SULTAN KUDARAT EDUCATIONAL INSTITUTION

College of Nursing and Education, College of

Midwifery &Technical Vocational Courses
Tacurong City, Sultan Kudarat

A Simple Case Study on Postpartum Infection

In Partial Fulfillment of the Requirement on the Degree of
Bachelor of Science in Nursing

Submitted by:
Napao,Kerks Von Gladiel A.

Clinical Instructor:
Cabaña,Armando G. ,RN

April 2024

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 TABLE OF CONTENTS

I.INTRODUCTION …………………………………………….………3

A.Objectives of the Study…………………………………………..4

II.DISEASE PROCESS……………………………………………….5

a.Anatomy and Physiology…………………………………………5,6

b.Pathophysiology…………………………………………………..7

i.Ischemic Diagram………………………………………………….7

ii.Definition of the disease…………………………………………8

iii.Predisposing factor………………………………………………8

V.MEDICAL MANAGEMENT……………………………………….9-11

VI.NURSING MANAGEMENT………………………………………12-15

VII.REFERENCES…………………………………………………….16

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 INTRODUCTION

Background of the study

Postpartum hemorrhage is excessive bleeding following the birth of a baby.

About 1 to 5 percent of women have postpartum hemorrhage and it is more likely
with a cesarean birth. Hemorrhage most commonly occurs after the placenta is
delivered. The average amount of blood loss after the birth of a single baby in
vaginal delivery is about 500 ml (or about a half of a quart). The average amount of
blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most
postpartum hemorrhage occurs right after delivery, but it can occur later as well.

Once a baby is delivered, the uterus normally continues to contract (tightening of

uterine muscles) and expels the placenta. After the placenta is delivered, these
contractions help compress the bleeding vessels in the area where the placenta was
attached. If the uterus does not contract strongly enough, called uterine atony, these
blood vessels bleed freely and hemorrhage occurs. This is the most common cause
of postpartum hemorrhage. If small pieces of the placenta remain attached, bleeding
is also likely.

Although an uncommon event, uterine rupture can be life-threatening for the

mother. Conditions that may increase the risk of uterine rupture include surgery to
remove fibroid (benign) tumors and a prior cesarean scar. A prior scar on the uterus
in the upper part of the fundus has a higher risk of uterine rupture compared with a
horizontal scar in the lower uterine segment called a lower transverse incision. It can
also occur before delivery and place the fetus at risk as well.

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GENERAL OBJECTIVES

At the end of this study, the Nursing student will able to have a deeper
understanding of what is Postpartum Hemorrhage and the understanding of how we
could provide appropriate care/intervention for our client with this particular disease.

SPECIFIC OBJECTIVES:

At the end of this study the nursing student will be able to:

 To understand and identify the underlying cause of Postpartum Hemorrhage ;

 To discuss the anatomy and physiology of the uterus;

 To know the drugs mechanism of action, indication, contraindication, side

effect and nursing responsibility;

 To establish essential nursing intervention to be implemented for the patient

wellness and recovery;

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II.DISEASE PROCESS

ANOTOMY AND PHYSIOLOGY

Anatomy of the Uterus

Uterus - is a pear-shaped organ in the reproductive system of people assigned

female at birth (AFAB). It’s where a fertilized egg implants during pregnancy and
where your baby develops until birth. It’s also responsible for your menstrual cycle.

Vagina - is a muscular canal that joins the cervix (the lower part of uterus) to the
outside of the body. It can widen to accommodate a baby during delivery and then
shrink back to hold something narrow like a tampon. It’s lined with mucous
membranes that help keep it moist.

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Labium minus - protect the vaginal and urethral openings from mechanical irritation,
dryness, and infections.

Cervix - is the lowest part of your uterus. A hole in the middle allows sperm to enter
and menstrual blood to exit. Your cervix opens (dilates) to allow a baby to come out
during a vaginal childbirth. Your cervix is what prevents things like tampons from
getting lost inside your body.

Ovaries - are small, oval-shaped glands that are located on either side of your
uterus. Your ovaries produce eggs and hormones.

