Page 307 - Critical Maternity & Newborn Health Nursing

6-Prolonged anesthesia and analgesia.

7-Full bladder or rectum. 8-Idiopathic.

2. Retention of partially or completely separated placenta.

3. Coagulation defects: DIC and Hypofibrinogenemia.

(B) Traumatic postpartum hemorrhage: due to laceration of the vulva,

vagina, cervix, or uterus.

Diagnosis:

(A) General examination:

• The general condition of the patient is corresponding to the amount

of blood loss.

• In excessive blood loss, manifestations of shock appear as

hypotension, rapid pulse, cold sweaty skin, pallor, restlessness, air
hunger and syncope.

(B) Abdominal examination:

• In atonic postpartum hemorrhage: The uterus is larger than

expected, soft and squeezing it leads to gush of clotted blood

pervaginum.

• In traumatic postpartum hemorrhage: The uterus is contracted.

Combination of the 2 causes may be present.

(C) Vaginal examination:

In atony: Bleeding is usually started few minutes after delivery of the

fetus.

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