Chapter 22
Various medications are available to help control hemorrhage in the postpartum client. When reviewing the client's history, the nurse notes the client's history of asthma. Which medication if prescribed would the nurse question? a). dinoprostone b). methylergonovine c). oxytocin d). carboprost
carboprost Carboprost is contraindicated with asthma due to the risk of bronchial spasms. Oxytocin should be given undiluted as a bolus injection, and methylergonovine should not be given to a woman who is hypertensive. Dinoprostone and methylergonovine can be used in pregnant clients with asthma, although should be used cautiously. Dinoprostone may cause hypotension, nausea/vomiting, diarrhea and temperature elevation.
The nurse is caring for a client who has given birth to twins. During which time period would the nurse instruct on the possibility of a late postpartum hemorrhage? a)6 weeks to 6 months after birth b)24 hours to 12 weeks after birth c)24 to 48 hours after birth d)6 weeks to 3 months after birth
24 hours to 12 weeks after birth Mothers who give birth to twins are instructed on postpartum hemorrhage at the same time as a mother with a single newborn. Delayed or late postpartum hemorrhages occur more than 24 hours but less than 12 weeks postpartum. Immediate, early, or primary postpartum hemorrhages occur within 24 hours of birth.
Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps birth that resulted in lacerations 4 hours ago. What should the nurse do next? a)Have the client void. b)Change the client's peri-pad. c)Assess for uterine contractions. d)Obtain the client's vital signs.
Assess for uterine contractions. The nurse needs to identify whether the bleeding is from lacerations or uterine atony. This can be done by looking for a well-contracted uterus with bright-red vaginal bleeding. Lacerations commonly occur during forceps birth. In subinvolution of the uterus, there is inadequate contraction, resulting in bleeding. A boggy uterus with vaginal bleeding is seen in uterine atony. Once the nurse knows the cause of the bleeding, the condition can be treated.
The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? a)On her left side b)Semi-Fowler c)Flat in bed d)Trendelenburg
Semi-Fowler A semi-Fowler position encourages lochia to drain so it will not become stagnant and cause further infection. Placing the woman flat in bed, on her left side, or in the Trendelenburg position would not accomplish this goal and could result in the infection spreading to other parts of the body.
A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. -manifestations of mania -decreased interest in life -loss of confidence -bizarre behavior -inability to concentrate
inability to concentrate loss of confidence decreased interest in life The nurse should monitor the client for symptoms such as inability to concentrate, loss of confidence, and decreased interest in life to verify the presence of postpartum depression. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis.
A nurse is assessing the perineum of a postpartum woman using the REEDA scale. The woman is one day postpartum. The nurse notes that the woman has serous discharge. Which score would the nurse assign this finding? a). 2 b). 1 c). 0 d). 3
1 When using the REEDA score, each component is assigned a score from 0 to 3. Serous discharge would be given a score of 1. A score of 0 would be used if no discharge was present. A score of 2 is assigned if there is serosanguinous discharge present. A score of 3 is assigned if there is bloody, purulent discharge present.
One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for? a)Consistency, location, and place b)Location, shape, and content c)Content, lochia, place d)Consistency, shape, and location
Consistency, shape, and location Assess the fundus for consistency, shape, and location. Remember that the uterus should be firm, in the midline, and decrease 1 cm each postpartum day.
A nurse finds that a client is bleeding excessively after a vaginal birth. Which assessment finding would indicate retained placental fragments as a cause of bleeding? a). soft and boggy uterus that deviates from the midline b). firm uterus with trickle of bright red blood in perineum c). Large uterus with painless dark red blood mixed with clots d). firm uterus with a steady stream of bright red blood
Large uterus with painless dark red blood mixed with clots The presence of a large uterus with painless dark red blood mixed with clots indicates retained placental fragments in the uterus. This cause of hemorrhage can be prevented by carefully inspecting the placenta for intactness. A firm uterus with a trickle or steady stream of bright red blood in the perineum indicates bleeding from trauma. A soft and boggy uterus that deviates from the midline indicates a full bladder, interfering with uterine involution.
