Just hoping I can pick your knowledgeable brains because we had a situation last night that I hadn't seen before, but we learned about it in L&D clinical, and all of the things I'd learned about were not done. So I am looking to understand the "real world" a little bit better
We had a G1P1, 2-weeks-postpartum, breastfeeding mom present to triage passing fist-sized clots. Soaked 4 pads within the hour. HR ~170, BP 130/90. Got her back to a trauma room and in bed between all the clots. She denied any pain or cramping. Fundus was midline, 1" below umbilicus and boggy. Pt states she wasn't doing anything unusual when the bleeding started.
So what I'd *expected* to see in her management was something to promote uterine contractions (oxytocin or massages or something), but really what it looked like to my inexperienced eyes was symptom management until we could get her transferred out to the ob/gyn unit at another hospital.
We had some new residents in last night so I wondered if that was the reason, but they relied very heavily on RN advice (wrt stuff like inserting 18ga AC IVs, running NS at a bolus instead of at the ordered 100cc, and at one point she crashed to 70/50 and the RN went to put her on an NRB and the resident asked her why because she was satting 100%). Anyway the orders were very symptom focused (8 mg Zofran was the only drug we gave), blood type and screen, NS "at 100cc" which turned into 2L bolus. Then she was transferred.
So that's what happened last night in our small ER and I was wondering what this situation would have looked like if it was managed by L&D nurses and OB/gyn docs?
Jul 5, '11
Quote from LilyRoseRN
I'm also wondering like the PP if it was a rare clotting disorder, because if she's able to breastfeed, it's probably not retained placenta. The removal of the placenta is what signals the brain's hormones to tell the breasts to make milk, right?
You're right but if it's a smallish piece, or if it's not attached to the uterine wall anymore, it might not impede BFing. Also, the body starts making colostrum as early as the second trimester, so it's not necessarily an all-or-nothing proposition.
Last edit by Elvish on Jul 5, '11