Overview
Postpartum hemorrhage (PPH) is defined as cumulative blood loss ≥500 mL after vaginal delivery or ≥1000 mL after cesarean section, or any blood loss accompanied by signs of hemo...
Postpartum hemorrhage (PPH) is defined as cumulative blood loss ≥500 mL after vaginal delivery or ≥1000 mL after cesarean section, or any blood loss accompanied by signs of hemodynamic instability within 24 hours of delivery. Primary PPH occurs within the first 24 hours; secondary (late) PPH occurs between 24 hours and 12 weeks postpartum. PPH is the leading preventable cause of maternal mortality worldwide and the number-one cause in Canada. Missing early signs — a fundus that is boggy rather than firm, or a modest but continuous trickle — can result in coagulopathy, multi-organ failure, and death within 2 hours of delivery. Top 3 nursing priorities: 1. Uterine massage and bimanual compression to treat uterine atony (accounts for 70–80% of cases) 2. Quantitative blood loss measurement (replace visual estimation — studies show nurses underestimate by 30–50%) 3. Rapid IV access × 2 large-bore (16G or 18G), volume resuscitation, and immediate physician/midwife notification when loss exceeds 500 mL or vital signs deteriorate Classic NCLEX trap: Fundal massage is the FIRST intervention for uterine atony — not oxytocin administration. Oxytocin is given...
