[MIA-RN1]

hi all! My orientation into postpartum and the world of nursing in general is going along great. But every once in a while something will happen and I won' t have time to ask another nurse about it at the time.
last night a co-worker was talking about a clot that her pp patient passed--about twice as big as a tennis ball! Pt had no pain etc and said it just 'plopped out'. nurse massaged fundus, was firm and all was good. But I was wondering does that increase risk of pp hemorrhage? I keep thinking maybe that clot was needed for healing??
And the whole topic of expressing clots confuses me. On one hand I remember being taught to watch the pt for bleeding while palpating the fundus but I thought that was to watch for bleeding that would indicate a hemorrhage. Now I am confused because another nurse mentioned expressing clots and I just don't know what I am missing.

[NiteRocker]

Well, it's been a few years since I've done PP, but I had a few thoughts about your questions. I also started my career in a Mother/Baby PP unit.

With lying in bed for recovery the pool of blool will sometimes form a clot. These can be quite heavy, so it can cause more issues. It's good to inform pts about increased risk of bleeding and clots so they can alert you to this increased risk for hemorrage. If the large clot stays within, the fundus can't clamp down effectively.

When I was in PP the number of patients often caused condensed reports. Anyway, the delivery history that may not have been relayed can be clues to PP risks. Not only for mom but for baby. I now do NICU nursing, so there are things that have more importance to me now.

Anyway, have fun in your job. You make this happy time of life for many women memorable...the good and bad. The shear number of duties in the PP unit can be overwhelming...so keep smiling, their special time can be yours too!

[MIA-RN1]

Originally Posted by NiteRocker

Well, it's been a few years since I've done PP, but I had a few thoughts about your questions. I also started my career in a Mother/Baby PP unit.

With lying in bed for recovery the pool of blool will sometimes form a clot. These can be quite heavy, so it can cause more issues. It's good to inform pts about increased risk of bleeding and clots so they can alert you to this increased risk for hemorrage. If the large clot stays within, the fundus can't clamp down effectively.

When I was in PP the number of patients often caused condensed reports. Anyway, the delivery history that may not have been relayed can be clues to PP risks. Not only for mom but for baby. I now do NICU nursing, so there are things that have more importance to me now.

Anyway, have fun in your job. You make this happy time of life for many women memorable...the good and bad. The shear number of duties in the PP unit can be overwhelming...so keep smiling, their special time can be yours too!

Thank you! So the presence of clots are not to stop bleeding where the placenta was attached, which is what I was wondering. Instaed its the clotted blood that has sat within the uterus. THat makes much more sense now.
I do have tons of fun. I've had several patients already request me for their second night and I have really enjoyed being a part of such a time in one's lives!

[NurseNora]

That's right, post partum bleeding is not stopped by a clot over the site of the placenta. It is controlled by contraction of the uterine muscle. When doing patient teaching, I tell them that the blood vessels leading into the placenta are about as big around as my fingers (which I hold up as a visual aid). I then spread the fingers of each hand apart and place one hand over the other at about 90 degrees so that there are holes made by the spread fingers. As I explain about the muscle fibers contracting and mechanically closing off the ends of the blood vessles, I bring my fingers back together to show the holes closing up. It sounds really complicated as I'm trying to write it, but it isn't. When I explain it that way, the ones who need extra massage or clot removal, which is quite painful, seem to understand what I'm trying to do and are able to put up with the increased discomfort.

As you gain experience in PP nursing, you'll become familiar at recognizing the age of clots. I would be very concerned with a clot as large as you described it if were a new and fresh clot. An old one of that size with no other signs excess bleeding is not as concerning. When a clot first forms, it's very soft and delicate and usually bright red. As it ages, the fibrin strands which give it form continue to shrink and the clot becomes firmer and usually darker in color. Think of Jello going thru the process of gelling. As it sets, it moves from watery to raw egg white to set, to tough and rubbery.

And remember when you're expressing clots to always use two hands. Always have one hand giving superpubic pressure straight down so you don't push out the uterus along with the clots. I know that's basic and you already know it, but I don't like to assume anything.

Best of luck in your new career.

[MIA-RN1]

thank you! I do remember how important to use two hands and now its all making sense to me. And I can visualize what you mean with your hands and will probably use it in practice!

[SmilingBluEyes]

some good advice offered here. Keep asking questions. I sure wish I had known about allnurses.com when I started out in OB right out of nursing school in 1997!!!! Glad you feel comfortable and confident enough to ask here. Good luck to you!

[MIA-RN1]

Originally Posted by SmilingBluEyes

some good advice offered here. Keep asking questions. I sure wish I had known about allnurses.com when I started out in OB right out of nursing school in 1997!!!! Glad you feel comfortable and confident enough to ask here. Good luck to you!

I love how much info is shared here. This site is awesome!