Page 793 - Saunders Comprehensive Review For NCLEX-RN

C. Interventions
1. Monitor client for abnormal pain or perineal pressure,
especially when forceps delivery has occurred.
2. Monitor vital signs and for signs of shock.
3. Place ice at the hematoma site.
4. Administer analgesics as prescribed.
5. Prepare for urinary catheterization if the client is
unable to void.
6. Administer blood products as prescribed.
7. Monitor for signs of infection, such as increased
temperature, pulse rate, and white blood cell count.
8. Administer antibiotics as prescribed because infection
is common after hematoma formation.
9. Prepare for incision and evacuation of hematoma if
necessary.
III. Uterine Atony
A. Description: A poorly contracted uterus that does not adequately
compress large open vessels at the placental site; this can result in
hemorrhage. This can involve the anterior, posterior, or both areas
of the uterus.
B. Assessment: A soft (boggy) uterus noted on palpation of the
uterine fundus
C. Interventions
1. Massage the uterus until firm (Fig. 26-2).
2. Empty the woman’s bladder (by voiding or
catheterization) if that is contributing to the uterine
atony.
3. Notify the obstetrician (OB) if interventions do not
resolve the atony, because this could be an indication
of hemorrhage.
IV. Hemorrhage and Shock
A. Description
1. Bleeding of greater than 1000 mL or more after
delivery or a 10% drop in hemoglobin and hematocrit
from admission to postdelivery with signs and
symptoms of hemorrhage.

2. Can occur early during the first 24 hours after

delivery or later after the first 24 hours following
delivery
3. Early postpartum hemorrhage is within the first 4
hours postpartum.
4. Late postpartum hemorrhage is anything beyond 4
hours postpartum.
5. While postpartum hemorrhage can occur any time
during the postpartum period, the greatest risk is
during the 4 hours immediately after delivery, and
the second greatest risk is the first 24 hours following

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