Maternity Nursing: Postpartum Q 36

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Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage?

  

     A. Hypertension

     B. Cervical and vaginal tears

     C. Urine retention

     D. Endometritis

    

    

Correct Answer: C. Urine retention.

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Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period.

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Option A: Women with hypertensive disorders are reported to be at increased risk of developing postpartum hemorrhage (PPH). Severe PPH can result in serious morbidities, such as adult respiratory distress syndrome, coagulopathy, shock, loss of fertility, Sheehan syndrome, and ultimately maternal mortality.

Option B: 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. Postpartum bleeding that is encountered within the first 24 hours following delivery is termed primary postpartum bleeding, whereas secondary postpartum bleeding is defined as excessive vaginal bleeding that occurs between the first 24 hours of delivery and the 6th week of the puerperium.

Option D: Postpartum endometritis is an infection of the lining of the womb which can occur up to six weeks after childbirth. It is much more common after cesarean section births. It usually causes a temperature, tummy pain, and heavier vaginal bleeding. Postpartum endometritis needs prompt treatment with antibiotics.

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