When Your Patient Is From the Obstetric Department: Postpartum Hemorrhage and Massive Transfusion

Volume Replacement Following Severe Postpartum Hemorrhage

“…Adequate treatment of severe hemorrhage extends beyond volume replacement. Maximizing oxygen exchange to minimize tissue hypoxia may be provided by administering oxygen at 10 liters to 12 liters per minute flow rate via a nonrebreather face mask . While oxygen and fluids are essential to maintaining tissue perfusion, the administration of cool air and fluids can lower maternal body temperature.…”

“…Long‐term psychological sequelae are possible following a severe PPH . Providing information about the woman's treatment and condition to the woman and her family, and offering time to debrief after the event, may help the woman and her support persons effectively cope with the experience . Women who have had a severe hemorrhage may benefit from mental health counseling immediately postpartum or years later.…”

“…Maximizing oxygen exchange to minimize tissue hypoxia may be provided by administering oxygen at 10 liters to 12 liters per minute flow rate via a nonrebreather face mask. 32 While oxygen and fluids are essential to maintaining tissue perfusion, the administration of cool air and fluids can lower maternal body temperature. Hypothermia or a temperature less than 36°C (96.8°F) may: 1) increase the hemoglobin affinity for oxygen, decreasing oxygen available for tissue perfusion; 2) disrupt the conduction system in the heart, resulting in arrhythmias; and 3) decrease metabolic activity, which impairs drug activity and metabolism.…”

Cesarean Delivery Is Rising: Implications for Care for the Perianesthesia Nurse

“…If the obstetrician needs to perform an internal examination, often a painful procedure, the nurse should support the patient during the examination, administering pain medication if regional anesthesia has worn off. 15 Monitor vital signs and urine output for signs of volume deficit and continue to assess the fundal height and lochia every 15 minutes until stable. 18 If bleeding is significant, transfer out of the PACU may be postponed while a CBC and coagulation studies are checked.…”

“…Continue vital signs and assessments every 15 minutes and monitor intake & output (I&O). 15,19 On rare occasions, a mother may need to return to the OR for removal of adherent placental tissue, such as placenta accreta, to search for internal bleeding and, possibly, hysterectomy. 15 Ongoing explanation to patients and support persons of all care measures being performed will help to reassure them, as even the slightest deviation from what is expected can cause fear and anxiety ( Table 2).…”