Maternity Nursing: Postpartum Q 28
Which of the following complications is most likely responsible for a delayed postpartum hemorrhage?
A. Uterine subinvolution
B. Clotting deficiency
C. Perineal laceration
D. Cervical laceration
Correct Answer: A. Uterine subinvolution
Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution. Delayed postpartum bleeding should always raise the possibility of subinvolution. Although subinvolution may cause bleeding anytime between 1 week and several months postpartum, the most common reported timeline for presentation is within the second week after delivery.
Option B: A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn’t corrected at the time of delivery. Postpartum hemorrhage (PPH) affects 6% of all deliveries and is the leading cause of maternal death worldwide (19.7%). The incidence of PPH in women with inherited bleeding disorders is substantially greater than in unaffected women; however, estimates of relative risk are highly variable.
Option C: Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. Genital tract trauma is the second leading cause of postpartum bleeding, followed by uterine atony. The interventions to control the bleeding include vaginal packing, surgical repair of the lacerations, vascular ligation and hysterectomy. To preserve future fertility, transcatheter arterial embolization might be a useful option for the management of intractable postpartum bleeding before the consideration of more invasive methods.
Option D: Cervical lacerations (CL) are a known cause of postpartum hemorrhage. Although CL occurs in more than half of vaginal deliveries,1 they are less than 0.5 cm in length and rarely require repair. Suspect a tear in cases of postpartum hemorrhage where there are a good uterine retraction and uterine rupture has been ruled out.