Maternity Nursing: Postpartum Q 46
Which measure would be least effective in preventing postpartum hemorrhage?
A. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered.
B. Encourage the woman to void every 2 hours.
C. Massage the fundus every hour for the first 24 hours following birth.
D. Teach the woman the importance of rest and nutrition to enhance healing.
Correct Answer: C. Massage the fundus every hour for the first 24 hours following birth.
The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Uterine atony refers to the corpus uteri myometrial cells inadequate contraction in response to endogenous oxytocin that is released in the course of delivery. It leads to postpartum hemorrhage as delivery of the placenta leaves disrupted spiral arteries which are uniquely void of musculature and dependent on contractions to mechanically squeeze them into a hemostatic state.
Option A: Active management of the third stage includes uterine massage with concomitant sustained low-level traction on the umbilical cord. Simultaneous oxytocin infusion is helpful, although it is reasonable to defer it to after delivery of the placenta. Medications used for postpartum hemorrhage secondary to Uterine atony include the following: oxytocin (Pitocin) can be given IV 10 to 40 units per 1000 ml or 10 units intramuscularly (IM). The rapid undiluted infusion may cause hypotension; methylergonovine (Methergine) given IM 0.2 mg. Given every 2 to 4 hours. Should be avoided in patients with hypertension: misoprostol (Cytotec): 800 to 1000 mg placed rectally. May cause a low-grade fever. It has a delayed action.
Option B: A fundus that is higher than 2 cm above the umbilicus may indicate a distended bladder or a uterus that is filled with blood. After delivery of a large infant, the fundal height can be slightly elevated, and this may be a normal finding. Assist the woman to empty her bladder. Catheterize only if the woman is unable to void and the bladder is distended. Once the bladder is empty, reevaluate the fundal height. Bladder distention, incomplete emptying, urine retention, and/or the inability to void may occur during the first few days postpartum. Within 12 hours of birth, changes in hormone levels (decreased estrogen and oxytocin) occur resulting in diuresis. Measure and record urine output in the first 24 hours post-birth. A bladder scan can also be used at this time to assess for post-void residual.
Option D: This is an effective measure to enhance and maintain contraction of the uterus and to facilitate healing. The nurse must be well versed in postpartum assessment and be able to identify subtle changes that could indicate a woman’s deteriorating condition. Components of care should be standardized regardless of whether the recovery is done in a post-anesthesia care unit (PACU), a labor and delivery room, or a postpartum room.