Bleeding Disorders

1. Name and discuss the various bleeding put outs of the postpartum mother.
a. uterine atony lack of muscle tone in the womb resulting in failure to contract firmly around stock vessels when the placenta separates. Rapid bleeding falls from the endometrial arteries at the placental site. This disorder may be due to factors much(prenominal) as overdistention of the womb caused by multiple gestations, multiparity, birth of a large infant, intrapartum factors such as prolonged labor, or hydramnios. Clinical signs atomic number 18 a soft boggy uterus, uterine fundus difficult to locate, uppity lochia on pad after 15 minutes (especially bright red), and excessive clots expelled. Nurse should massage fundus, assist mother to urinate if vesica full, call for charge nurse and doctor. A rapid IV infusion of diluted Pitocin is the drug of choice.
b. Traumas such as vaginal, cervical or perineal lacerations and hematomas. The most common are the perineum, vagina and cervix and the area around the urethral meatus. Cervical lacerations legislate during first stage of labor when the cervix dilates rapidly. While vagina, perineum, and periurethral lacerations occur during the second stage of labor. Due to use of assistive devices or the fetal head descends rapidly. Bleeding may be forbidding or dribbles of continuous blood. Surgical repair required.




c. Subinvolution is when the uterus does not return to its prepregnant size. Fragments of placenta remain attached to the myometrium and clots form around the bear placenta fragments. Caused by prematurely separating placenta from uterine wall, manual removal, or placenta adhering to the uterine wall. Occurs 24 hours to 6 weeks after delivery. Mother is instructed to seek fast medical care if she experiences fever, pelvic pain or dogged lochia rubra. Treatment includes ultrasound to identify fragments, Pitocin, or D& adenosine monophosphate;C.
d. * Placenta previa (discussed below)
e. * Abruptio placentae (discussed below)
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