A nurse is caring for a client who had a vaginal delivery 4 hours ago.

The nurse notes that the client’s fundus is boggy, deviated to the right, and above the umbilicus.

The client’s perineal pad is saturated with blood.

What is the most likely cause of this client’s postpartum hemorrhage?

The client has severe coagulation impairment.

This is because the client’s platelet count, fibrinogen level, and prothrombin time are all significantly abnormal compared to the normal ranges.

• The normal platelet count is 150,000 to 450,000/mm3.

A platelet count of 80,000/mm3 indicates thrombocytopenia, which is a low number of platelets that can impair clotting and cause bleeding.

• The normal fibrinogen level is 200 to 400 mg/dL.

A fibrinogen level of 150 mg/dL indicates hypofibrinogenemia, which is a low level of fibrinogen that can impair clotting and cause bleeding.

• The normal prothrombin time is 11 to 13.5 seconds.

A prothrombin time of 18 seconds indicates a prolonged clotting time that can impair clotting and cause bleeding.

Choice A is wrong because the client does not have normal coagulation parameters.

All three tests are abnormal and indicate a severe coagulation impairment.

Choice B is wrong because the client does not have mild coagulation impairment.

The degree of abnormality in the test results is too high to be considered mild.

Choice C is wrong because the client does not have moderate coagulation impairment.

The degree of abnormality in the test results is too high to be considered moderate.

These are the instructions that the nurse should include in the teaching for a client who had a postpartum hemorrhage due to uterine atony.

• Choice A is correct because foul-smelling lochia or fever can indicate an infection of the uterus or other reproductive organs, which can worsen bleeding and cause complications.

• Choice B is correct because iron intake and supplements can help replenish the blood loss and prevent anemia.

• Choice C is correct because sexual intercourse can cause trauma to the healing tissues and increase the risk of infection and bleeding.The lochia usually stops within four to six weeks after delivery.

• Choice D is wrong because limiting fluid intake can cause dehydration and impair blood circulation and clotting.The client should drink plenty of fluids to stay hydrated and promote healing.

• Choice E is correct because pelvic floor exercises can help strengthen the muscles that support the uterus and bladder, and prevent prolapse and urinary incontinence.

Uterine atony is a condition where the uterus does not contract enough after delivery, which can lead to excessive bleeding or postpartum hemorrhage.It is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases.It can be caused by several factors, such as multiple pregnancy, large baby, prolonged or rapid labor, obesity, uterine fibroids, or medications that affect uterine contractions.It requires immediate medical treatment to stop the bleeding and prevent shock and organ failure.