Nursing Care of Postpartum Hemorrhage with Hypovolemic shock : case study
บทคัดย่อ
ABSTRACT
Postpartum hemorrhages is the most common cause of obstetric complications and leading cause of maternal mortality. There are many causes of postpartum hemorrhage, so the nurses who care for the mothers in labor room should have risk assessment skill and nursing skill to prevent postpartum hemorrhage, complication of maternal and fetal in utero.
Objective: To compare the nursing care of two patients who have postpartum hemorrhage with hypovolemic shock
Methods: 2 comparative case study of mother that had vaginal deliveries with postpartum hemorrhage and hypovolemic shock in pregnancy history, risk factor, and nursing process by using medical record, interview patient and family. Case 1st studied in October 2018 and case 2nd studied in May 2019.
Result: Both case studies had the same nursing problems: Hemorrhagic shock after delivery. Case 1 was the 34 year olds, garvidity3rd, a gestation of 37 weeks and 5 days , gestation hypertension in pregnancy. On admission with labour pain and no fetal movement. The assessment found death fetus in utero and without abruptioplacenta. Still birth weight 2,150 grams. After birth found abruptio placenta with uterine atony estimate blood loss 1200ml, continuous care in ICU. Case 2nd was the 37 yearolds, garvidity2nd with a gestation of 39 weeks and 1 day, Iron deficiency anemia in pregnancy. On admission with labour pain and mucous bleedy wasshown. New born weight 3760 grams. Retained placenta with active bleeding 400ml and Manual removal of placenta, total estimate blood loss 1100ml.2 case had IV fluid, Blood component, medication, uterine massage and closed monitoring. Cause and complications of case studies were different. Case 1st was a hemorrhage from Abruptio placenta, DIC, Stress from loss of fetus. Major risk factor of Abruptioplacenta was Gestational age hypertension, relative risk was massive bleeding and prolonged bleeding from undetection of abruptioplacenta and inability assessment volume of bleeding. She needed a multidisciplinary team to participate in the care. Case 2nd was a hemorrhage from retained placenta, so received iv fluid, drug and blood replacement.
Conclusion: Postpartum hemorrhage with Hypovolemic shock are difference complication and cause. Therefore the nurses should have competence in assessment, the diagnosis of risk factor onadmission, joining a multidisciplinary team in time appropriate correction of shock conditions, andusing evidence-based nursing practice to provide efficient nursing care for pregnant women with postpartum hemorrhage. These will be decrease the rate of maternal dead and fetal mortality.
Keywords: Postpartum hemorrhage, Nursing Care of Postpartum Hemorrhage with Hypovolemic shock
