Common sources of postpartum hemorrhage include; uterine and lower genital tract tear, loss of tone of the uterus, and retained conception products. There will be bleeding at the site in the presence of a tear, and it’s painful on touch. Predisposing factors to tears include a rigid vagina, the prolonged second stage of labor, instrumental deliveries, and a big baby. There will be a sudden decrease in uterine pressure in uterine rupture coupled with rapid onset slower and less intense contractions with pain with the baby’s head receding into the birth canal. The tear should be repaired properly with the right suture to treat postpartum hemorrhage. Other sutures may need the application of gauze packing’s to exert pressure. Uterine atony occurs when there is a loss of tone of the uterus, meaning the uterus has not contracted. Its predisposing factors include the use of uterine relaxants, uterine fatigue as may be occasioned by prolonged labor or even uterine fibroid or grand multiparity. One of the signs may be a boggy soft enlarged uterus with more than usual active fresh bleeding from the uterus through the cervical os in uterine atony. Thus, there will be profuse bleeding, and the uterus will be above the umbilical cord. The first part of uterine atony management is to do uterine massage after ensuring the uterine cavity is empty. Secondly, uterotonics such as starting from 10 to 40 i.u per 1000ml may be given as a slow infusion. Besides, per rectal misoprostol, 800mcg per vaginal may be given, but this has a delayed onset. Surgical options may then be considered if medical management fails and includes B lynch sutures and uterine artery ligation. Intractable cases may see the uterus removed.
In cases of retained products of conception, risk factors include previous scars on the uterus, premature labor, difficult labor, history of abnormal placental implantation, and older age at the time of delivery. Management includes manual removal of the products. In cases where the code is still in situ, controlled code traction needs to be done after administering low dose uterotonics.
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Normal estimated blood loss for a vaginal delivery is less than or equal to 500mls.
Yes, Roquanda's blood loss was normal.
Factors that increase initial blood loss in delivery include instrumental deliveries, prolonged labor, multiple gestations, existing medical comorbidities such as anemia, bleeding diathesis, HIV, and uterine fibroids.
The history factors that increase the risk of bleeding include being a young grand multiparous lady, shortened space-time between subsequent pregnancies, history of delivering big babies, and history of uterotonics.
The labor and delivery Risk Factors that may increase postpartum hemorrhage in the patient include prolonged labor, prolonged use of Pitocin, the mediolateral episiotomy, and instrumental vacuum extraction.
The initial vitals are normal for postpartum. However, the vitals after two hours are not.
Low blood pressure indicates that the patient is going into shock, meaning she is losing blood hence has postpartum hemorrhage. The pulse is also on the upper side, meaning the heart tries to compensate for the shock through increased pumping.
Feelings of shock related to hypovolemia may include confusion, hypotension, feeling weak, tachycardia, cold hands, feet, headache, sweating, and even collapsing.
Consequences of hemorrhage include anemia and hypovolemic shock and even acute kidney injury.
She is at a higher risk of shock because her vitals had not compensated well for the blood loss encountered even at the time of delivery. Secondly, intravenous fluids seem not to be working for her. Besides, she has a tear that may be internally bleeding.
Hematocrit levels usually reflect acute blood loss, unlike the hemoglobin. Usually, they reflect in 2 to 4 hours after onset of acute blood loss. Thus there will be a drop. Immediately. The hematocrit levels will be lower than the normal range.
The use of iron supplements in postpartum hemorrhage helps to restore iron hence hemoglobin levels. She needs to ensure she uses them every day for at least a month, with her iron levels checked twice a month. If there are clinical signs of severe anemia, such as severe dizziness, easy fatigue, or a new bleeding episode, she needs to seek health care immediately at the hospital.
