NUR 4210 Module 1 Postpartum Hemorrhage Paper: Quantified Blood Loss, the Hemorrhage Bundle and Tranexamic Acid Example

Weigh the Pads: Quantified Blood Loss and a Fast Response to Postpartum Hemorrhage

Student Name

B.S.N., Accelerated Second Degree, Thomas Edison State University

NUR-4210: Women's Health Across the Lifespan

Mentor Name

Month Day, Year

Weigh the Pads: Quantified Blood Loss and a Fast Response to Postpartum Hemorrhage

The Patient

Ms. Alvarez is invented for this paper. She is 31, pregnant for the first time, and was induced at 41 weeks. After 22 hours of labor, including a long second stage, she delivered a healthy 4.1-kilogram boy. The placenta delivered complete ten minutes later. Twenty minutes after birth, the nurse found her fundus soft and boggy above the umbilicus and a steady trickle of blood soaking the underpad. Her pulse climbed from the high 80s to 112. Her husband was holding the baby skin to skin across the room.

Why She Bled

Most postpartum hemorrhage comes from uterine atony, failure of the uterine muscle to contract firmly after the placenta separates. Contraction squeezes the blood vessels at the placental site closed. A long labor, induction with oxytocin over many hours and a large baby all tire or overstretch the uterus and raise the risk of atony. Other causes include retained tissue, tears and clotting problems. Because pregnant women increase their blood volume by nearly half, early signs of blood loss can be subtle: a rising heart rate often appears before any fall in blood pressure.

A National Bundle

Main et al. (2015) described the National Partnership for Maternal Safety's consensus bundle on obstetric hemorrhage, organized into four domains. Readiness means every unit has a hemorrhage cart, rapid access to medications and blood, a response team and regular drills. Recognition and prevention mean assessing every woman's hemorrhage risk on admission, during labor and after birth, actively managing the third stage of labor and measuring cumulative blood loss quantitatively rather than by estimate. Response means a staged plan with defined actions as bleeding increases. Reporting and systems learning mean huddles, debriefs and review of serious cases.

Managing the Third Stage

Begley et al. (2019) reviewed trials comparing active management of the third stage of labor, which includes giving a uterotonic drug such as oxytocin at birth, with expectant management, in which the placenta delivers without intervention. Active management lowered the chance of losing more than a liter of blood and of needing a transfusion, though the review judged the certainty of that result to be low. Some regimens increased side effects such as nausea and raised blood pressure. The authors supported offering active management with information about benefits and harms.

Tranexamic Acid

In an international trial, women diagnosed with postpartum hemorrhage in 21 countries, over 20,000 in all, received tranexamic acid or a placebo on top of usual care (WOMAN Trial Collaborators, 2017). Fewer women given the drug died from bleeding, and the gain was largest when the first dose came within three hours of delivery. There was no increase in blood clots. The drug works by slowing the breakdown of clots that are forming.

Measuring the Bleeding

The unit used quantified blood loss. The student weighed underpads, sponges and the drape with a gram scale and subtracted the dry weights; each gram counts as about one milliliter of blood. The first total was 780 mL, more than the team would have estimated by looking. Visual estimates commonly underestimate large losses.

The Response

The nurse massaged the fundus firmly while the student called for help using the unit's hemorrhage alert. Following the bundle's staged plan, the team increased the oxytocin infusion, checked that her bladder was empty, started a second large IV line and drew blood for a type and crossmatch and clotting tests. When bleeding continued, the physician ordered methylergonovine, which was safe because her blood pressure was normal, and tranexamic acid, given 45 minutes after birth. Cumulative blood loss reached 1,350 mL before the uterus stayed firm. Her heart rate settled to 98, and she received two units of red cells.

Nursing Diagnoses

The student identified deficient fluid volume related to uterine atony, risk for shock and anxiety in the patient and her husband related to a sudden emergency.

The Family

In the rush, her husband stood frozen in the corner holding the baby. The student, once the team had enough hands, stood beside him, explained in short sentences what was happening and why, and helped him keep the baby warm. Afterward, the nurse and physician sat with the couple to explain what had happened, which the bundle's reporting domain supports.

Team Roles

The bundle's response domain works only when people know their jobs. On this unit, the primary nurse stayed at the bedside with fundal massage and vital signs, a second nurse managed medications and IV lines, the charge nurse phoned the blood bank and tracked the times and the student recorded weights and totals on the hemorrhage flow sheet. Clear roles prevented two people from doing the same task while another was missed. The student learned that a recorder with accurate times is a real contribution to safety.

The First Days Home

Women who have bled heavily are tired and often anemic for weeks. Before discharge the student taught Ms. Alvarez to rest, to eat iron-rich foods and take the iron tablets prescribed and to report heavy bleeding, large clots, fever or dizziness. Her husband learned to watch for these signs too. A follow-up appointment was scheduled within one week rather than the usual six.

Evaluation and Learning

By morning Ms. Alvarez's hemoglobin was stable, her fundus firm and her bleeding light. The unit held a brief debrief, which noted that her risk score on admission had been medium and that the long induction had raised it, a point to reassess sooner next time.

Limits

Most WOMAN trial sites were in low- and middle-income countries. Quantified blood loss requires scales and staff time. A student assists and reports but does not give medications independently. Ms. Alvarez is invented.

Conclusion

Ms. Alvarez's hemorrhage followed a long, induced labor and a large baby. The national bundle supplied a plan for readiness, recognition, response and learning; active management lowered risk at birth; quantified blood loss revealed how much she had lost; and tranexamic acid, given early, added protection. Quick teamwork and attention to her family completed the nursing role.

References

Begley, C. M., Gyte, G. M., Devane, D., McGuire, W., Weeks, A., & Biesty, L. M. (2019). Active versus expectant management for women in the third stage of labour. Cochrane Database of Systematic Reviews, (2), Article CD007412. https://doi.org/10.1002/14651858.CD007412.pub5

Main, E. K., Goffman, D., Scavone, B. M., Low, L. K., Bingham, D., Fontaine, P. L., Gorlin, J. B., Lagrew, D. C., & Levy, B. S. (2015). National Partnership for Maternal Safety: Consensus bundle on obstetric hemorrhage. Anesthesia & Analgesia, 121(1), 142-148. https://doi.org/10.1097/AOG.0000000000000869

WOMAN Trial Collaborators. (2017). Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): An international, randomised, double-blind, placebo-controlled trial. The Lancet, 389(10084), 2105-2116. https://doi.org/10.1016/S0140-6736(17)30638-4