Fallopian tubes - These are narrow tubes that are attached to the upper part of your
uterus and serve as pathways for your egg (ovum) to travel from your ovaries to your
uterus. Fertilization of an egg by sperm normally occurs in the fallopian tubes. The
fertilized egg then moves to the uterus, where it implants into your uterine lining.

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Pathophysiology

POSTPARTUM HEMORRHAGE

Predisposing Factor Precipitating Factor

Age Birth trauma
Genes Medications
Anxiety Placental defects
Depression Infection

Anemia
Over distended uterus
Clotting deficiencies
Rapid or prolonged
labor

Uterine atony Retained placental

Or membrane
Vaginal cervical Coagulation
fragments
lacerations defects

Bleeding Ineffective uterine

from contraction Fundus firm
placental site continued
bleeding Bleeding from all
sites

Correction
Uterine Repair of of
exploration laceration underlying
removal of ligations of cause
fragments arteries

Drugs Fluid replacement 7

bimanual transfusion blood and
conception bod products
 Risk factors for postpartum hemorrhage (PPH) are dependent on the etiology of
the hemorrhage. Risk factors for uterine atony include high maternal parity,
chorioamnionitis, prolonged use of oxytocin, general anesthesia, and conditions that
cause increased distention of the uterus such as multiple gestation, polyhydramnios,
fetal macrosomia, and uterine fibroids. Risk factors that can lead to uterine inversion
include excessive umbilical cord traction, short umbilical cord, and fundal
implantation of the placenta. Genital tract trauma risk factors include operative
vaginal delivery and precipitous delivery. Retained placenta and abnormal
placentation are more common if an incomplete placenta is noted at delivery, a
succenturiate lobe of the placenta is present, or if the patient has a history of
previous uterine surgery. Coagulation abnormalities are more common in patients
presenting with fetal death in utero, placental abruption, sepsis, disseminated
intravascular coagulopathy (DIC), and in those with a history of an inherited
coagulation defect.

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 MEDICAL MANAGEMENT
DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
ACTION CONSIDERATION
Generic name: Oxytocin stimulates To reduce • Contraindicated in CNS: Alert: All patients receiving
Oxytocin uterine contraction by postpartum patients subarachnoid oxytocin IV must be under
activating G-protein- bleeding after hypersensitive to drug. hemorrhage, continuous observation by
Brand name: coupled receptors Adults: 10 to 40 seizures, coma. trained personnel who have
that trigger increases CV: arrhythmias,
Evatocin units IV infused at • Contraindicated a thorough knowledge of the
in intracellular
calcium levels in
rate needed to when vaginal delivery HTN, PVCs, hy- drug and are qualified to
Dosage: uterine myofibrils. sustain uterine isn't advised (placenta potension, identify complications.
10 units contraction and previa, vasa previa, tachycardia. Gi:
Oxytocin also
con-to uterine invasive cervical nausea, vomiting. Alert: Discontinue oxytocin
increases local
Route: prostaglandin atony. Also, may carcinoma, genital infusion immediately if
IM production, further give 10 units IM herpes), when GU: abruptio uterine hyperactivity or fetal
stimulating uterine after delivery of cephalopelvic placentae, tetanic distress occurs. Administer
contraction. placenta. disproportion is uterine oxygen to the mother. Mother
present, or when contractions, and fetus must be evaluated
delivery requires postpartum by the responsible physician.
conversion, as in hemorrhage,
transverse lie. uterine rupture, • Drug is used to induce or
impaired uterine reinforce labor only when
• Contraindicated in blood flow, pelvic pelvis is known to be
fetal distress when hematoma, adequate, when vaginal
delivery isn't imminent, increased uterine delivery is indicated, when
in prematurity, in other motil-ity. fetal maturity is assured, and
obstetric emergencies, when fetal position is
and in patients with Hematologic: favorable. Use drug only in
severe toxemia or afibrinogenemia, hospital where critical care
hypertonic uterine p possibly related facilities and prescriber are
Use cautiously, if at to postpartum in-mediately available.
all, in patients with bleeding, pelvic

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invasive cervical hematoma. • Monitor fluid intake and
cancer and in those output. Antid-iuretic effect
with previous cervical Other: may lead to fluid overload,
or uterine surgery anaphylaxis, seizures, and coma from
(including cesarean death from water intoxication.
section), grand ayrocin-induced
multiparity, uterine water • Monitor and record uterine
sepsis, traumatic intoxication, contractions, HR, BP,
delivery, or hypersensitivity intrauterine pressure, fetal
overdistended reactions. HR, and character of blood
uterus. loss at least every 15
minutes.
Fetal CNS: infant
brain damage,
seizures.

