Quantcast Retained Placental Fragments in the Uterus - Obstetrics and Newborn Care II

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c. Retained Placental Fragments in the Uterus. These fragments are the
major cause of late postpartum hemorrhage.
(1)
Signs and symptoms.
(a)
Large amount of bright red bleeding or persistent trickle type
bleeding.
(b) Uterus may be boggy due to its inability to contract properly.
(c)
Signs of shock.
(d)  Sudden rise in uterine fundal height indicating the formation of clots
inside the uterine cavity.
(2)
Medical treatment.
(a) Manual removal of the remaining placenta is done by the physician,
if it is a result of incomplete separations of the placenta with increased vaginal bleeding.
(b) A D&C is performed, if it is retained fragments.
(c)
Intravenous fluids are administered.
(d) Oxytocic drugs are given immediately after either procedure.
(3)
Nursing interventions.
(a) Check the uterine fundus tone frequently (every 15 minutes the first
hour, then every 30 minutes for 2 hours, and every hour until stable).
(b) Check the nature and amount of lochia flow (every 15 minutes the
first hour, then every 30 minutes for 2 hours, and every hour until stable).
(c)
Keep accurate count of perineal pads used.
(d) Monitor the patient's vital signs and blood pressure every 15
minutes or more frequently as necessary.
(e) Observe for signs of shock.
(f)
Turn the patient on her side to prevent pooling of blood under her.
(g) Provide emotional support to the patient and family.
MD0922
6-15



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