Postpartum Haemorrhage, Hypovolaemic Shock, Post-Traumatic Stress Essay

Postpartum Haemorrhage, Hypovolaemic Shock, Post-Traumatic Stress Disorder - Essay Example This essay will also explore the effects of postpartum haemorrhage in relationship to the case study of Mrs. H, focusing on the physical range of interventions that were undertaken to prevent fatal consequences by using oxytocic drugs and fluid replacement as per trust guidelines; care given by the Midwife and also the psychosocial care that is needed to prevent women from suffering from post-traumatic stress disorder. Mrs H was found to have ruptured her uterus affecting the involution of the uterus and therefore causing the haemorrhage. A postpartum haemorrhage is traditionally defined as bleeding from the genital tract of five hundred millilitres or more following delivery (Hofmeyr, 2001). This can result in death from hypovolemic shock. Sometimes these effects occur long after the event of the haemorrhage, which can cause women to experience psychological impact from effects such as post-traumatic stress disorder. This essay focuses on two effects that can come as a result of pos tpartum haemorrhage: hypovolemic shock and post-traumatic stress disorder. The basic definition of haemorrhage is the abnormal loss of blood (Varney, Kriebs, & Gegor 2004, p. 925). Intrapartum haemorrhage (IPH, occurring during delivery) and bleeding that is considered primary postpartum haemorrhage (PPH, occurring immediately after delivery) is the experience of excessive blood loss during the course of delivery or within the 24 hour period after labour and for which the source of the blood is the genital tract (Crafter 2011, p. 149). Women in labour suffer from substantial fluid loss; so they need to be kept well hydrated to ensure enough circulating volumes to enable them to cope with any excessive blood loss (Hofmeyr and Mohlala 2001, p. 646). After childbirth there is the risk of haemorrhage that can come from a variety of locations. Immediate haemorrhage is more commonly associated with mortality and can come from different factors surrounding the birth. In as much as 90% of t he cases of immediate post-birth haemorrhage the cause is uterine atony which has a number of causes, including incomplete delivery of the placenta. When there are cotyledons, or retained placental fragments, there is both the risk of immediate haemorrhage and of delayed haemorrhage (Varney, Kriebs, & Gegor 2004, p. 925). The amount of bleeding can be any amount that compromises the health of the mother but is generally considered to be 500mls or more. In healthy pregnancy, women have a plasma volume increase of at least 1250mls and the red cell mass also increases, as a result women are able to tolerate up to a litre of blood loss with no adverse effects (Hofmeyr, 2001) In cases of women who suffer from severe anaemia, they may be unable to tolerate blood loss that healthy women can (Crafter, 2011). The speed of the blood flow through the intervillous space can be estimated to be about 600ml per minute (Hofmeyr et al, 2008). There are 4 most common known causes of PPH; traditionall y known as the 4T: tone, trauma, tissue, and thrombin (Mukherjee and Arulkukarin 2009, p. 4). Tone refers to poor contraction of the uterus, which is also called uterine atony. The tearing of tissue and vessels known as trauma is the cause that is seen in the case of Mrs. H. The contributing factors to her ending up with a PPH were instrumental delivery, episiotomy, uterine rupture as well as genital tract lacerations. Tissue refers to when the placenta or membranes are not totally