CV: bradycardia,
arrhythmias,
PVCs.
EENT: neonatal
retinal
hemorrhage.
Hepatic neonatal
jaundice. Other:
low Apgar scores
at 5 minutes,
death.

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 DRUG MECHANISM OF INDICATION CONTRAINDICAT SIDE EFFECTS NURSING CONSIDERATION
ORDER ACTION ION
Generic Stimulates Induction and  Uterine Prior to administration
name: collagenase in the management of Misoprostol is hyperstimulati
cervix, promoting abortion contraindicated in on  Reinforce education provided by
Misoprostol cervical ripening Cervical ripening those with  Abnormal obstetrician / midwife
Control previous allergic fetal heart  Assessments: contraindications
Brand Increases postpartum reaction or rate and precautions; cervical status,
name: intracellular hemorrhage hypersensitivity to  Nausea fetal lie, fetal position; baseline
Cytotec calcium within prostaglandin. Tho  Vomiting uterine and fetal heart monitoring
uterine smooth se at risk for  Diarrhea  If administering misoprostol, have
Dosage: muscle cells, gastric ulcers  Diaphoresis terbutaline readily available
200 mcg stimulating uterine secondary to  Cardiac
contraction NSAID use and arrhythmias After administration
Route: are pregnant  Disseminated
Oral should not take intravascular  Keep client supine 15–30 minutes
misoprostol given coagulation after receiving gel or for two hours
Frequency: the adverse effects  Amniotic fluid after receiving vaginal insert
PO qid reported during embolism  Assessments: uterine activity,
pregnancy. FHR, maternal vital signs; monitor
for side effects
 Therapeutic response: cervical
softening, minimal uterine activity,
normal FHR
 Undesired
outcomes: hyperstimulation;
monitor FHR for indeterminate /
abnormal patterns
 Provide comfort measures as
needed

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 NURSING MANAGEMENT
Patient: Mrs. K Diagnosis: Postpartum Hemorrhage

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Risk for ineffective After 8 hours of  Established  To gain clients
“subrang lakas parin tissue perfusion nursing rapport. trust. After 8 hours of nursing
po ng pagdurogo ko related to intervention  Monitored  To measure the interventions. the patient was
kahit natapos napo hemorrhage. the patient will able amount of amount of blood able to demonstrate adequate
akong nanganak” to demonstrate bleeding by loss perfusion and stable vital
adequate weighing all signs.
Objective: perfusion pads.
Restlessness and stable vital  Frequently  Early recognition GOAL MET
Irritability sings. monitor vital of possible
Confusion sings. adverse effects
Bleeding allows to prompt
intervention.
VS:
 Massaged the  To help expel
Temp-36.8 area of the clots of blood and
PR-105 uterus it is also used to
RR-24 check the tone of
BP-90/60 the uterus and
ensure that it is
clamping down to
prevent excessive
bleeding
 Placed the
mother in  Encourages
Trendelenberg venous return to
position facilitate
circulation, and
prevents further

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 bleeding
 Provided
comfort measure  Promotes
like back rubs, relaxation and
deep breathing. may enhance
Instruct in patient's coping
relaxation or abilities by
visualization refocusing
exercises. attention.
Provided
diversional
activities.

 Administer  To supply
oxygen as adequate oxygen
indicated. to patient and
prevents further
complication.
 Administer
medication as  To promote
indicated contraction and
(Pitocin,Cytotec) prevents further
bleeding.

