POSTPARTUM HEMORRHAGE UPDATED EXAMS
TEST PAPER QUESTIONS AND ANSWERS SURE A+
✔✔Causes and Risk Factors of Late Postpartum Hemorrhage - ✔✔Commonly caused
by subinvolution (delayed return of the uterus to its nonpregnant size and consistency),
which is often the result of retained placental fragments.
Frequently happens after the woman has been discharged from the hospital. Women
should be educated on the normal amount and characteristics of lochia flow expected
after discharge from the hospital and encouraged to call their health care provider if
bleeding saturates more than one pad in an hour or if they begin to pass clots.
Risk factors include manual removal of the placenta, attempts to deliver a placenta that
has not fully detached from the uterine wall, placenta accreta, previous cesarean
delivery, uterine myelomas, early postpartum hemorrhage, and advanced maternal age.
Retention of placental fragments can be prevented easily. When the placenta is
delivered, the health care provider carefully inspects it to determine whether it is intact.
If a portion of the placenta is missing, the health care provider manually explores the
uterus, locates the missing fragments, and removes them. This procedure may require
a dilation and curettage (D&C).
✔✔Which woman is at greatest risk for late postpartum hemorrhage - ✔✔A 38-year-old
woman with placenta accreta
Advanced maternal age and placenta accreta are risk factors for development of late
postpartum hemorrhage.
, ✔✔A woman with a body mass index (BMI) of 30 delivered an infant after 12 hours of
labor. The woman has the greatest risk for which complication? - ✔✔Uterine atony
Obesity and prolonged labor put the woman at increased risk for uterine atony.
✔✔A woman with a firm fundus who presents with excessive vaginal bleeding may be
at risk for which complication? - ✔✔Laceration
Excessive vaginal bleeding with a firm fundus may be a sign of a vaginal, cervical, or
perineal laceration.
✔✔Postpartum hemorrhage can sometimes be prevented by - ✔✔careful examination
of factors that predispose to excessive bleeding.
✔✔Signs of Postpartum Hemorrhage - ✔✔A uterus that does not contract or does not
remain contracted; "boggy" or soft-feeling fundus; large gush or slow, steady trickle,
ooze, or dribble of blood from the vagina
Saturation of one perineal pad per hour
Severe, unrelieved perineal or rectal pain
Tachycardia
✔✔Assessment Findings of postpartum hemorrhage - ✔✔The fundus should be firmly
contracted, at or near the level of the umbilicus, and midline.
If the fundus is above the level of the umbilicus and displaced, a full bladder may be the
cause of uterine atony and excessive bleeding.
If the fundus is firm, but bleeding is excessive, the cause may be lacerations of the
cervix or birth canal.
If the mother complains of deep, severe pelvic or rectal pain, or if vital signs or skin
changes suggest hemorrhage but bleeding is not obvious, the cause may be the
formation of a hematoma.
✔✔Aside from heavy bleeding, the first vital sign change the nurse assesses in
postpartum hemorrhage is - ✔✔tachycardia. It is important to note that the postpartum
patient will not usually be hypotensive until she has lost a significant amount of blood
due to the increased blood volume of pregnancy. Sometimes she will have lost up to
20% of total blood volume before her blood pressure decreases significantly.
✔✔Patient-Centered Goals for Postpartum Hemorrhage - ✔✔The patient's vital signs
will be within normal limits.
The patient will have the appropriate amount of lochia.
The patient's hemoglobin and hematocrit will be stable.
The patient will not experience any signs or symptoms of hypovolemia
✔✔Planning for Postpartum Hemorrhage - ✔✔Monitor for signs of postpartum
hemorrhage.
Perform actions that minimize postpartum hemorrhage and prevent hypovolemic shock.
TEST PAPER QUESTIONS AND ANSWERS SURE A+
✔✔Causes and Risk Factors of Late Postpartum Hemorrhage - ✔✔Commonly caused
by subinvolution (delayed return of the uterus to its nonpregnant size and consistency),
which is often the result of retained placental fragments.
Frequently happens after the woman has been discharged from the hospital. Women
should be educated on the normal amount and characteristics of lochia flow expected
after discharge from the hospital and encouraged to call their health care provider if
bleeding saturates more than one pad in an hour or if they begin to pass clots.
Risk factors include manual removal of the placenta, attempts to deliver a placenta that
has not fully detached from the uterine wall, placenta accreta, previous cesarean
delivery, uterine myelomas, early postpartum hemorrhage, and advanced maternal age.
Retention of placental fragments can be prevented easily. When the placenta is
delivered, the health care provider carefully inspects it to determine whether it is intact.
If a portion of the placenta is missing, the health care provider manually explores the
uterus, locates the missing fragments, and removes them. This procedure may require
a dilation and curettage (D&C).
✔✔Which woman is at greatest risk for late postpartum hemorrhage - ✔✔A 38-year-old
woman with placenta accreta
Advanced maternal age and placenta accreta are risk factors for development of late
postpartum hemorrhage.
, ✔✔A woman with a body mass index (BMI) of 30 delivered an infant after 12 hours of
labor. The woman has the greatest risk for which complication? - ✔✔Uterine atony
Obesity and prolonged labor put the woman at increased risk for uterine atony.
✔✔A woman with a firm fundus who presents with excessive vaginal bleeding may be
at risk for which complication? - ✔✔Laceration
Excessive vaginal bleeding with a firm fundus may be a sign of a vaginal, cervical, or
perineal laceration.
✔✔Postpartum hemorrhage can sometimes be prevented by - ✔✔careful examination
of factors that predispose to excessive bleeding.
✔✔Signs of Postpartum Hemorrhage - ✔✔A uterus that does not contract or does not
remain contracted; "boggy" or soft-feeling fundus; large gush or slow, steady trickle,
ooze, or dribble of blood from the vagina
Saturation of one perineal pad per hour
Severe, unrelieved perineal or rectal pain
Tachycardia
✔✔Assessment Findings of postpartum hemorrhage - ✔✔The fundus should be firmly
contracted, at or near the level of the umbilicus, and midline.
If the fundus is above the level of the umbilicus and displaced, a full bladder may be the
cause of uterine atony and excessive bleeding.
If the fundus is firm, but bleeding is excessive, the cause may be lacerations of the
cervix or birth canal.
If the mother complains of deep, severe pelvic or rectal pain, or if vital signs or skin
changes suggest hemorrhage but bleeding is not obvious, the cause may be the
formation of a hematoma.
✔✔Aside from heavy bleeding, the first vital sign change the nurse assesses in
postpartum hemorrhage is - ✔✔tachycardia. It is important to note that the postpartum
patient will not usually be hypotensive until she has lost a significant amount of blood
due to the increased blood volume of pregnancy. Sometimes she will have lost up to
20% of total blood volume before her blood pressure decreases significantly.
✔✔Patient-Centered Goals for Postpartum Hemorrhage - ✔✔The patient's vital signs
will be within normal limits.
The patient will have the appropriate amount of lochia.
The patient's hemoglobin and hematocrit will be stable.
The patient will not experience any signs or symptoms of hypovolemia
✔✔Planning for Postpartum Hemorrhage - ✔✔Monitor for signs of postpartum
hemorrhage.
Perform actions that minimize postpartum hemorrhage and prevent hypovolemic shock.
