Postpartum Hemorrhage Two Hours Following Delivery
1.	What factors increase a woman’s risk for postpartum hemorrhage?
Prolonged stage of labor, previous history of postpartum hemorrhage, multiple gestation, fetal macrosomia, uterine infection, manual extraction of placenta, arrest of descent, maternal exhaustion, malnutrition, anemia, mediolateral episiotomy, preeclampsia, precipitous birth, maternal hypotension, previous placenta previa, coagulation abnormalities, birth canal lacerations, operative birth, augmented labor with meds, coagulation abnormalities, grand multiparity, and polyhydramnios
2.	What are the differences between early and late hemorrhage?
Early hemorrhage is blood loss that occurs within 24hrs of birth.
Late hemorrhage is blood loss that occurs 24hrs to 6 weeks after birth.
3.	Why is the nursing assessment vital to caring for the postpartum woman?
Monitoring the patient for bleeding is vital because the signs of hemorrhage (falling bp, increasing pulse, and decreasing urinary output) do not appear until as much as 1800-2100mL of blood has been lost.  
4.	What is uterine atony and how does it cause postpartum hemorrhage?
Uterine atony is the failure of the uterus to contract and retract after birth.  The uterus must remain contracted after birth to control bleeding from the placental site.
5.	What are other causes of postpartum bleeding?
Lacerations of the genital tract, episiotomy, retained placental fragments, uterine inversion, coagulation disorders, and hematomas of the vulva, vagina, or subperitoneal areas
6.	How is postpartum hemorrhage treated?
Treating the underlying cause of the hemorrhage.  If it is uterine atony then the fundus should be massaged.  If retained placental fragments are the cause, fragments can be manually separated and removed.  Antibiotics are given.  Lacerations should be sutured.  Glucocorticoids, intraveonus anti-RhoD,  intraveonous immunoglobulin, and platelet transfusions may be given.

7.	What are the indications and contraindications of common medications used to treat postpartum hemorrhage? Oxytocin-controls bleeding by contracting uterus.  Methylergonovine-treats hemorrhage due to atony or subinvolution; monitor for seizure, htn, palpitations, chest pain. Prostaglandin- treats hemorrhage due to atony when not controlled by other methods; monitor for bronchospasms.