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Postpartum Hemorrhage (PPH)Case Study Instructions: Please read the case study carefully and answer the following questions. Please use references including in-text citations to support your answers. Janet Smith is a 32-year-old G 5 P 5 that delivered NSVD a baby girl about 2 hours ago. This was a term pregnancy at 39 weeks. The baby weight 9 lbs 2 oz. APGAR scores 8/9. Janet is breastfeeding. After delivery, Janet’s fundus was firm midline and @ the umbilicus, light lochia. She had no delivery complications or lacerations. Estimated blood loss was 300 ml. She had an epidural and was unable to void and received a straight cath for 500 ml urine. She is now able to ambulate with assistance. She has a saline lock in her right arm. Her admission H & H were 10.2 mg/dl and 32.5%. Platelets were 200K. Vital signs in L & D recovery were: BP 110;s/70’s, Pulse 90’s, Temp 98.6F, Respirations 18. She was stable and moved to postpartum via w/c. What are Janet’s risk factors for PPH based on the information above? How would you interpret her labs? Normal or abnormal and why? What is a normal blood loss for a vaginal birth? Shortly after getting into bed, Janet calls and states she is bleeding “a lot” and she is feeling lightheaded and nauseated. You go to the room and find a saturated chux pad under her. She is noted to have about 1000 ml of dark red blood with clots on the chux. What is your immediate intervention? What do you suspect is the etiology of the bleeding and why? You massage Janet’s fundus and note that it is boggy and she continues to bleed despite fundal massage. List 5 important interventions needed at this time and why? What medication will you use first and why? What are other uterotonic medications available and what dosage and route would you give these medications? What are the contraindications for Methergine and Hemabate? Which vital sign would you expect first to be abnormal and why? Janet is not responding to any uterotonic medications and is transferred back to L & D. She was taken to the OR for a dilation and curettage due to retained placental products. A Bakri Balloon placement is attempted. She has now lost 2500 ml but has blood and blood products infusing. Her vital signs are: BP 90/40, Pulse 125, RR 16, and Temp 97.6F. With the Bakri Balloon, Janet’s bleeding was under control following the D & C. However, Janet required 4 units of PRBC’s due to major blood loss. She is now in stable condition. What is a Bakri Balloon and what is the mechanism of action? In the event the Bakri Balloon does not work, what are the alternatives if Janet continues to bleed? What additional lab studies would be important once a massage hemorrhage is evident? Why is measuring quantitative blood loss recommended over estimated blood loss?
SCIENCE
HEALTH SCIENCE
NURSING
MATERNITY 224