NRSG 3302 TEST 2 QUESTIONS AND 100%
CORRECT ANSWERS!!
How much blood loss is considered a postpartum hemorrhage in a vaginal delivery? C-
section?
Loss of >500mL of blood after a vaginal delivery or >1000 mL after C-section;
any amount that places mom in hemodynamic jeopardy
How much decrease in % of hematocrit is considered a postpartum hemorrhage?
greater than or equal to 10% hematocrit
Primary postpartum hemorrhage
occurs in the first 24 hours after delivery
Secondary (late) postpartum hemorrhage
occurs more than 24 hours after delivery, usually because of retained placental fragments
What is the most common cause of postpartum hemorrhage?
TONE - uterine atony/boggy uterus causes slow, steady loss of blood because myometrium does
not contract and clamp off placental arteries
Causes of postpartum hemorrhage (4 T's)
Tone, Trauma, Tissue, Thrombin
Tone causes of postpartum hemorrhage
repeated distention (multiple pregnancies, overstretching from twins/triplets), uterine muscle
fatigue from prolonged labor, unable to empty bladder, obstetric medications (anesthetics -
halothane, magnesium sulfate, nifedipine, terbutaline)
Treatment for postpartum hemorrhage caused by tone
fundal massage, urination, medications, surgery
Trauma causes of postpartum hemorrhage
, damage to genital structures (incision from C-section, from baby coming through vaginal canal,
from medical instruments used during delivery), hematoma (mass or collection of blood)
Tissue causes of postpartum hemorrhage
Placental fragments retained in the uterine cavity (placenta acccrete)
retained placenta --> prevents contraction --> uterine atony
Placenta previa
Placenta accreta
placenta invades myometrium and doesn't easily separate
Thrombin causes of postpartum hemorrhage
Blood clotting conditions
Genetic - Von Willebrand disease
Obstetric - eclampsia, placental abruption
DIC - disseminated intravascular coagulation
What are the 4 leading causes of maternal mortality?
sepsis, cardiac disease, hemorrhage, venous thromboembolism
placenta previa
placenta adheres to lower uterine segment
Signs of impending hemorrhage
- excessive bleeding (more than 2 pads in 30-60mins)
- light headedness, nausea, visual disturbances
- anxiety, pale/ashen color, clammy skin
- increasing pulse, resp. rate, BP same or lower (signs of shock)
Medications that enhance uterine contractions
oxytocin, cytotec, methergine, hemabate
Puerperal sepsis
CORRECT ANSWERS!!
How much blood loss is considered a postpartum hemorrhage in a vaginal delivery? C-
section?
Loss of >500mL of blood after a vaginal delivery or >1000 mL after C-section;
any amount that places mom in hemodynamic jeopardy
How much decrease in % of hematocrit is considered a postpartum hemorrhage?
greater than or equal to 10% hematocrit
Primary postpartum hemorrhage
occurs in the first 24 hours after delivery
Secondary (late) postpartum hemorrhage
occurs more than 24 hours after delivery, usually because of retained placental fragments
What is the most common cause of postpartum hemorrhage?
TONE - uterine atony/boggy uterus causes slow, steady loss of blood because myometrium does
not contract and clamp off placental arteries
Causes of postpartum hemorrhage (4 T's)
Tone, Trauma, Tissue, Thrombin
Tone causes of postpartum hemorrhage
repeated distention (multiple pregnancies, overstretching from twins/triplets), uterine muscle
fatigue from prolonged labor, unable to empty bladder, obstetric medications (anesthetics -
halothane, magnesium sulfate, nifedipine, terbutaline)
Treatment for postpartum hemorrhage caused by tone
fundal massage, urination, medications, surgery
Trauma causes of postpartum hemorrhage
, damage to genital structures (incision from C-section, from baby coming through vaginal canal,
from medical instruments used during delivery), hematoma (mass or collection of blood)
Tissue causes of postpartum hemorrhage
Placental fragments retained in the uterine cavity (placenta acccrete)
retained placenta --> prevents contraction --> uterine atony
Placenta previa
Placenta accreta
placenta invades myometrium and doesn't easily separate
Thrombin causes of postpartum hemorrhage
Blood clotting conditions
Genetic - Von Willebrand disease
Obstetric - eclampsia, placental abruption
DIC - disseminated intravascular coagulation
What are the 4 leading causes of maternal mortality?
sepsis, cardiac disease, hemorrhage, venous thromboembolism
placenta previa
placenta adheres to lower uterine segment
Signs of impending hemorrhage
- excessive bleeding (more than 2 pads in 30-60mins)
- light headedness, nausea, visual disturbances
- anxiety, pale/ashen color, clammy skin
- increasing pulse, resp. rate, BP same or lower (signs of shock)
Medications that enhance uterine contractions
oxytocin, cytotec, methergine, hemabate
Puerperal sepsis
