NCM 109 STUDY GUIDE
is when a woman has heavy bleeding after giving birth. - Answers - Post-Partal
Hemorrhage
Causes of PPH - Answers - ● Uterine atony
● Retained placental fragments or incomplete expulsion of the placenta
● Placenta accreta
Assessment Findings of PPH - Answers - ● "Boggy uterus" relax state indicating atony.
● If uterus is firm with excess bleeding, may indicate laceration
● Dark red blood with clots
● Hemorrhage immediately after delivery
● With retained placental fragments delay up to 2 weeks
● Full bladder may displace the uterus & prevent it from contracting firmly.
Nursing Interventions of PPH - Answers - ● Identify client at risk for condition
● Monitor fundus frequently if bleeding occurs, when stable every 15 minutes 1-2 hours
● Monitor maternal vital signs
● Administer medications, IV fluid as ordered.
● Measure I &0.
● Remain with client for support and explanation of procedures
● Keep client warm
● Prepare for client's return to delivery room if needed for repair of laceration of removal
of placental fragment.
● Monitor for signs of DIC
relaxation of uterus, is the most frequent cause of postpartal hemorrhage. - Answers -
UTERINE ATONY
Conditions that lead uterus unable to contract - Answers - ● Deep anesthesia or
analgesia
● Oxytocin use during labor
● Maternal age above 30 years old
● High parity or grand multipara
● Previous uterine surgery
● Prolonged and difficult labor
● Possible chorioamnionitis
● Secondary maternal illness
● Poor history of maternal haemorrhage
● Delivery of twins
Assessment findings of PPH - Answers - ● Severe vaginal bleeding
● Blood loss
, ● Five saturated pads in half an hour or a woman had lost approximately 250 ml of
blood
● Shock
Medical Management of PPH - Answers - ● If bleeding is excessive, the physician
undertakes bi-manual uterine compression for boggy uterus Methylergonovine maleate
○ Methylgine may be ordered for immediate management of uterine atony
● Oxytocin (pitocin) is administered intravenously at a rapid rate. Oxygen by mask is
given.
● If atony does not respond to all measures, 250ug of methyl prostaglandin F2 Prostin
15u) maybe administered intramuscularly (IM) which is given at 15.90 minutes intervals
● Blood transfusion is given to severe, uncontrolled hemorrhage.
● Dilatation and curettage (D & C)
Nursing Interventions of PPH - Answers - ● Advise the woman to have good prenatal
care for early diagnosis and management of complication that may arise.
● Have intravenous lines in place.
● After the expulsion of the placenta, the fundus should be palpated to ensure that the
uterus is well contracted.
● If fundus is relaxed, fundus massage should be performed until the uterus contracts
● If bleeding persists, the cervix and the vagina should be inspected for lacerations
A tear which is suspected when bright red bleeding persists in the presence of a firmly
contracted uterus - Answers - LACERATIONS
Types of lacerations - Answers - 1. Cervical lacerations
2. Vaginal lacerations
3. Perineal lacerations
are usually found on the sides of the cervix, near the branches of uterine artery with
brighter red than the venous blood loss - Answers - Cervical lacerations
are rare but easier to assess than cervical lacerations because they are easier to view -
Answers - Vaginal lacerations
usually occur when a woman is placed in a lithotomy position for birth, because this
position increases tension on the perineum. - Answers - Perineal lacerations
Involves vaginal and perineal mucous membranes, or mucosa Some fibers of superficial
musculature. - Answers - 1st degree
Involves vaginal and perineal mucous membrane and the perineal muscles or the 1
degree and deeper structure of perineum - Answers - 2nd degree
is when a woman has heavy bleeding after giving birth. - Answers - Post-Partal
Hemorrhage
Causes of PPH - Answers - ● Uterine atony
● Retained placental fragments or incomplete expulsion of the placenta
● Placenta accreta
Assessment Findings of PPH - Answers - ● "Boggy uterus" relax state indicating atony.
● If uterus is firm with excess bleeding, may indicate laceration
● Dark red blood with clots
● Hemorrhage immediately after delivery
● With retained placental fragments delay up to 2 weeks
● Full bladder may displace the uterus & prevent it from contracting firmly.
Nursing Interventions of PPH - Answers - ● Identify client at risk for condition
● Monitor fundus frequently if bleeding occurs, when stable every 15 minutes 1-2 hours
● Monitor maternal vital signs
● Administer medications, IV fluid as ordered.
● Measure I &0.
● Remain with client for support and explanation of procedures
● Keep client warm
● Prepare for client's return to delivery room if needed for repair of laceration of removal
of placental fragment.
● Monitor for signs of DIC
relaxation of uterus, is the most frequent cause of postpartal hemorrhage. - Answers -
UTERINE ATONY
Conditions that lead uterus unable to contract - Answers - ● Deep anesthesia or
analgesia
● Oxytocin use during labor
● Maternal age above 30 years old
● High parity or grand multipara
● Previous uterine surgery
● Prolonged and difficult labor
● Possible chorioamnionitis
● Secondary maternal illness
● Poor history of maternal haemorrhage
● Delivery of twins
Assessment findings of PPH - Answers - ● Severe vaginal bleeding
● Blood loss
, ● Five saturated pads in half an hour or a woman had lost approximately 250 ml of
blood
● Shock
Medical Management of PPH - Answers - ● If bleeding is excessive, the physician
undertakes bi-manual uterine compression for boggy uterus Methylergonovine maleate
○ Methylgine may be ordered for immediate management of uterine atony
● Oxytocin (pitocin) is administered intravenously at a rapid rate. Oxygen by mask is
given.
● If atony does not respond to all measures, 250ug of methyl prostaglandin F2 Prostin
15u) maybe administered intramuscularly (IM) which is given at 15.90 minutes intervals
● Blood transfusion is given to severe, uncontrolled hemorrhage.
● Dilatation and curettage (D & C)
Nursing Interventions of PPH - Answers - ● Advise the woman to have good prenatal
care for early diagnosis and management of complication that may arise.
● Have intravenous lines in place.
● After the expulsion of the placenta, the fundus should be palpated to ensure that the
uterus is well contracted.
● If fundus is relaxed, fundus massage should be performed until the uterus contracts
● If bleeding persists, the cervix and the vagina should be inspected for lacerations
A tear which is suspected when bright red bleeding persists in the presence of a firmly
contracted uterus - Answers - LACERATIONS
Types of lacerations - Answers - 1. Cervical lacerations
2. Vaginal lacerations
3. Perineal lacerations
are usually found on the sides of the cervix, near the branches of uterine artery with
brighter red than the venous blood loss - Answers - Cervical lacerations
are rare but easier to assess than cervical lacerations because they are easier to view -
Answers - Vaginal lacerations
usually occur when a woman is placed in a lithotomy position for birth, because this
position increases tension on the perineum. - Answers - Perineal lacerations
Involves vaginal and perineal mucous membranes, or mucosa Some fibers of superficial
musculature. - Answers - 1st degree
Involves vaginal and perineal mucous membrane and the perineal muscles or the 1
degree and deeper structure of perineum - Answers - 2nd degree
