Postpartum Hemorrhage

Recognizing it early

Postpartum hemorrhage is blood loss over 500 mL after a vaginal birth or 1000 mL after a cesarean, but the clinical definition that matters is any bleeding causing hemodynamic change. Tachycardia appears well before hypotension, because a healthy young postpartum client compensates for a long time and then falls off a cliff.

Uterine atony causes roughly 70 to 80 percent of cases. Risk factors include a prolonged labor, an overdistended uterus from multiples or polyhydramnios, high parity, chorioamnionitis and oxytocin augmentation.

The intervention sequence

Massage the fundus first. If it firms and bleeding slows, atony is confirmed. If the fundus is firm and bleeding continues, the source is likely a laceration or retained fragments and the provider must be notified.

• Massage the fundus
• Have the client empty the bladder, or catheterize
• Administer uterotonics as ordered — oxytocin first line
• Establish large-bore IV access and monitor vital signs frequently
• Weigh pads for accurate quantification: 1 g equals 1 mL