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If bleeding does not respond to the above measures or if the fundus remains firm and the patient exhibits bright red vaginal discharge, retained placental fragments or cervical or vaginal laceration should be suspected the practitioner who delivered the baby should be notified. If the bladder is distended, the patient is encouraged to void and then postvoiding fundal status is assessed if the fundus remains firm after massage, the fundus and vaginal flow are reassessed in 5 min. If the fundus is boggy, it is massaged to stimulate uterine contractions, and then the status of the woman's bladder is assessed.
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The presence of risk factors is noted, and the woman's pulse, blood pressure, fundal and bladder status, and vaginal discharge are assessed every 15 min. The woman's prenatal, labor, and delivery records are reviewed. Many instances of PPH can be prevented with the administration of oxytocin, misoprostol, or other uterotonic medications. It usually is caused by retained placental fragments. Late postpartum hemorrhage occurs after the first 24 hr have passed. Other causes include prolonged or precipitate labor uterine overstimulation trauma, rupture, or inversion lacerations of the lower genital tract or blood coagulation disorders. The most common cause is loss of uterine tone caused by overdistention. Early postpartum hemorrhage is defined as a blood loss of more than 500 ml of blood during the first 24 hr after delivery. It is a major cause of maternal morbidity and mortality in childbirth. CAUTION!Standard precautions should be used for all procedures involving contact with blood or wounds. These devices may prevent hemorrhagic shock. Transfusions of red blood cells may be given if bleeding compromises heart or lung function or threatens to do so because of its pace or volume.įor trauma patients with massive bleeding, the experienced nurse or emergency care provider may apply pneumatic splints or antishock garments during patient transportation to the hospital. Procoagulants (such as vitamin K, fresh frozen plasma, cryoprecipitate, desmopressin) may be administered to patients with primary or drug-induced bleeding disorders. Ligation of blood vessels, surgical removal of hemorrhaging organs, or the instillation of sclerosants is often effective in managing internal hemorrhage. Cautery may be used to stop bleeding from visible vessels. Pressure should be applied directly to any obviously bleeding body part, and the part should be elevated. Signs of hemorrhage include tachycardia, hypotension, pallor, and cold moist skin. Orthostatic dizziness, weakness, fatigue, shortness of breath, and palpitations are common symptoms of hemorrhage. hemorrhagic (hem-o-raj'ik), adjective See: table Symptoms The risk of uncontrolled bleeding is greatest in patients who have coagulation disorders or take anticoagulant drugs. The most hazardous forms of blood loss result from arterial bleeding, internal bleeding, or bleeding into the cranium. The term is usually used for episodes of bleeding that last more than a few minutes, compromise organ or tissue perfusion, or threaten life.