Nursing care of postpartum hemorrhage with shock: Case study

Abstract

Maternity who has postpartum hemorrhage as an obstetric complication is the most common causes of death. The causes of postpartum hemorrhage are poor uterine muscle contraction, residual placental tissue in the uterine cavity, injury to the vagina and blood clotting disorders. The principles of nursing care are finding the cause, providing nursing care according to the cause, infusion therapy immediately, always ready for the operating room and the surgical team.

Case study: A 40-year-old Thai woman, 5th pregnancy, never had an abortion, 39 weeks pregnant, admitted to Singburi Hospital with labor pain 3 hours before coming to the hospital, reject congenital disease. The 1st – 3rd phase of labor provides pain relief, increase comfort, monitoring of perinatal asphyxia and nursing care according to the guidelines to prevent postpartum hemorrhage (active management of third stage of labor: AMTSL), normal delivery, male baby weight 3,710 grams, Apgar score at 1, 5 minutes = 9,10. During placental delivery found that the placenta accrete, blood lost 550 cc, the blood concentration of 27.6 percent, providing nursing care according to the standard of postpartum hemorrhage prevention. By providing oxygen increase water intake The drug stimulates the contractions of the uterus, according to the protocol to give blood for replacement after the placenta delivery for 20 minutes, with an additional 550 cc of bleeding. While suture with bleeding throughout 400 cc, resulting in patients with severe shock. Blood pressure levels continuously decrease (70 / 55-84 / 47 mm Hg) and need medication to increase blood pressure (Dopamine). The bleeding cannot stopped, doctors considered hysterectomy (Total Hysterectomy) to stop bleeding immediately. The operation had 500 cc of blood lost, Total blood lost was 2,000 cc. After the surgery moved to the intensive care unit for 2 days. The patient was safe from shock. The wound was dry. Normal vaginal bleeding and moved to the postpartum ward. Able to take care of children and without breastfeeding problems Total duration of hospitalization was 4 days. The role of nurse in delivery room was an important in keeping the delivery safe. Must have the knowledge and ability to take care of the delivery at all stages of the birth beginning with the assessment of the risk of postpartum hemorrhage, observe for warning symptoms of postpartum hemorrhage. Providing nursing care according to the guidelines for preventing postpartum hemorrhage, prepare a team, equipment, tools, medicine, including helping physicians to perform various procedures until surgical preparation in case of emergency. After the crisis, there is still an important role in preparing the postpartum mothers to be able to take care of themselves and children correctly. Which will result in achieving the goal of the child to be safe and mother.