Exhibits

The nurse is reviewing the clients' chart.

Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage.

36-year-old client who is gravida 5, para 5, transferred to the postpartum unit 1 hour after delivery of a 9 lb 1 oz (4.1 kg) female. She was in labor for 25 hours and forceps were used to assist with the delivery. She was given an epidural for anesthesia that was effective. The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale. Her vital signs were stable, and she was catheterized for 500 mL of light yellow urine just prior to delivery. Her spouse was at the bedside for delivery and appeared supportive. Blood type A+. Estimated blood loss was 600 ml. after delivery.

36-year-old client who is gravida 5, para 5, transferred to the postpartum unit 1 hour after delivery of a 9 lb 1 oz (4.1 kg) female. She was in labor for 25 hours and forceps were used to assist with the delivery. She was given an epidural for anesthesia that was effective. The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale. Her vital signs were stable, and she was catheterized for 500 mL of light yellow urine just prior to delivery. Her spouse was at the bedside for delivery and appeared supportive. Blood type A+. Estimated blood loss was 600 ml. after delivery.

Rationale:

Gravida 5, Para 5 (G5P5): Having multiple pregnancies can increase the risk of uterine atony and hemorrhage after delivery. Each subsequent pregnancy may carry a higher risk for complications.

Prolonged Labor (25 hours): Prolonged labor is associated with increased uterine fatigue and can lead to uterine atony, which is a primary cause of PPH.

Delivery of a 9 lb 1 oz (4.1 kg): Macrosomia can lead to complications during birth, such as maternal and/or fetal trauma, which in turn may increase the likelihood of PPH.

Use of Forceps: The use of forceps during delivery can lead to trauma and lacerations, which may contribute to increased bleeding, especially with a 4th degree laceration.

4th Degree Laceration: This type of laceration extends through the anal sphincter and can lead to significant bleeding. It also increases the risk of infection and other complications.

Estimated Blood Loss of 600 mL: While this is within the normal range for delivery, it may be concerning in the context of the other risk factors and warrants careful monitoring for additional bleeding.