What are the 4 T's of postpartum hemorrhage?

The Four T's mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]).

Which one of the 4 Ts is the most common cause of PPH?

Uterine atony.

This is the most common cause of PPH. It happens when the muscles in your uterus don't contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.

What are the 5 most common causes of PPH?

In many International and local studies it was revealed that the main cause of PPH is uterine atony followed by vaginal hematoma, cervical or vaginal tear, adherent placenta, uterine angle extension and retained placenta [3,5].

What is the first intervention for postpartum hemorrhage?

External uterine massage and bimanual compression are generally used as first-line treatments. These compression techniques encourage uterine contractions that counteract atony and assist with expulsion of retained placenta or clots.

What should nurse do during postpartum hemorrhage?

Nursing Interventions

Save all perineal pads used during bleeding and weigh them to determine the amount of blood loss. Place the woman in a side lying position to make sure that no blood is pooling underneath her. Assess lochia frequently to determine if the amount discharged is still within the normal limits.

Postpartum hemorrhage - causes, symptoms, treatment, pathology

What do nurses do in postpartum hemorrhage?

The primary role of the nurse in caring for patients with postpartum hemorrhage is to assess and intervene early or during a hemorrhage to help the client regain her strength and prevent complications. Early recognition and treatment of PPH are critical to care management.

What are the 3 main causes of postpartum hemorrhage?

The Four T's mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]).

How much blood loss is considered postpartum hemorrhage?

Traditionally, postpartum hemorrhage (PPH) has been defined as greater than 500 mL estimated blood loss associated with vaginal delivery or greater than 1000 mL estimated blood loss associated with cesarean delivery.

What is the main cause of primary PPH?

The major causes of primary postpartum hemorrhage include uterine atony, retained placenta, lower genital tract lacerations and hematomas, uterine rupture, consumptive coagulopathy, and acute inversion of the uterus.

What does boggy uterus mean?

A boggy uterus refers to an enlarged, soft, and tender uterus identified during physical examination. It is most commonly caused by uterine atony or adenomyosis.

How do you fix postpartum hemorrhage?

The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as soon as possible. Treatment may include: Medicine or uterine massage to stimulate uterine contractions. Removing pieces of the placenta that remain in the uterus.

How do you stop postpartum hemorrhage?

You will be given oxygen via a facemask and a second drip for extra intravenous fluids. You may be given a blood transfusion or medication to help your blood to clot. If the bleeding continues, you may be taken to the operating theatre to find the cause of the haemorrhage. You will need an anaesthetic for this.

When is highest risk for postpartum hemorrhage?

When should I worry about postpartum hemorrhage?

Tell your doctor or call 911 if you have any of these symptoms or signs: Bright red bleeding beyond the third day after birth. Blood clots bigger than a plum. Bleeding that soaks more than one sanitary pad an hour and doesn't slow down or stop.

How long is postpartum hemorrhage a concern?

It's a serious and dangerous condition. PPH usually occurs within 24 hours of childbirth, but it can happen up to 12 weeks postpartum. When the bleeding is caught early and treated quickly, it leads to more successful outcomes.

Can postpartum hemorrhage be stopped?

After your baby is born, you will be offered an injection of medicine to help your uterus contract to help the placenta come out, and reduce your risk of postpartum haemorrhage. If you have a postpartum haemorrhage, you may need additional medicines, a blood transfusion or surgery to stop the bleeding.

What happens if postpartum hemorrhage goes untreated?

If postpartum hemorrhage is not properly treated, it can cause the mother's blood pressure to drop dangerously, which can lead to death, shock and other serious medical conditions.

What are two drugs used to treat postpartum hemorrhage?

The medications most commonly used in PPH management are uterotonic agents. These medications include oxytocin (Pitocin^®), misoprostol (Cytotec^®), methylergonovine maleate (Methergine^®,), carboprost tromethamine (Hemabate^®), and dinoprostone (Prostin E2^®). All of these medications are available in the United States.

What are the signs of uterine atony?

What are the symptoms of uterine atony? The biggest sign of uterine atony is prolonged or excessive bleeding from your uterus. Your healthcare provider detects most cases of uterine atony soon after your baby is born. Additionally, your uterus is relaxed, weak and loose after delivery.

Why do you massage the fundus?

Why Is Fundal Massage Done after Childbirth? The main reason to perform uterine massages is to help encourage the uterus continue to contract and prevent postpartum hemorrhage. After the placenta detaches and is delivered, the area where it was attached to the uterine wall bleeds.

What to do if fundus is boggy?

(b) Massage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle). (c) Monitor patient's vital signs every 15 minutes until stable. (d) Prevent bladder distention. Bladder distention displaces the uterus and prevents effective uterine contractions.

Should the fundus be hard or soft?

12 hours after delivery, the fundus of the uterus should be firm - we always like firm - midline, meaning in the middle of the body, not deviated to one side or the other, and approximately at the level of the umbilicus, so at the level of the belly button.

How do you prevent uterine atony?

Initial prevention and management of uterine atony requires active management of the third stage of labor. This includes performing uterine massage while gently pulling the end of the umbilical cord in order to detach the entire placenta from the uterine walls.

What you shouldn't do after giving birth?

Avoid stairs and lifting until your doctor says these activities are OK. Don't take a bath or go swimming until the doctor says it's OK. Don't drive until your doctor says it's OK. Also wait until you can make sudden movements and wear a safety belt properly without discomfort.

What is golden hour after birth?

The first hour after birth when a mother has uninterrupted skin-to-skin contact with her newborn is referred to as the “golden hour.” This period of time is critical for a newborn baby who spent the past nine months in a controlled environment.