Postpartum hemorrhage (PPH) is the second leading cause of maternal mortality worldwide, accounting for over 30% of maternal deaths in Africa and Asia. In Tanzania, almost 7,900 mothers die each year from childbirth or pregnancy complications, with PPH being one of the direct causes in 14.9% of cases. This case study examines a 33-year old woman admitted to Mnazi Mmoja Hospital in Tanzania suffering from PPH, as evidenced by a hemoglobin level of 8.4 and excessive vaginal bleeding. She received IV fluids, oxytocin, uterine massage and monitoring to manage her fluid deficit, stabilize her vital signs and prevent infection at the placental attachment site.

1. A CASE STUDY ON POSTPARTUM HEMORRHAGE
(PPH)
PREPARED BY : SEIF SAID KHALFAN

2. • Postpartum hemorrhage (PPH) is the second
leading cause of maternal mortality worldwide
with a prevalence rate of approximately 6%;
Africa has the highest prevalence rate of about
10.5%.
• In Africa and Asia, where most maternal deaths
occur, PPH accounts for more than 30% of all
maternal deaths

3. • Each year, almost 7,900 mothers die due to
childbirth and pregnancy related complications
in Tanzania. According to Muhimbili National
Hospital postpartum deaths in a year 2011 –
2014 is of an average of 14.9% of all direct
causes of maternal deaths.

4. • In Zanzibar data obtained from the Muembe Ladu
Hospital shows the incidence of postpartum
hemorrhage for the years 2013 – 2015 are
14.76%, 18.01% and 16.17% respectively.
• PPH is defined as blood loss of greater than 500
mL after vaginal delivery and greater than 1000
mL after cesarean delivery.

5. DEMOGRAPHIC DATA
• Patient name: H. A. N
• Address: Chukwani
• Age: 33 years
• occupation: Housewife
• Sex: Female
• Marital status: Married
• Hospital: Mnazi Mmoja
• Date of admission: march 04, 2016

6. Medical history
• In 2013, she diagnosed with peptic ulcer disease,
which resolved after three months on cimetidine.
She describes no history of cancer, lung disease or
previous heart disease. She also has allergy with
Penicillin; experienced rash and hives in 2008.

7. Present history
• The patient has been admitted at Mnazi Mmoja
Hospital since March 04, 2016. She was in her
usual state of good health until one day prior to
admission. Weight of patient is 65kg. She
complains of labour pain which started at
04:30am

8. Current diagnosis
• Postpartum hemorrhage (PPH)

9. • Patient vital signs on admission are:-
BP = 130/90, Pulse Rate = 78 bpm,
Temperature = 36.4 0C, Resp. rate = 20r/m.
• Patient vital signs after delivery ( during PPH )
BP = 92/47, Pulse rate = 102bpm,
Temperature = 36.1 0C, Resp. rate = 30r/m

10. Treatment
Non-pharmacological treatment
• Resuscitation with intravenous fluid e.g. ringer
lactate
• Uterine massage every 15 minutes for the first
two hours
Pharmacological treatment
• Oxytocin 40 I.U via I.V in ringer lactate

11. Test results
• HB – 8.4mls
• Blood group - O+
• PMTCT - 2
• Bleeding time (BT) – Normal
• Clotting time (CT) – Normal

12. Nursing observation on mental state of the patient
• Language: patient able to express by speech of signs
• Orientation: well oriented to person, time and place
• Attention: able to concentrate
• Level of consciousness: she is conscious (awake)

13. NURSING CARE PLAN

14. NURSING
DIAGNOSIS
EXPECTED
OUTCOME
NURSING INTERVENTION EVALUATION
Fluid volume deficit
related to uterine
atony as evidenced
by excessive
vaginal blood loss.
After 2 – 5 days
will be Prevented
from
dysfunctional
bleeding and
improve fluid
volume.
I/: Advise patients to sleep with
feet higher, while the body
remained supine.
R/: With feet higher will increase
the venous return, and allowing
the blood to the brain and other
organs.
I/: Monitor vital signs.
R/: Changes in vital signs when
bleeding occurs more intense.
I/: Monitor intake and output
every 15 minutes.
R/: Change the output is a sign of
impaired renal function.
After 2 days the
client’s body
fluid volume
improved

