About 1 in to 5 in women have postpartum hemorrhage. It is more likely with a cesarean birth. It most often happens after the placenta is delivered, but it can also happen later. Once a baby is delivered, the uterus normally contracts and pushes out the placenta. After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached.
If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta stay attached, bleeding is also likely. Bleeding into a hidden tissue area or space in the pelvis. This mass of blood is called a hematoma.
It is usually in the vulva or vagina. Some women are at greater risk for postpartum hemorrhage than others. To measure the fundal height, which is measured in centimeters , you will take a tape measure and extend it from the symphysis pubis to the fundus of the uterus. Lay the patient down on their back. NOTE : monitor the mother for supine hypotension because she is at risk for this, especially if she is late into her pregnancy.
This occurs when the baby and other structures in the uterus compress the great vessels of the heart in the supine positon back position. This leads to the blood pressure to drop. Therefore, monitor the patient for reports of feeling dizzy, lightheaded, nauseous etc. The fundus top portion of the uterus should be felt at the level of your belly button or lower.
You can attempt to feel your fundus by gently pressing on your abdomen. The uterus shrinks at about the rate of one cm. Where is fundus located?
Depending on the organ, the fundus may be at the top or bottom of the organ. For example, the fundus of the uterus is the top part of the uterus that is across from the cervix the opening of the uterus. The fundus of the bladder is the back, bottom part of the bladder.
How do you check fundus? Gently palpate the abdomen with the left hand to determine the height of the fundus of the uterus: If the fundus is palpable just above the symphysis pubis, the gestational age is probably 12 weeks. If the fundus reaches halfway between the symphysis and the umbilicus, the gestational age is probably 16 weeks. What does fundus u'u mean? What does a boggy fundus mean? From Wikipedia, the free encyclopedia. A boggy uterus is a finding upon physical examination where the uterus is more flaccid than would be expected.
Patients are instructed to avoid sexual activity until lochial flow has ceased. REEDA stands for:. Redness is considered normal with episiotomies and lacerations; however, if there is significant pain present, further assessment is necessary. The use of ice packs during the immediate postpartum period is generally indicated.
There should be an absence of discharge from the episiotomy or laceration, and the wound edges should be well approximated. Perineal pain must be assessed and treated. Performing Kegel exercises are an important component of strengthening the perineal muscles after delivery and may be begun as soon as it is comfortable to do so. An elevated temperature may also be present. The legs for assessed for adequate circulation by checking the pedal pulses and noting temperature and color.
In addition, the lower extremities are assessed for edema. Emotions are an essential element of the postpartum assessment. The postpartum blues are caused by a multitude of factors, including hormonal fluctuations, physical exhaustion, and maternal role adjustment. This is a normal part of the postpartum experience. If symptoms last longer than a few weeks or if the postpartum patient becomes nonfunctional or expresses a desire to harm herself or her infant, she should be instructed to report this to her certified nurse-midwife or physician immediately.
Mother care after a C-section has some additional assessment needs during the postpartum period, including incision status, pain, respirations, and lung and bowel sounds. C-section patients may have vertical or horizontal incisions that will need to be assessed throughout the postpartum period. The REEDA method redness, edema, ecchymosis, discharge, and approximation can be used to assess these incisions.
It is important to teach patients to examine their incision each day with a mirror or have a family member monitor the incision for them. Patients are instructed to immediately report any abnormal findings, such as hematomas, abnormal drainage, odors, or significant pain, to their healthcare provider.
Postpartum hemorrhage is one of the leading causes of death among postpartum women. PPH refers to a blood loss of at least mL after a vaginal birth and at least mL after a C-section. Postpartum hemorrhage is categorized as early or late. Early refers to a hemorrhage occurring within the first 24 hours after birth, while late refers to a hemorrhage occurring 24 hours to 12 weeks after delivery.
Early postpartum hemorrhage is often caused by uterine atony, or a failure of the uterine muscles to contract properly, thereby inhibiting the healing of blood vessels at the site of placental attachment. The blood vessels continue to bleed until the uterine muscles contract. Signs of uterine atony include a boggy uterus, a fundus that is higher than expected upon palpation, and excessive lochia. The nurse must report a PPH immediately and prepare for the insertion of a large-bore intravenous catheter, if one is not already present, and the administration of intravenous fluids and oxygen.
In the case of an early PPH caused by damage to the birth canal, surgical repair is usually necessary. A sequelae of PPH is hypovolemic shock. In the presence of a PPH, hypovolemic shock can occur and cause severe organ damage and even death if untreated. These patients will also require oxygen usually 8—10 L via face mask , IV fluids, and possibly blood products.
This is a very serious situation, and nurses must be prepared to assist in this life-threatening emergency. Women can suffer from thrombophlebitis as a result of venous stasis and the normal hypercoagulability state of the postpartum period.
Thrombophlebitis is an inflammation of the blood vessel wall in which a blood clot forms and causes problems in the superficial or deep veins of the lower extremities or pelvis.
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