![]() ![]() anatomic abnormalities, such as fibroids or placenta previa.intraamniotic infection caused by fever or prolonged labor.uterine muscle exhaustion caused by rapid labor, prolonged labor, or high parity. ![]() an overly distended uterus caused by polyhydramnios, multiple gestation, or macrosomia.This condition accounts for 75% to 80% of postpartum hemorrhage cases. Retained products of conception can lead to uterine atony-failure of effective uterine contraction after delivery. Clinicians should suspect retained fragments in a patient with delayed lactogenesis. Pelvic ultrasound may be done to detect retained placental fragments. Infection and retained products of conception are the leading causes of secondary postpartum hemorrhage. A patient who’s hemorrhaging may assume she’s just having heavy-but normal-postpartum bleeding. Secondary postpartum hemorrhage can be hard to identify. Postpartum hemorrhage refers to an estimated blood loss of 500 mL or more after delivery.Some experts add a hematocrit decrease of 10% or more to the definition. Fortunately, with appropriate diagnosis and management, catastrophic consequences can be prevented. In fact, postpartum hemorrhage (primary and secondary combined) is the leading cause of maternal morbidity in low-income countries and accounts for about 25% of maternal deaths globally. Most postpartum patients aren’t aware of the potentially life-threatening complications that can occur if bleeding goes untreated. In contrast, primary (early) postpartum hemorrhage occurs within the first 24 hours after delivery. Typically occurring after discharge, it’s the leading cause of readmission in postpartum patients. Also called late or delayed hemorrhage, secondary postpartum hemorrhage occurs between 24 hours and 6 weeks postpartum. Scenarios like this happen more often than you might think. She’s now presenting with a secondary postpartum hemorrhage. Her only notable medical history is dietary-controlled gestational diabetes mellitus (GDM), which occurred during both pregnancies. Nursing assessment reveals a temperature of 102° F (38.8° C) heart rate, 140 beats/minute and blood pressure, 88/42 mm Hg. ![]() Two weeks earlier, she’d delivered an infant by a repeat Cesarean section. Jayne Kennedy, a 35-year-old, gravida 2, para 2, is admitted to the emergency department with heavy vaginal bleeding. ![]()
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