Nu631U10peerresponsePatricia

1. What is the diagnosis?

The diagnosis is secondary postpartum hemorrhage. It is defined as any significant vaginal bleeding that occurs between 24 hours after placental delivery and during the following 6 weeks. The incidence of SPPH has been reported to be 0.2–0.8%, and it is one of the most common indications for readmission after delivery (Cash & Drummond, 2020). 

1. What is your immediate management plan?

Immediate transport to an emergency care facility is required. Oxygen should be administered and two large-bore intravenous (IV) lines should be established as soon as possible for fluid replacement until blood is available. The provider should perform a complete physical examination, looking especially for S/S of hypovolemia, including tachycardia, hypotension, tachypnea, weak peripheral pulses, delayed capillary refill, pallor, skin mottling, and altered mental status, as well as S/S of coagulopathy (“American Academy of Pediatrics Policy Statements and American College of Obstetricians and Gynecologists’ Committee Opinions and Practice Bulletins,” 2022). This patient is tachycardiac as well as showing signs of hypotension. The provider should palpate the abdomen for tenderness, distention, uterine enlargement (may indicate atony), and bladder overdistension.4 During the perineal and speculum exam, the HCP should carefully evaluate the current status of bleeding, as well as the presence and extent of lacerations, hematomas, and malodorous lochia. A bimanual examination should be performed to assess for uterine bogginess, enlargement, or tenderness (“American Academy of Pediatrics Policy Statements and American College of Obstetricians and Gynecologists’ Committee Opinions and Practice Bulletins,” 2022).

1. What is your subsequent management plan?

When secondary PPH is suspected, prompt consultation with an obstetrician/gynecologist is necessary in the event that advanced interventions may be needed. The provider can expect to make arrangements for hospital admission so that these advanced interventions can be initiated.Patients with secondary PPH may not experience typical signs of anemia meaning the hemoglobin and hematocrit values may not accurately reflect the amount of blood loss, and vital signs may not change until substantial blood loss occurs. If suspected blood loss is 1,500 mL or more and vital signs are unstable, immediate preparation for blood transfusion should be made. Pharmacologic management of subinvolution of the placental site involves the use of uterotonic agents such as methylergonovine 0.2 mg intramuscularly (IM) every 2-4 hours for up to three doses, carboprost tromethamine 250 mcg IM every 15 minutes for up to eight doses, and/or oxytocin by intravenous infusion (Cash & Drummond, 2020). If pharmacologic management fails to control bleeding, the patient may require surgical intervention such as a dilation and curettage or suction curettage. Some patients may not respond to pharmacotherapy or curettage, and a hysterectomy may be necessary (Cash & Drummond, 2020). 

1. Should an ultrasound be ordered?

Pelvic ultrasound and laboratory tests may assist in determining the cause of the bleeding. Ultrasound may reveal retained placental fragments. However, the provider needs to keep in mind that, on ultrasound, the uterus of a patient with secondary PPH may appear similar to that of a normal postpartum uterus. Laboratory tests should include a complete blood cell count, pro-thrombin time, activated partial thromboplastin time, fibrinogen level, and quantitative human chorionic gonadotropin (Cash & Drummond, 2020). 

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now