Editing Maternal and Newborn Nursing (section)

=== Postpartum hemorrhage ===

Commonly defined as cumulative blood loss of 1,000 mL or more, or blood loss with signs or symptoms of hypovolemia, within 24 hours of birth regardless of route. Older thresholds of 500 mL after vaginal and 1,000 mL after cesarean birth still appear in test material. '''Early (primary)''' hemorrhage occurs within 24 hours; '''late (secondary)''' occurs from 24 hours to 12 weeks and is most often from retained placental fragments or subinvolution.

'''The four T's''': '''T'''one (uterine atony, the cause in roughly 70 to 80 percent), '''T'''rauma (lacerations, hematoma, uterine inversion or rupture), '''T'''issue (retained placenta), '''T'''hrombin (coagulopathy, including DIC).

'''Nursing sequence for a boggy uterus with heavy bleeding''': '''massage the fundus first''' (an independent nursing action that often works), '''have the patient empty the bladder or catheterize''', then anticipate '''uterotonics''', large-bore IV access, isotonic fluids, oxygen, type and crossmatch, quantitative blood loss measurement, and provider notification. Reassess after every intervention.

'''Uterotonics and their key contraindications''' (a very high-yield set):
* '''Oxytocin (Pitocin)''' - first line; watch blood pressure and, with prolonged high-dose use, water intoxication.
* '''Methylergonovine (Methergine)''' - '''contraindicated in hypertension and preeclampsia'''; check the blood pressure before every dose.
* '''Carboprost tromethamine (Hemabate)''' - '''contraindicated in asthma'''; commonly causes diarrhea, nausea, and fever.
* '''Misoprostol (Cytotec)''' - can be given by several routes; causes fever and shivering.
* '''Tranexamic acid''' is used as an adjunct within 3 hours of birth.

Classic early signs of hypovolemia in a healthy young obstetric patient are '''tachycardia, narrowing pulse pressure, restlessness or anxiety, and cool clammy skin'''; a falling blood pressure is a late sign.