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 Patient: Mrs. K Diagnosis: Postpartum Hemorrhage

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Acute Pain After 8 hours  Established rapport  To gain clients trust
“Subrang sakit related to of nursing  Frequently monitor vital signs  To have baseline data After 8 hours of
po ng puson physical intervention  Determine and document  Acute pain is that nursing intervention
ko” injury agent the patient will presence of possible which follows an injury the patient was able
as be able to patophysio-logical and trauma, or procedure to report that the pain
Objective: evidenced report pain is psychological causes of pain such as surgery, or was relieved or
Restlessness by guarding relieved or occurs suddenly. with controlled.
Irritability behavior controlled the onset of a painful
Bleeding condition GOAL MET
Guarding  Assess for potential types of  to aid in understanding
behavior pain that may be affecting reason for severity of
client pain associated with
VS: client's condition and
Temp-36.8 point toward needed
PR-105 interventions for pain
RR-24 management.
BP-90/60  Note client's age and  affecting ability to
developmental level and report pain parameters
current condition or response to pain
and pain management
interventions.
 Assess client's perceptions of  Client's perception of
pain, along with behaviors and and expression of pain
cultural expectations regarding are influenced by age,
pain developmental stage,
underlying problem
causing pain,
cognitive, and
behavioral and
sociocultural factors.
 Determine history or presence  that may also be
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 of chronic conditions (e.g., associated with acute
multiple sclerosis, stroke, and chronic pain
diabetes, sickle cell disease, simultaneously, be
depression) associated with an
exacerbation of pain
symptoms, or interfere
with accurate
assessment of acute
pain.
 Assess for referred pain, as  to help determine
appropriate possibility of
underlying condition or
organ dysfunction
requiring treatment.
 Determine medications (e.g.,  may affect choice of
Skeletal muscle relaxants, analgesics.
antibiotics, antidepressants,
anticoagulants), alcohol or
other drugs currently being
used, and any medication
allergies
 Note cultural and  Verbal and/or
developmental influences behavioral cues may
affecting pain response. have no direct
relationship to the
degree of pain
perceived .
 Administered analgesic  to maintain
medication prescribed by the "acceptable" level of
physician pain. Notify physician if
regimen is inadequate
to meet pain control
goal. Combinations of
medications may be
used on prescribed

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intervals.

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REFERENCES

 Bienstock JL, Eke AC, Hueppchen NA. Postpartum

Hemorrhage (https://pubmed.ncbi.nlm.nih.gov/33913640/). N Engl J Med. 2021 Apr
29;384(17):1635-1645. Accessed 11/1/2021.

 Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and

Treatment (https://pubmed.ncbi.nlm.nih.gov/28409600/). Am Fam Physician. 2017 Apr
1;95(7):442-449. Accessed 1/3/2022.

 Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing

postpartum haemorrhage (https://pubmed.ncbi.nlm.nih.gov/23818022/). Cochrane
Database Syst Rev. 2013 Jul 1;(7):CD006431. Accessed 1/3/2022.

 March of Dimes. Postpartum

Hemorrhage (https://www.marchofdimes.org/pregnancy/postpartum-
hemorrhage.aspx). Accessed 1/3/2022.

 Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary
postpartum
haemorrhage (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483801/). Cochrane
Database Syst Rev. 2014;2014(2):CD003249. Accessed 1/3/2022.

 World Health Organization. WHO Recommendations on Prevention and Treatment of

Postpartum Haemorrhage and the WOMAN
Trial. (https://www.who.int/reproductivehealth/topics/maternal_perinatal/pph-woman-
trial/en/) Accessed 1/3/2022.

 Weeks A. The prevention and treatment of postpartum haemorrhage: what do we

know, and where do we go to
next? (https://pubmed.ncbi.nlm.nih.gov/25289730/) BJOG. 2015 Jan;122(2):202-10.
Accessed 1/3/2022.

Wormer KC, Jamil RT, Bryant SB. Acute Postpartum

Hemorrhage (https://www.ncbi.nlm.nih.gov/books/NBK499988/). [Updated 2021 Jul 26]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 1/3/2

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