09.01 Postpartum Hematoma

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08.04 Breastfeeding
Postpartum Hemorrhage (PPH)

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Episiotomy – Evaluation of Healing (Mnemonic)
Vacuum Assisted Delivery (Image)
Forceps Assisted Delivery (Image)
Episiotomy (Image)

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Outline

Overview

  1. Localized collection of blood in loose connective tissue beneath the skin of the vagina or c-section incision

Nursing Points

General

  1. Occurs from trauma
  2. Most often in assisted deliveries (vacuum, forceps)

Assessment

  1. Pain, pressure
  2. Cannot void due to hematoma obstructing flow
  3. Apparent bulging area, skin discolored
  4. Decreasing H/H due to bleeding
  5. Signs and symptoms of hypovolemic shock
    1. Hypotension
    2. Tachycardia
    3. Febrile
    4. Pallor

Therapeutic Management

  1. Prepare to administer IVF, pain meds,  blood products
  2. Monitor I&O, vitals
  3. May need to insert foley if urinary obstruction has occurred
  4. Medical management:
    1. Watch and let reabsorb
    2. Surgically drain

Nursing Concepts

  1. Perfusion
  2. Clotting
  3. Skin Integrity

Patient Education

  1. Perineal care after episiotomy
  2. Cold packs to reduce hematoma and swelling
  3. Report pain that doesn’t go away with meds
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