The nurse is caring for a woman who experienced a vaginal birth 6 hours prior. The health care provider is concerned the woman may have retained placental tissue. What assessment finding would alert the nurse to further assess the client for complications of retained placental tissue? a)The client's pulse is 130 beats/min at rest and base line was 98 beat/min. b)The client states being slightly nauseated and having no appetite since giving birth. c)The client reports perineal discomfort and burning pain. d)The client's blood pressure is 160/78 mm Hg with a base line of 102/62 mm Hg.
The client's pulse is 130 beats/min at rest and base line was 98 beat/min. Retained placental fragments (or tissue) is a cause of postpartum hemorrhage. The nurse would assess the client for signs of hemorrhage, including a high pulse rate. The blood pressure would be lower if hemorrhaging. The client's appetite and perineal pain are not indicative of a hemorrhage as stand-alone data.
A nurse is caring for a postpartum client who has a history of thrombosis during pregnancy and is at high risk of developing a pulmonary embolism. For which sign or symptom should the nurse monitor the client to prevent the occurrence of pulmonary embolism? a)difficulty in breathing b)sudden change in mental status c)sudden chest pain d)calf swelling
calf swelling The nurse should monitor the client for swelling in the calf. Swelling in the calf, erythema, and pedal edema are early manifestations of deep vein thrombosis, which may lead to pulmonary embolism if not prevented at an early stage. Sudden change in the mental status, difficulty in breathing, and sudden chest pain are manifestations of pulmonary embolism, beyond the stage of prevention.
A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first? a)STI status b)urinalysis results c)coagulation studies d)HIV status
coagulation studies
A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first? a)coagulation studies b)urinalysis results c)HIV status d)STI status
coagulation studies Coagulation studies should be obtained immediately to determine her coagulation status to help eliminate potential bleeding problems. Her STI and HIV status and urinalysis results, although important, are not necessary emergently.
Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply. -severe preeclampsia -isoimmunization -placental abruption (abruptio placentae) -ectopic pregnancy -septicemia
placental abruption (abruptio placentae) severe preeclampsia septicemia DIC is not itself a specific illness; rather it is always a secondary diagnosis that occurs as a complication of placental abruption, anaphylactoid syndrome of pregnancy, intrauterine fetal death with prolonged retention of the fetus, acute fatty liver of pregnancy, severe preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), septicemia, and postpartum hemorrhage.
Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? a)headache b)seizures c)uterine hyperstimulation d)flushing
seizures Seizures, hypertension, uterine cramping, nausea, vomiting, and palpitations are adverse effects of methylergonovine. Uterine hyperstimulation is an adverse effect of oxytocin. Flushing and headache are adverse effects of carboprost.
Every postpartum client has the potential of hemorrhage. While assessing a client's status, which finding would be of little benefit in identifying the possibility of hemorrhage? a)vital signs b)uterine tone c)estimated amount of blood loss d)signs of shock
signs of shock Signs of shock do not appear until the hemorrhage is far advanced due to the increased fluid and blood volume of pregnancy. Vital signs would show an increased pulse rate and decreased level of consciousness. The amount of lochia would be much greater than usual, and urinary output would be diminished with signs of acute renal failure. The uterus may also appear soft and spongy instead of firm.
Quickly determining the cause of postpartum hemorrhaging enables effective treatment. A nurse using the 5 Ts tool will recognize which of the following as potential causes of postpartum hemorrhage? Select all that apply. -thrombin -tone -time -technique of birth -tissue
tone tissue thrombin A helpful way to remember the causes of postpartum hemorrhage is by using the 5 Ts: tone, tissue, trauma, thrombin, and traction.
The nurse is providing education to a postpartum woman who has developed a uterine infection. Which statement by the woman indicates that further instruction is needed? a)"If my abdomen becomes firm, or if I don't urinate as much, I need to call the doctor." b)"I will change my perineal pad regularly to remove the infected drainage." c)"When I am sleeping or lying in bed, I should lie flat on my back." d)"I will take frequent walks around my home to promote drainage."
