When assessing a multiparous woman who has just given birth to an 8-lb boy,the nurse notes that the woman's fundus is firm and has become globular in shape.A gush of dark red blood comes from her vagina.The nurse concludes that:

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Placental separation is indicated by a firmly contracting uterus,a change in the uterus from a discoid to a globular ovoid shape,a sudden gush of dark red blood from the introitus,an apparent lengthening of the umbilical cord,and a finding of vaginal fullness.Cervical tears that do not extend to the vagina result in minimal blood loss.Signs of hemorrhage are a boggy uterus,bright red vaginal bleeding,alterations in vital signs,pallor,lightheadedness,restlessness,decreased urinary output,and alteration in the level of consciousness.If clots have formed in the upper uterine segment,the nurse would expect to find the uterus boggy and displaced to the side.

When Assessing a Multiparous Woman Who Has Just Given Birth