15. NURSING
DIAGNOSIS
EXPECTED
OUTCOME
INTERVENTION EVALUATIO
N
Ineffective tissue
perfusion related to
vaginal bleeding as
evidenced by
fluctuation of vital
signs
After 2 – 3 days vital
signs and blood gases
will be within normal
limits.
I/: Monitor vital signs every 5-
10 minutes.
R/: Changes in tissue perfusion
causing changes in vital signs.
I/: Monitor blood gas levels
and pH
R/: Changes in blood gases and
pH levels are a sign of tissue
hypoxia
I/: Give oxygen therapy
R/: Oxygen transport is needed
to maximize circulation to
tissue.
After 2 days
patient’s vital
signs were at
normal range.

16. NURSING
DIAGNOSIS
EXPECTED
OUTCOME
INTERVENTION EVALUATION
Body weakness
related to altered
body chemistry
(insufficient
electrolytes) as
evidenced by
inability to
maintain usual
routines.
• Verbalize
increase in
energy level.
• Display
improved ability
to participate
in desired
activities.
I/: Discuss with patient the need for
activity. Plan schedule with patient
and identify activities that lead to
fatigue.
R/: Education may provide
motivation to increase activity level
even though patient may feel too
weak initially.
I/: Increase patient participation in
ADLs as tolerated.
R/: It can increases confidence level,
self-esteem and tolerance.
I/: Alternate activity with periods of
rest and uninterrupted sleep.
R/: It can prevent excessive fatigue.
The patient can
perform some
activities

17. NURSING
DIAGNOSIS
EXPECTED
OUTCOME
INTERVENTION EVALUATION
Anxiety related to
knowledge deficit
regarding
procedures,
management and
disease condition
as evidenced by
patient asks many
questions about
the disease.
The client can
verbalize
anxiety and said
anxiety is
reduced or lost.
I/: Assess the client's psychological
response to the post- childbirth
bleeding.
R/: Perceptions of client influence the
intensity of anxiety.
I/: Treat the patient
calm, empathetic and supportive
attitude.
R/: Provide emotional support.
I/: Provide information about care and
treatment.
R/: Accurate information can reduce
the anxiety and fear of the unknown.
I/: Help clients identify a sense of
anxiety.
R/: The expression can reduce feelings
of anxiety.
Client said
anxiety is
reduced.

18. NURSING
DIAGNOSIS
EXPECTED
OUTCOME
INTERVENTION EVALUATION
Sleeping pattern
disturbance
related to acute
pain as
evidenced by
verbal report of
difficult falling
asleep.
Falls asleep
without
difficulty
I/: Assess for new onset of depression:
depressed mood state, statement of
hopelessness and poor appetite
R/: It can help to understand which
psychological therapy can help the patient
I/: Provide pain relief shortly before
bedtime
R/: Help to keep the body not to suffer
from pain at that time.
I/: Keep environment quit
R/: This can reduce anxiety and lead to
peace of mind
After 2 days the
patient falls
asleep without
difficulty

19. NURSING
DIAGNOSIS
EXPECTED
OUTCOME
INTERVENTION EVALUATION
Risk for
infection
related to
excessive
blood loss
and exposed
placental
attachment
site and
lacerations.
To keep
patient free
from
infection
I/: Note the changes in vital signs.
R/: Changes in vital signs (temperature) is
indicative of infection.
I/: Note the signs of fatigue, chills, anorexia,
and uterine contractions were flabby and
pelvic pain.
R/: The signs are an indication of the
occurrence of bacteremia, shock is not
detected.
I/: Consider the possibility of infection in
other places, such as respiratory infections,
mastitis and urinary tract.
R/: Infection elsewhere worsens the situation.
I/: Give antibiotics
R/: Antibiotics are necessary for the proper
state of infection.
After 5 days the
patient was free
from infection