"When I am sleeping or lying in bed, I should lie flat on my back." With a uterine infection, the client needs to be in a semi-Fowler position to facilitate drainage and prevent the infection from spreading. Changing the perineal pads regularly; walking to promote drainage; and contacting the doctor if her uterus becomes rigid (or if she notes a decrease in urinary output) are all correct actions.
What is a risk factor for developing a postpartum infection? Select all that apply. -rupture of membranes at time of birth -thin build -type 1 diabetes -cesarean birth -prolonged labor
-type 1 diabetes -prolonged labor -cesarean birth Several risk factors make it more likely for a postpartum woman to develop a wound infection. They include prolonged labor, prolonged ruptured membranes, obesity, history of chronic illnesses such as diabetes or hypertension, and a surgical incision from a cesarean birth. Hematomas and chorioamnionitis are also contributory factors.
A postpartum woman is being treated for hemorrhage and is to receive a blood transfusion. The nurse understands that this treatment is being instituted based on which amount of estimated blood loss? a). 1000 ml b). 1,500 ml c). 1,250 ml d). 750 ml
1,500 ml Once estimates of blood loss reach 1,500 ml to 2000 ml, transfusion of blood products should be instituted immediately.
The nurse is caring for a client who has given birth to twins. During which time period would the nurse instruct on the possibility of a late postpartum hemorrhage? a). 24 hours to 12 weeks after birth b). 24 to 48 hours after birth c). 6 weeks to 3 months after birth d). 6 weeks to 6 months after birth
24 hours to 12 weeks after birth Mothers who give birth to twins are instructed on postpartum hemorrhage at the same time as a mother with a single newborn. Delayed or late postpartum hemorrhages occur more than 24 hours but less than 12 weeks postpartum. Immediate, early, or primary postpartum hemorrhages occur within 24 hours of birth.
A client arrives in the emergency department accompanied by her husband and new 10-week-old infant, crying, confused, and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear within which time frame after birth?
3 months Postpartum psychosis generally surfaces within 3 months of giving birth.
A nurse is assessing the perineum of several postpartum clients using the REEDA score. The nurse initiates interventions to minimize the risk for postpartum infection for the client with which score? a). 5 b). 7 c). 3 e). 9
9 The nurse would implement measures to minimize the risk for postpartal infection for the woman with a REEDA score of 9. The acronym REEDA is frequently used for assessing a woman's perineum status. It is derived from five components that have been identified to be associated with the healing process of the perineum. These include: redness, edema, ecchymosis, discharge and approximation of skin edges. Each category is assessed and a number assigned (0 to 3 points, with 0 indicating none or intact and 3 indicating more significant problems). The total REEDA score ranges from 0 to 15. Higher scores indicate increased tissue trauma predisposing the woman to an increased risk for infection and a greater risk for postpartal hemorrhage. Therefore the woman with a total score of 9 is at greatest risk for problems.
The nurse is caring for several postpartum clients and notes various warning signs that are concerning. Which client should the nurse suspect is developing endometritis? a). A woman with PROM before birth; reports severe burning with urination, malaise and severe temperature spikes on the 7th postpartum day. WBC is 21,850/mm3; temperature 101°F (38.3°C); skin pale and clammy. b). A woman with a history of infection and smoking, temperature 101°F (38.3°C) on the fourth postpartum day; reports severe perineal pain; edges of the episiotomy have separated. c). A woman with diabetes, vaginal birth, HR 110, temperature 101.7°F (38.7°C) on the third postpartum day. The next day, appears ill; temperature now 102.9°F (39.3°C); WBC 31,500/mm3; negative blood cultures. d). An obese woman with temperature 100.4°F (38°C) at 12 hours after birth; lochia is moderate; negative vaginal cultures.
