Postpartum hemorrhage
Uterine blood loss in excess of 500 ml
Classified as early, if the blood loss occurs during the first hour after delivery
Classified as late, if the blood loss occurs after the first postpartum day, anytime during the remaining 6-week postpartum period; sometimes it may not occur until 5 to 15 days after delivery
Predisposing factors: delivery of a large infant, hydramnios, dystocia, grand multiparity, and trauma during delivery
Causes
Uterine atony
Incomplete placental separation
Retained placental fragments
Lacerations of the birth canal
Disseminated intravascular coagulation (DIC)
Signs and symptoms
Bleeding, which can occur suddenly in large amounts or gradually as seeping or oozing of blood
Frequent saturation of perineal pads
Soft, relaxed uterus on palpation to the right or left of midline with distended bladder, if cause is uterine atony
Soft noncontracting uterus on palpation with slow trickle, oozing or frank hemorrhage, if the cause is retained placental fragments
If the bleeding continues or is copious, signs and symptoms of hypovolemic shock
Pallor
Decreased sensorium
Rapid, shallow respirations
Drop in urine output to below 25 ml/hour
Rapid, thready peripheral pulses
Cold, clammy skin
Mean arterial pressure below 60 mm Hg
Narrowing pulse pressure
