Post partum hemorrhage (PPH) is an abnormal loss of blood that occurs after a cesarean birth, or C-section. All women generate up to a 50% extra amount of blood in a regular pregnancy. Since a C-Section is an invasive surgical procedure, the blood loss that will come from the pregnancy itself during this type of delivery will be different than when the mother delivers a child naturally.
PPH is diagnosed idealistically on a patient-by-patient basis since the body's tolerance to blood loss and recovery varies from person to person. However, it is when the red cell count is very low when physicians look into a diagnosis of PPH.
The first step to treat blood loss of this type depends on whether the blood loss happens immediately after birth or 24 hours or more after the delivery. When the loss happens immediately after birth, there are a few first steps:
A) Fluid resuscitation, which is the process of activating the body's natural flow of blood through the injection of a formula called Lactated Ringer's Solution (LRS). Along with it, the caretakers would lift legs and limbs in order to allow for blood flow to occur naturally. Through this system the body will use its natural resources to make up for the loss of blood, if they are healthy.
B) Transfusions- According to the will of the mother, it is the process of using blood products of the same type to supplement for the loss of blood. This is done intravenously and carries with it a series of potential consequences, especially if the blood products are contaminated with any virus.
When the loss is massive and requires the intervention of multiple processes, usually the patient is likely to be in a shock. This is when the resuscitation protocol must be put in place ensuring that there is a proper administration of oxygen to the body in order to inject enough units of "Packed Red Blood Cells" or PRBCs, which will replace the massive loss of red blood cells in the body which, if not treated, will cause the patient to go into a massive anemic imbalance that can lead to a heart attack.
- Observe the fundus for height, firmness and position. Because the fundus must be firm to compress bleeding vessels at the placenta site. Do not over massage the uterus because it is a muscle and excessive stimulation to contract it will tire it and can actually cause inability of the uterus to contract.
- Make sure the patient void or the patient should be catheterized if unable to void but bladder is full, because bladder distention interferes with uterine contraction and causes the fundus to be high and displaced to one side.
- Have the mother breast-feed her baby. Infant suckling helps to stimulate the posterior pituitary gland of the mother to secrete natural Oxytocin which causes uterus contraction.
- Oxytocin (pitocin) IV infusion may be ordered by the physician if the uterus does not become firm or stay firm. Oxytocin will help contract the uterus. Or other drugs such as methylergonovine would be given to increase the uterine tone.
- Small hematomas on the vulva can be limited by applying cold pack to the area. This will numb the area and make the patient more comfortable.
- Patient should be on NPO until her bleeding is controlled.