A woman with diabetes, vaginal birth, HR 110, temperature 101.7°F (38.7°C) on the third postpartum day. The next day, appears ill; temperature now 102.9°F (39.3°C); WBC 31,500/mm3; negative blood cultures. Endometritis is an infection of the endometrium of the uterus. Clinical manifestations include a fever of 100.4°F (38°C) or higher, usually between the 2nd and 10th day after delivery; tachycardia, chills, anorexia, and general malaise; client may also report abdominal cramping and pain. Reports of severe perineal pain and signs of fever and separation of the episiotomy edges would be suspicious for a wound infection. An elevated temperature of up to 100.4°F (38°C) within the first 24 hours is a normal response to the birthing process. Reports of severe burning on urination accompanied by fever and malaise would be suspicious of a UTI.
What would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis? a)Platelet level b)Fibrinogen level c)Activated partial thromboplastin time d)Prothrombin time
Activated partial thromboplastin time The activated partial thromboplastin time is used to monitor the effectiveness of intravenous anticoagulant therapy, most commonly heparin. Prothrombin time is used to monitor the effectiveness of the oral anticoagulant warfarin. Although platelets and fibrinogen are involved in blood clotting, they are not used to monitor the effectiveness of intravenous anticoagulant therapy.
A nurse has just received a client from the surgical suite following a cesarean birth. The report given states a history of magnesium sulfate in the preoperative period. The nurse should assess the client for adverse effects from the magnesium sulfate by which initial nursing action? a)Assessment for abdominal pain b)Assessment of large vaginal clots c)Assessment of client temperature d)Assessment of the fundus
Assessment of the fundus Magnesium sulfate has properties that act as a smooth-muscle relaxant; therefore, the uterus may fail to adequately contract after administration. Initial assessment begins with the assessment of the fundus. Failure of the uterus to contract may result in excessive blood loss. Large vaginal clots are particularly related to retained placental fragments. Postoperative assessment is important but not the highest priority. The temperature and visual changes are not affected by the administration of magnesium sulfate.
A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instruction in her discharge teaching? a)Wear knee-high stockings when possible. b(Shortness of breath is a common adverse effect of the medication. c)Avoid iron replacement therapy. d)Avoid over-the-counter (OTC) salicylates.
Avoid over-the-counter (OTC) salicylates.
A client develops mastitis 3 weeks after giving birth. What part of client self-care is emphasized as most important? a)Increase her fluid intake to ensure that she will continue to produce adequate milk b)Administer antibiotic medication for the full 10 days even if she begins to feel better c)Breastfeed or otherwise empty her breasts every 1 to 2 hours d)Use NSAIDs, warm showers, and warm compresses to relieve her discomfort
Breastfeed or otherwise empty her breasts every 1 to 2 hours Mastitis treatment involves complete removal of the milk from the breast as often as possible, but no longer than a 3-hour time span. It is most important to have the woman keep the breast empty to prevent further stasis of milk ducts and worsening mastitis. The use of analgesics, warm showers, and warm compresses to relieve discomfort may be encouraged; increasing her fluid intake will keep the mother well-hydrated and able to produce an adequate milk supply. However, these actions would not be considered the most important aspects of self-care.
When planning care for a postpartum client, the nurse is aware that which site is the most common for postpartum infection? a)in the urinary bladder b)within the blood stream c)in the reproductive tract d)in the milk ducts
in the reproductive tract The most common site for a postpartum infection is the reproductive tract. This is important for teaching and education of clients.
A nurse is caring for a client with a postpartum laceration. Which nursing diagnoses would be most appropriate? Select all that apply. -Risk for disuse syndrome -Impaired tissue integrity -Ineffective thermoregulation -Ineffective tissue perfusion -Risk for injury
Ineffective tissue perfusion Risk for injury Impaired tissue integrity The nursing diagnoses associated with postpartum laceration include ineffective tissue perfusion, risk for injury, and impaired tissue integrity. Ineffective thermoregulation is a nursing diagnosis associated with an infection such as urinary tract infections. Risk for disuse syndrome is a nursing diagnosis associated with thromboembolic disorders.
The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady gush of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider? a)Infection of the uterus b)Perineal hematoma c)Laceration d)Uterine atony
Laceration A gush of blood with a firm uterus is more likely to occur from a laceration rather than from the uterine atony. This type of bleeding is usually bright red in color rather than the dark red color of lochia. A perineal hematoma presents as a bulging, swollen mass on the perineum. Uterine infection typically presents with a foul smelling discharge.
