Postpartum Hemorrhage – RN Recognition &

Clinical significance: Postpartum hemorrhage (PPH) is the leading cause of preventable maternal mortality worldwide and a leading cause of maternal morbidity in the United States and Canada. The RN is the first responder in most PPH events — early recognition, accurate quantification of blood loss, and rapid intervention are life-saving. Definition: PPH = cumulative blood loss ≥1000 mL within 24 hours of delivery (regardless of delivery mode), OR blood loss with signs/symptoms of hypovolemia. Traditional definitions used 500 mL vaginal and 1000 mL cesarean, but current ACOG guidelines use 1000 mL as a unified threshold. Four T's — causes of PPH: 1. Tone (most common — 70–80%): uterine atony — uterus fails to contract after delivery 2. Tissue: retained placental fragments preventing uterine contraction 3. Trauma: lacerations of the cervix, vagina, or perineum; uterine rupture 4. Thrombin: coagulopathy (DIC, pre-existing clotting disorders, amniotic fluid embolism) RN Priority: Identify PPH early. Assess uterine tone every 15 minutes in the first hour postpartum and every 30–60 minutes thereafter. Uterine atony is identified and treated immediately — delay leads to hemorrhagic shock. On...