A nurse is evaluating a client who had a postpartum hemorrhage and received fluid resuscitation and blood transfusion therapy.

Which of the following findings indicates an improvement in the client’s condition?

Retained placental fragments are the most common cause of late postpartum hemorrhage.Retained placental fragments can lead to infection and subinvolution of the placental site, which prevents the uterus from contracting and stopping the bleeding.

Choice B is wrong because uterine atony is the most common cause of early postpartum hemorrhage, not late postpartum hemorrhage.Uterine atony occurs when the uterus fails to contract after delivery.

Choice C is wrong because trauma is a rare cause of late postpartum hemorrhage.Trauma can occur during delivery and cause lacerations or hematomas that can bleed later, but this is uncommon.

Choice D is wrong because lacerations are also a rare cause of late postpartum hemorrhage.Lacerations can occur in the cervix, vagina or perineum during delivery and cause bleeding, but this usually happens immediately or within 24 hours after delivery.

Heavy vaginal bleeding and clots are symptoms of postpartum hemorrhage due to uterine dehiscence.Uterine dehiscence is the opening of the incision line after cesarean section and it is a rare complication.It can be caused by infection, hematoma, suture technique or trauma.

Choice A is wrong because abdominal pain and tenderness are more likely to be caused by other postpartum complications such as endometritis, wound infection, hematoma or uterine rupture.

Choice B is wrong because foul-smelling lochia and fever are signs of postpartum infection such as endometritis or wound abscess.

Choice C is wrong because absent or decreased bowel sounds and distension are not specific to postpartum hemorrhage.They can be caused by ileus, bowel obstruction, peritonitis or other abdominal disorders.

Normal ranges for blood loss after delivery are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery.Normal ranges for vital signs after delivery are pulse 50 to 90 beats/minute, blood pressure 85/60 to 140/90 mm Hg, respiratory rate 12 to 20 breaths/minute and temperature 36.2 to 37.6 °C.