocin agent
3. Maternal age greater than 30 years
4. High parity
5. Previous uterine surgery
6. Prolonged and difficult labor
7. Secondary maternal illness (anemia)
8. Prior history of postpartum hemorrhage
9. Endometritis
10. Prolonged use of magnesium sulfate or other tocolytic agent

Signs and Symptoms:
1. Excessive or bright red bleeding
2. A boggy uterus that does not respond to massage
3. Abnormal clots
4. Any unusual pelvic discomfort or backache

Levels of Care
PREVENTIVE:
* Active management of the third stage of labor-best way to prevent uterine atony. * Controlled Cord Tract (CCT)
- Fundal massage after the delivery of the placenta
- Identifying and correcting anemia before delivery
- Reexamination of patients vital sign before and after leaving the delivery room * Other preventive measures may either increase the woman’s chance of survival or prevent...
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