Procedural Manual For Delivery Cases

• Early Bleeding: Occurs within the first 24 hours after delivery.
• Late Bleeding: Occurs after 24 hours and up to 6 weeks post-delivery. Early bleeding is more common than late bleeding and is more often associated with hemorrhagic conditions.

Symptoms of Postpartum Hemorrhage: Some common signs of postpartum bleeding include:

• Severe, uncontrollable bleeding
• Low blood pressure
• Increased heart rate
• Swelling and pain in the vagina

Causes and Risk Factors of Postpartum Hemorrhage:

1. Causes of Early Bleeding:
• Failure of uterine contraction, which may be a secondary issue from an overly enlarged uterus.
• Following multiple pregnancies, large baby, excessive amniotic fluid, prolonged labor, use of uterine relaxants, or infection of amniotic fluid.
• Tears in the birth canal, often caused by vacuum or forceps-assisted delivery, large baby size, or rapid labor.
• Retained placenta may hinder uterine contraction, leading to bleeding.
2. Causes of Late Bleeding:
• Infection of the uterus.
• Uterine atony.
• Retained placenta.
• Blood clotting disorders.

Risk Factors:

• Placental separation, retained placenta, placenta previa, rapid labor, multiple gestations, vaginal trauma, obesity, and large baby size (greater than 4 kg).

Complications of Postpartum Bleeding:

• Infertility
• Uterine perforation
• Urinary tract injury
• Pelvic hematoma
• Sepsis
• Maternal death

Diagnosis of Postpartum Bleeding: Bleeding can be difficult to diagnose due to reliance on subjective assessment of blood loss. Additional methods, such as:

• Hemoglobin and hematocrit tests
• Blood transfusion needs May be used to determine the extent of blood loss.

Treatment of Postpartum Bleeding: Successful treatment involves identifying the underlying cause and preventing further complications:

• Manual uterine massage
• Use of uterotonic medications like Oxytocin immediately post-delivery.
• Surgical intervention may be required for uterine rupture or retained placenta.

Nursing Care for Postpartum Bleeding:

• Initial Resuscitation:
• Insert large-bore IV catheters and perform necessary blood tests.
• Administer IV fluids as directed by the physician.
• Monitor vital signs and keep track of fluid input and output.
• Monitor uterine tone and massage the uterus as needed.
• Observation:
• Assess vital signs every 30 minutes.
• Monitor lochia for volume and consistency.
• Watch for signs of shock and bleeding.
• Laboratory Tests:
• Blood type and Rh factor
• Complete blood count (CBC)
• Coagulation studies
• Nursing Interventions:
• For uterine atony: Manual uterine massage, use of uterotonic drugs, and breastfeeding to stimulate uterine contractions.
• For retained placenta: Manual removal or surgical intervention as per doctor’s orders.
• For vaginal or cervical tears: Assess and prepare for repair as needed.
• If infection is suspected: Administer antibiotics and follow infection control procedures.