8 Postpartum Hemorrhage Nursing
Care Plans
Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than or equal to
1,000 mL of blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after
the birth process, regardless of route of delivery. Nevertheless, a blood loss greater than 500 mL
in a vaginal delivery should be considered abnormal (American College of Obstetricians and
Gynecologists [ACOG], 2017).
Postpartum hemorrhage is the fifth leading cause of maternal mortality in the United States and
causes approximately 11-12% of maternal deaths. It is the leading cause of maternal morbidity
and mortality globally (Nathan, 2019).
Primary postpartum hemorrhage may occur within the first 24 hours after birth, while secondary
postpartum hemorrhage occurs more than 24 hours and up to 12 weeks after delivery. The four
main causes for postpartum hemorrhage are the four T’s: tone (uterine atony), trauma
(lacerations, hematomas, uterine inversion or rupture), tissue (retained placental fragments), and
thrombin (disseminated intravascular coagulation).
Nursing Care Plans
The primary role of the nurse in caring for patients with postpartum hemorrhage is to assess and
intervene early or during a hemorrhage to help the client regain her strength and prevent
complications. Early recognition and treatment of PPH are critical to care management. Data
such as the amount of bleeding, the condition of the uterus, checking the maternal vital signs,
and observing for signs of shock would play a vital role in the care of the patient with
hemorrhage.
Here are eight nursing care plans and nursing diagnosis for postpartum hemorrhage:
1. Deficient Fluid Volume
2. Risk for Imbalanced Fluid Volume
3. Ineffective Tissue Perfusion
4. Risk For Infection
5. Acute Pain
6. Risk for Impaired Attachment
7. Anxiety
8. Deficient Knowledge
, Deficient Fluid Volume
The body initially responds to a reduction in blood volume with increased heart and respiratory
rates. These reactions increase the oxygen content of each erythrocyte and cause faster
circulation of the remaining blood. Blood flow to nonessential organs gradually stops to make
more blood available for vital organs, specifically the heart and brain. Blood flow to the brain and
the kidneys decreases as blood loss continues and fluid is conserved. Urine output decreases
and eventually stops.
Nursing Diagnosis
● Deficient Fluid Volume
May be related to
● Excessive blood loss after birth
Possibly evidenced by
● Changes in the mental status
● Concentrated urine
● Delayed capillary refill
● Decrease in the red blood cell count (hematocrit)
● Decrease blood pressure (hypotension)
● Dry skin/mucous membrane
● Increase heart rate (tachycardia)
Desired Outcomes
● The client will maintain a blood pressure of at least 100/60 mm Hg.
● The client will maintain a pulse rate between 70-90 beats per minute.
● The client will have a balanced 24-hour intake and output.
● The client will have a cognitive status within the expected range.
● The client will have a lochia flow of less than one saturated perineal pad per hour.
● The client will demonstrate improvement in the fluid balance as evidenced by a
good capillary refill, adequate urine output, and skin turgor.
Care Plans
Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than or equal to
1,000 mL of blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after
the birth process, regardless of route of delivery. Nevertheless, a blood loss greater than 500 mL
in a vaginal delivery should be considered abnormal (American College of Obstetricians and
Gynecologists [ACOG], 2017).
Postpartum hemorrhage is the fifth leading cause of maternal mortality in the United States and
causes approximately 11-12% of maternal deaths. It is the leading cause of maternal morbidity
and mortality globally (Nathan, 2019).
Primary postpartum hemorrhage may occur within the first 24 hours after birth, while secondary
postpartum hemorrhage occurs more than 24 hours and up to 12 weeks after delivery. The four
main causes for postpartum hemorrhage are the four T’s: tone (uterine atony), trauma
(lacerations, hematomas, uterine inversion or rupture), tissue (retained placental fragments), and
thrombin (disseminated intravascular coagulation).
Nursing Care Plans
The primary role of the nurse in caring for patients with postpartum hemorrhage is to assess and
intervene early or during a hemorrhage to help the client regain her strength and prevent
complications. Early recognition and treatment of PPH are critical to care management. Data
such as the amount of bleeding, the condition of the uterus, checking the maternal vital signs,
and observing for signs of shock would play a vital role in the care of the patient with
hemorrhage.
Here are eight nursing care plans and nursing diagnosis for postpartum hemorrhage:
1. Deficient Fluid Volume
2. Risk for Imbalanced Fluid Volume
3. Ineffective Tissue Perfusion
4. Risk For Infection
5. Acute Pain
6. Risk for Impaired Attachment
7. Anxiety
8. Deficient Knowledge
, Deficient Fluid Volume
The body initially responds to a reduction in blood volume with increased heart and respiratory
rates. These reactions increase the oxygen content of each erythrocyte and cause faster
circulation of the remaining blood. Blood flow to nonessential organs gradually stops to make
more blood available for vital organs, specifically the heart and brain. Blood flow to the brain and
the kidneys decreases as blood loss continues and fluid is conserved. Urine output decreases
and eventually stops.
Nursing Diagnosis
● Deficient Fluid Volume
May be related to
● Excessive blood loss after birth
Possibly evidenced by
● Changes in the mental status
● Concentrated urine
● Delayed capillary refill
● Decrease in the red blood cell count (hematocrit)
● Decrease blood pressure (hypotension)
● Dry skin/mucous membrane
● Increase heart rate (tachycardia)
Desired Outcomes
● The client will maintain a blood pressure of at least 100/60 mm Hg.
● The client will maintain a pulse rate between 70-90 beats per minute.
● The client will have a balanced 24-hour intake and output.
● The client will have a cognitive status within the expected range.
● The client will have a lochia flow of less than one saturated perineal pad per hour.
● The client will demonstrate improvement in the fluid balance as evidenced by a
good capillary refill, adequate urine output, and skin turgor.
