Question

Assessing Postpartum Bleeding Diana is a healthy 35-year-old G5P5 who vaginally delivered an 8 pound, 6 ounce baby girl with an intact perineum. Her estimated blood loss (EBL) was 500 mL. During the fourth stage of labor her vital signs, fundus, and lochia were within normal limits (WNL). She is transferred to the mother-baby unit 3 hours after birth. 1.     What is the postpartum period? 2.     What is the process of uterine involution after childbirth? 3.     How is postpartum hemostasis achieved? 4.     After the report, the nurse goes in to assess Diana. Her vital signs are WNL, but her fundus is 2 cm above the umbilicus and displaced to the right. Her sanitary pad is completely saturated with lochia rubra. Is this an expected finding 3 hours after birth? 5.     The nurse asks Diana to dangle her feet at the bedside for several minutes. After confirming that Diana does not feel dizzy or lightheaded, she helps Diana up to the bathroom to void. Why does the nurse think that Diana’s bladder is full? 6.     When Diana first gets out of the bed, she has a gush of blood. Is this a sign of hemorrhage?

7.     Diana voids 500 mL of urine. Her fundus is boggy but became firm with massage and is now at the level of the umbilicus. Her lochia flow is slightly decreased. Diana has an IV of lactated Ringer (LR) solution with 20 units of oxytocin infusing at 125 mL per hour. What else can the nurse do to help Diana’s uterus contract?

Answer 1

Answer1. Postpartum period is the phase just after the child birth. It is also called as post natal phase which includes revert changes from pregnant to non pregnant conditions inside the mother. This phase can be divided into 3 further phases; the initial or acute phase of 6–12 hours just after childbirth; sub acute postpartum period which lasts for 2–6 weeks, and the delayed postpartum period which can last up to six months. At this time, much care is needed for the mother besides the new born as many different changes occur inside her body.

Answer 2. Uterine involution is one of the changes occurring during postnatal phase that involves the transformation of uterus back to normal as in its shape and hormones concerned. It also ensures the restoration of ovarian functions so as to prepare the body for a new pregnancy. It is a physiological change which is assisted by the hormone oxytocin.The changes happen until the diameter of the uterus returns to its original size during a woman's menstrual cycle.

Answer 3. Postpartum homeostasis involves the balancing act of the body to normalize the changes that have so far occurred. It includes mainly the compression of myometrial blood vessels (intra) as the uterine muscle contracts rather than by platelet aggregation & clot formations.

Answer 4. Lochia in urinary excretion is the waste of placenta, its vessels and the debris from the decidua. It is well expected even upto some days after delivery not only hours. It is mandatory to remove such waste out of body by itself because such debris is risky for infections inside mother. In specific, one kind of lochia i.e. lochia rubra is a bright red discharge with some bits of fetal membranes, meconium and cervical discharges that occurs from delivery day 1-3 and is normal to be seen.