Is PP Hemorrhage usually pretty obvious???

You are very welcome MamaMadge and thank YOU as well! In my own personal experience and in many of the post I have read, I have heard too many stories of physician "laziness" -- even when the nurses are CERTAIN there is a problem. Unfortunately for me, I had two OB's (out of four) whom fell in this category and put my life at risk. I cannot say enough for the work that nurses do and for advocating for their patients!!

No not always obvious. You will learn by what your patient does/doesn't do, what you see and gut instinct (and time). The obvious ones are easy, you see it coming with the gushing blood and boggy uterus. The ones I worry about are the ones that aren't obvious because they can go one longer without detection. Signs I find worrisome are NO bleeding and a very tender uterus that was not tender before. Everyone bleeds pp and if someone has no bleeding I am worried about retained clots that need to be expressed.

I had a case of a preciptous delivery, minmal bleeding who had a foley in place, draining well. She had a very tender uterus and immediately became unresponsive, with still no bleeding. This was also several hours post delivery. I called the doc in and he expressed several hundred ccs worth of clots. She got pit, stablized, and bleeding slowed. I went to check in on another pt, came back and asked how she felt. She was dizzy again, her color was terrible and her BP bottomed out. Called the doc back, expressed more clots and we ended up going for an emergency D&C. Several nits of blood later she stablized properly.

If you are ever in doubt about someone,ask a more experienced nurse or physician to check her over.

I think it's great that you are a little intimidated going into OB...my guess is that you will do just wonderfully!!! When new OB/L&D nurses start and are not scared (or know it all), that's when the rest of us get pretty concerned, because those are the ones who (in my experience anyway) don't listen or take the initiative (like you are) to learn and grow in their profession.

As far as PPH, just stay on top of your assessment. If color, level of orientation, fundus, or bleeding seems abnormal, there's a pretty good possibility something is going on. As with everything else in OB, there is no single tried-and-true way to determine if PPH is occuring or not.

Not to sound like a broken record, but you should always nab a more experienced nurse when in doubt. On my unit, all of us pick each other's brains...for opinions, etc...Best resource available, for sure!!!

Good Luck!!!

with post partum hem...you usually get that gut feeling when looking at the patient...most patients will turn pale and one key sign is when doing fundal checks you wont get a lot of lochia back...check after check...and the fundus will be above the umbilicus...and at times...may continue to creep higher and higher up versus coming down....also make sure you know the hx of each pt...usually pts who have had a pp hem in the past will have it again...also those women who have very quick labors and deliver rapidly...as well as those pts who have very big babies....and also...red heads!!

The uterus i not likely to rupture but I was taught to place one hand at the symphysis t prevent inversion of the uterus.

Being an "oldie" I have the pleasure of introducing new OB nurses to our unit. It is very hard to teach instinct, "the look" be it the patient arriving in advanced labor or a sick HELLP syndrome or PPH. This thread is going to become required reading for any further newbies. The stories are so on the mark to describe ways we can not miss that silent PPH. hank you all.