A nurse finds that a client is bleeding excessively after a vaginal birth. Which assessment finding would indicate retained placental fragments as a cause of bleeding? a)soft and boggy uterus that deviates from the midline b)Large uterus with painless dark red blood mixed with clots c)firm uterus with trickle of bright red blood in perineum d)firm uterus with a steady stream of bright red blood
Large uterus with painless dark red blood mixed with clots The presence of a large uterus with painless dark red blood mixed with clots indicates retained placental fragments in the uterus. This cause of hemorrhage can be prevented by carefully inspecting the placenta for intactness. A firm uterus with a trickle or steady stream of bright red blood in the perineum indicates bleeding from trauma. A soft and boggy uterus that deviates from the midline indicates a full bladder, interfering with uterine involution.
The nurse is monitoring several postpartum women for potential complications related to the birthing process. Which assessment should a nurse prioritize on an hourly basis? a)Complete blood count b)Vital signs c)Urine volume excreted d)Pad count
Pad count The way to monitor for bleeding every hour is to assess pads and percentage of the pad saturated by blood in the previous hour. It would not be necessary to do a complete blood count every hour, nor hourly urines. Vital signs are not typically taken every hour.
Upon examination of a postpartal client's perineum, the nurse notes a large hematoma. The client does not report any pain, and lochia is dark red and moderate in amount. Which factor would most likely contribute to the nurse not discovering the perineal hematoma prior to the examination? a)The client has a history of epidural anesthesia. b)The client is receiving oral pain medications. c)The client has a distended bladder. d)The client had an episiotomy.
The client has a history of epidural anesthesia. If a client has an epidural, her sensation of pain is decreased, so nurses cannot rely on client reports of pain as a symptom of a perineal hematoma. The nurse should always inspect the perineum to determine if there is a hematoma present. Having an episiotomy, having a distended bladder, or taking oral pain medications would have no effect on a perineal hematoma.
The nurse is caring for a woman who experienced a vaginal birth 6 hours prior. The health care provider is concerned the woman may have retained placental tissue. What assessment finding would alert the nurse to further assess the client for complications of retained placental tissue? a). The client states being slightly nauseated and having no appetite since giving birth. b). The client's pulse is 130 beats/min at rest and base line was 98 beat/min. c). The client reports perineal discomfort and burning pain. d). The client's blood pressure is 160/78 mm Hg with a base line of 102/62 mm Hg.
The client's pulse is 130 beats/min at rest and base line was 98 beat/min. Retained placental fragments (or tissue) is a cause of postpartum hemorrhage. The nurse would assess the client for signs of hemorrhage, including a high pulse rate. The blood pressure would be lower if hemorrhaging. The client's appetite and perineal pain are not indicative of a hemorrhage as stand-alone data.
The nurse inspects the client's perineum and finds it is red, swollen, and tender. The nurse explains to the client that she needs to be monitored for blood loss, especially because of bleeding into the tissue of the perineum because of the third degree laceration sustained while giving birth. What parameters will the nurse assess to detect signs of additional blood loss? Select all that apply. a). Urine output b). Uterine fundus c). Blood pressure d). Pulse rate e). Amount of lochia
Urine output Blood pressure Pulse rate Assessment findings consistent with blood loss are increased pulse rate, decreased blood pressure, and decreased urine output. Bleeding into the perineal tissue may not be visible, therefore monitoring these parameters is important. Because bleeding is related to the laceration, uterine involution is not impacted and the assessment of the fundus is not going to provide useful data. Similarly, the amount of lochia will not provide useful data about bleeding into the perineal tissue.
A 25-year-old nulliparous client presents in active labor. She has had no prenatal care, and her coagulation status is determined. Which result would the nurse identify as placing the client at risk for postpartum hemorrhage? a)international normalized ratio (INF) 1.0 b)platelet count 350,000 c)activated partial thromboplastin time 60 seconds d)prothrombin time 11 seconds
activated partial thromboplastin time 60 seconds Activated partial thromboplastin time of 60 seconds is increased and suggestive of a coagulopathy. The platelet count, prothrombin time, and INR are within normal parameters.
