Postpartum hematomas

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Postpartum hematomas

  1. 1. PostpartumHematomasHannilore Villamor, RN
  2. 2. Postpartum hematomas• Localized collections of blood in loose connective tissue beneath the skin covering external genitalia, beneath the vaginal mucosa, or in the broad ligaments• Usually occurs without laceration of the overlying tissue
  3. 3. PATHOPHYSIOLOGY ANDETIOLOGY
  4. 4. • Trauma during spontaneous labor• Trauma during operative vaginal delivery• Inadequate suturing of an episiotomy• Delayed homeostasis or difficult or prolonged second stage of labor, or both
  5. 5. CLINICALMANIFESTATIONS
  6. 6. • Complaints of pressure and pain  Pain may be verbalized as excruciating.• Discolored skin that is tight, full feeling, and painful to touch.• Possible decrease in BP, tachycardia.• Decrease or absence of lochia flow if the vagina is impeded
  7. 7. MANAGEMENT
  8. 8. • Small hematomas (< 3 cm) are left to resolve on their own—ice packs may be applied• Large hematomas (> 3 cm) may require evacuation of the blood and ligation of the bleeding vessel• Analgesics and broad-spectrum antibiotics may be ordered  Due to increased chance of infection
  9. 9. COMPLICATIONS
  10. 10. • Hypovolemia and shock from extreme blood loss• Anemia, infection• Increased length of postpartum recovery period• Sepsis• Calcification and scar tissue• Dyspareunia (painful intercourse)
  11. 11. NURSINGINTERVENTIONS ANDPATIENT EDUCATION
  12. 12. • Inspect perineal and vulvar area for signs of a hematoma periodically postpartum• Inspect the vaginal area for signs of a hematoma if woman is unable to void• Monitor vital signs periodically and evaluate for signs of shock
  13. 13. • Relieve pain of a hematoma:  Apply an ice bag to perineal area  Medicate with mild analgesics  Position for comfort to decrease pressure on the affected area• Catheterize patient if unable to void• Teach the woman the importance of eating a balanced diet and to include food high in iron
  14. 14. • Help relieve voiding problems by assisting to bathroom to void if able to ambulate• If patient is unable to ambulate, then assist her to sit on bedpan with legs hanging over side of bed• Provide privacy, and run water while the woman is attempting to void
  15. 15. • Encourage the woman to take vitamin supplements and to take medications as ordered.• Instruct the woman in the use of the sitz bath to provide perineal comfort after the first 24 hours and at home.

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