The nurse reviews the chart of a client who gave birth 4 hours ago. Which contributing factor indicates that the client has an increased risk of postpartum hemorrhage?

Question

The nurse reviews the chart of a client who gave birth 4 hours ago.  Which contributing factor indicates that the client has an increased risk of postpartum hemorrhage?

Quizplus · Accepted Answer

Postpartum hemorrhage (PPH) is usually defined as maternal blood loss of >500 mL after a vaginal birth or >1000 mL after a cesarean birth. Uterine atony, characterized by a soft, "boggy," and poorly contracted uterus, is the most common cause of early PPH (occurring ≤24 hours after birth). Delayed PPH (>24 hours after birth) usually results from retained placental fragments associated with a long third stage of labor (ie, time from birth of baby to expulsion of placenta, lasting >30 minutes). Risk factors for PPH include: History of PPH in prior pregnancyUterine distension due to:Multiple gestationPolyhydramnios (ie, excessive amniotic fluid)Macrosomic infant (≥8 lb 13 oz [4000 g]) (Option A)Uterine fatigue (labor lasting >24 hours)High parityUse of certain medications:Magnesium sulfateProlonged use of oxytocin during laborInhaled anesthesia (ie, general anesthesia) History of PPH in prior pregnancy Uterine distension due to:Multiple gestationPolyhydramnios (ie, excessive amniotic fluid)Macrosomic infant (≥8 lb 13 oz [4000 g]) (Option A) Multiple gestationPolyhydramnios (ie, excessive amniotic fluid)Macrosomic infant (≥8 lb 13 oz [4000 g]) (Option A) Multiple gestation Polyhydramnios (ie, excessive amniotic fluid) Macrosomic infant (≥8 lb 13 oz [4000 g]) (Option A) Uterine fatigue (labor lasting >24 hours) High parity Use of certain medications:Magnesium sulfateProlonged use of oxytocin during laborInhaled anesthesia (ie, general anesthesia) Magnesium sulfateProlonged use of oxytocin during laborInhaled anesthesia (ie, general anesthesia) Magnesium sulfate Prolonged use of oxytocin during labor Inhaled anesthesia (ie, general anesthesia) (Option B) Natural, unmedicated labor and birth reduces the chance of PPH. (Option C) Labor lasting <24 hours does not increase the risk for PPH. (Option D) A third stage of labor lasting <30 minutes does not increase the risk for PPH. Educational objective: Postpartum hemorrhage is defined as maternal blood loss of >500 mL after a vaginal birth or >1000 mL after a cesarean birth. Uterine atony (ie, "boggy" uterus) is the most common cause of early postpartum hemorrhage (occurring ≤24 hours after birth). Risk factors include uterine distension, uterine fatigue, high parity, and certain medications.

The Nurse Reviews the Chart of a Client Who Gave