A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation? Select all that apply. -tachycardia -lochia less than usual -hypertension -acute renal failure -bleeding gums
bleeding gums tachycardia acute renal failure The nurse should monitor for bleeding gums, tachycardia, and acute renal failure to assess for an increased risk of disseminated intravascular coagulation in the client. The other clinical manifestations of this condition include petechiae, ecchymosis, and uncontrolled bleeding during birth. Hypotension and amount of lochia greater than usual are findings that might suggest a coagulopathy or hypovolemic shock.
A nurse is assigned to care for a client experiencing early postpartum hemorrhage. The nurse is required to administer the prescribed methylergonovine maleate intramuscularly to the client. Which condition would the nurse identify as necessitating the cautious administration of this drug? a)low blood pressure b)respiratory problems c)cardiovascular disease d)mild fever
cardiovascular disease Nurses must administer methylergonovine maleate with caution in women who have elevated blood pressure or cardiovascular disease because it causes a sudden increase in blood pressure and could initiate a cerebrovascular accident (stroke) in women at risk with preexisting conditions. Low blood pressure, respiratory problems, or mild fever are not known to enforce cautious use of methylergonovine maleate in clients with early postpartum hemorrhage.
A nurse is developing a plan of care for a postpartum woman with superficial venous thrombosis of the left leg. Which intervention would the nurse most likely include? a). encouraging elevation of the left leg b). applying cool compresses to the left leg c). dministering opioids for pain relief d). administering intravenous anticoagulant therapy
encouraging elevation of the left leg For the woman with superficial venous thrombosis, administer nonsteroidal anti-inflammatory drugs (NSAIDs) for analgesia, provide for rest and elevation of the affected leg, apply warm compresses to the affected area to promote healing, and use antiembolism stockings to promote circulation to the extremities. Intravenous anticoagulant therapy would be used for a woman with deep vein thrombosis.
A postpartum woman has a history of von Willebrand disease (vWD). The client is being prepared for discharge, and a referral for health care follow-up is made to assess for potential postpartum hemorrhage. The nurse understands that this client is at greatest risk for hemorrhage during which time during the postpartum period? a). first 6 weeks b). first 3 days c). first monthf d). first week
first week During pregnancy, the von Willebrand factor level increases in most women; thus, labor and birth usually proceed normally. However, all women should be monitored for excessive bleeding, particularly during the first week postpartum.
The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor? a)retained placental fragments b)prolonged labor with multiple vaginal examinations to evaluate progress c)increased vaginal acidity leading to growth of bacteria d)loss of protection with premature rupture of membranes
increased vaginal acidity leading to growth of bacteria
While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect? a). uterine atony b). laceration c). uterine inversion d). hematoma
laceration Lacerations typically present with a firm contracted uterus and a steady stream of unclotted bright red blood. Hematoma would present as a localized bluish bulging area just under the skin surface in the perineal area, accompanied by perineal or pelvic pain and difficulty voiding. Uterine inversion would present with the uterine fundus at or through the cervix. Uterine atony would be manifested by a noncontracted uterus.
A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? a). placenta accreta b). multiparity c). preeclampsia d). fetal demise
multiparity Risk factors for postpartum hemorrhage due to uterine atony include many factors, including multiparity. Placenta accreta is associated with placental issues, preeclampsia is seen in disruption of maternal clotting factors, and fetal demise can cause a disruption in maternal clotting factors, but not uterine atony.
A client who gave birth several hours ago is experiencing postpartum hemorrhage. She had a cesarean birth and received deep, general anesthesia. She has a history of postpartum hemorrhage with her previous births. The blood is a dark red. Which cause of the hemorrhage is most likely in this client? a)disseminated intravascular coagulation b)retained placental fragment c)uterine atony d)cervical laceration
uterine atony Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. A cervical laceration is less likely because the blood is dark, not bright red, and bleeding from such a laceration usually occurs immediately after detachment of the placenta. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, and could contribute to the atony, but there is no evidence for this in the scenario.
