Postpartum Hemorrhage (PPH) Complications
Postpartum hemorrhage is defined by excessive bleeding after childbirth, often categorized by
the following causes:
● Uterine Atony
○ Definition: The failure of the uterus to contract effectively after childbirth, which is
the most common cause of PPH.
○ Etiology/Causes: Overdistended uterus (from multiple gestation or macrosomia),
prolonged or rapid labor, use of uterine relaxants (e.g., magnesium sulfate), grand
multiparity (\ge5 births), and retained placental fragments.
○ Signs/Symptoms: A soft, "boggy" uterus upon palpation, heavy vaginal bleeding,
increased fundal height, and signs of shock like hypotension and tachycardia.
○ Management: Fundal massage to stimulate contractions, administration of
uterotonic agents (Oxytocin, Methergine, Hemabate, Cytotec), IV fluid resuscitation,
and potentially surgical interventions like hysterectomy in severe cases.
○ Nursing Diagnosis: Risk for deficient fluid volume related to excessive blood loss.
● Lacerations
○ Definition: Tears in the cervix, vagina, perineum, or surrounding structures
occurring during childbirth.
○ Etiology/Causes: Rapid delivery, large fetal head, use of forceps/vacuum
extraction, or insufficient perineal stretching.
○ Signs/Symptoms: Continuous bright red vaginal bleeding despite a firm uterus,
pain at the site, and swelling or bruising.
○ Management: Surgical repair (suturing), pain management (NSAIDs, ice packs),
and antibiotics if indicated.
○ Nursing Management: Apply ice packs for the first 24 hours and educate on
perineal hygiene.
● Retained Placental Fragments
○ Definition: Retention of placental tissue in the uterus after delivery.
○ Etiology/Causes: Incomplete placental separation or abnormal attachment (e.g.,
placenta accreta).
○ Signs/Symptoms: Prolonged/excessive bleeding, uterine subinvolution,
foul-smelling lochia, and persistent lower abdominal pain.
○ Management: Manual removal of fragments, uterotonics, Dilation and Curettage
(D&C), and antibiotics.
○ Nursing Diagnosis: Risk for infection related to retained placental tissue.
● Disseminated Intravascular Coagulation (DIC)
○ Definition: A life-threatening condition where widespread clotting and bleeding
occur simultaneously due to excessive activation of the coagulation system.
○ Pathophysiology: Complications (like sepsis or placental abruption) release tissue
thromboplastin, overactivating the clotting system until clotting factors are used up,
leading to uncontrolled bleeding and organ damage.
○ Signs/Symptoms: Uncontrolled bleeding from IV sites, gums, or nose; petechiae;
hypotension; and a platelet count below 100,000.
○ Management: Treat the underlying cause, provide blood transfusions (RBCs,
plasma, platelets), and monitor coagulation studies (PT, PTT, INR).
● Subinvolution
Postpartum hemorrhage is defined by excessive bleeding after childbirth, often categorized by
the following causes:
● Uterine Atony
○ Definition: The failure of the uterus to contract effectively after childbirth, which is
the most common cause of PPH.
○ Etiology/Causes: Overdistended uterus (from multiple gestation or macrosomia),
prolonged or rapid labor, use of uterine relaxants (e.g., magnesium sulfate), grand
multiparity (\ge5 births), and retained placental fragments.
○ Signs/Symptoms: A soft, "boggy" uterus upon palpation, heavy vaginal bleeding,
increased fundal height, and signs of shock like hypotension and tachycardia.
○ Management: Fundal massage to stimulate contractions, administration of
uterotonic agents (Oxytocin, Methergine, Hemabate, Cytotec), IV fluid resuscitation,
and potentially surgical interventions like hysterectomy in severe cases.
○ Nursing Diagnosis: Risk for deficient fluid volume related to excessive blood loss.
● Lacerations
○ Definition: Tears in the cervix, vagina, perineum, or surrounding structures
occurring during childbirth.
○ Etiology/Causes: Rapid delivery, large fetal head, use of forceps/vacuum
extraction, or insufficient perineal stretching.
○ Signs/Symptoms: Continuous bright red vaginal bleeding despite a firm uterus,
pain at the site, and swelling or bruising.
○ Management: Surgical repair (suturing), pain management (NSAIDs, ice packs),
and antibiotics if indicated.
○ Nursing Management: Apply ice packs for the first 24 hours and educate on
perineal hygiene.
● Retained Placental Fragments
○ Definition: Retention of placental tissue in the uterus after delivery.
○ Etiology/Causes: Incomplete placental separation or abnormal attachment (e.g.,
placenta accreta).
○ Signs/Symptoms: Prolonged/excessive bleeding, uterine subinvolution,
foul-smelling lochia, and persistent lower abdominal pain.
○ Management: Manual removal of fragments, uterotonics, Dilation and Curettage
(D&C), and antibiotics.
○ Nursing Diagnosis: Risk for infection related to retained placental tissue.
● Disseminated Intravascular Coagulation (DIC)
○ Definition: A life-threatening condition where widespread clotting and bleeding
occur simultaneously due to excessive activation of the coagulation system.
○ Pathophysiology: Complications (like sepsis or placental abruption) release tissue
thromboplastin, overactivating the clotting system until clotting factors are used up,
leading to uncontrolled bleeding and organ damage.
○ Signs/Symptoms: Uncontrolled bleeding from IV sites, gums, or nose; petechiae;
hypotension; and a platelet count below 100,000.
○ Management: Treat the underlying cause, provide blood transfusions (RBCs,
plasma, platelets), and monitor coagulation studies (PT, PTT, INR).
● Subinvolution
