c-section p.p bleeding

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Ok now ya'll know i've only been at this post partum thing here for a few months...... but i thought i'd share an interesting case with you all to share my new found knowledge for those that are as ignorant about these things as I was/am. You know the things you can't read in a book anywhere.........

Ok, coming in for night shift at 7pm. Getting report on patients to include a post op c-section from 8o'clock that morning. Nurses report the patient has had NO bleeding and were as we were getting report, getting the patient out of bed to ambulate in the hallway to "see if anything would come down" . This is your basic scheduled c/s, still on the lr with 20u pitocin x's 2 liters etc. etc. well i go in to assess her and she rates her pain a 7/10 ( a bit unusual for our duramorph patients). gave some tordol, assessed her to be firm @umb. peri pad looked like it was just out of the package- bone dry. checked on her a few more times over the next few hours- still doing fine, pain control better after the tordol, still no bleeding at ALL!! by 11:30pm.... patient was diaphoretic. no other complaints. no temp. well lets check your fundus again. firm @2+u !! Gee this blood has got to be going somewhere??!! had an L&D nurse come check internally for clots. - couldn't find none, and took gloved hand out without a smear or a drop of blood on the glove. Luckily oncall ob/gyn was in house doing a delivery and she came over- gave me a hard time about my assement of the womans fundus- but once i explained the patients increase pain and the fact that she has had NO bleeding she remarks "well i'll go ahead and check her inside even though she's firm @U".... (i'm thinking- screw you- no she's not). anyways after digging around a bit, and finally putting her finger through the os- POP-GUSH......... 500cc blood loss on the bed......... needless to say she didnt say much to me- i'm thinking its a doctor thing - that maybe she screwed up somewhere along the line. I heard later on that the next night she was telling the nurses that this should've gotten caught very early on (l&D, and certainly before the passing of a 12 hour shift before I got there in the evening). apparently when they do unlabored c/s- the doc manually dilates the cervix to allow for the passing of any bleeding after surgery. She never did this as she was called to another case emergently. Just one of those things you dont read in your nursing books anywhere or that they dont teach you in orientation. needless to say something you dont see very often. But just to say- in the future- if your c/s patient has NO bleeding post op- call right away. Hope this helps someone............ smile.gif

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Originally posted by earthangel30:

Ok now ya'll know i've only been at this post partum thing here for a few months...... but i thought i'd share an interesting case with you all to share my new found knowledge for those that are as ignorant about these things as I was/am. You know the things you can't read in a book anywhere.........

Ok, coming in for night shift at 7pm. Getting report on patients to include a post op c-section from 8o'clock that morning. Nurses report the patient has had NO bleeding and were as we were getting report, getting the patient out of bed to ambulate in the hallway to "see if anything would come down" . This is your basic scheduled c/s, still on the lr with 20u pitocin x's 2 liters etc. etc. well i go in to assess her and she rates her pain a 7/10 ( a bit unusual for our duramorph patients). gave some tordol, assessed her to be firm @umb. peri pad looked like it was just out of the package- bone dry. checked on her a few more times over the next few hours- still doing fine, pain control better after the tordol, still no bleeding at ALL!! by 11:30pm.... patient was diaphoretic. no other complaints. no temp. well lets check your fundus again. firm @2+u !! Gee this blood has got to be going somewhere??!! had an L&D nurse come check internally for clots. - couldn't find none, and took gloved hand out without a smear or a drop of blood on the glove. Luckily oncall ob/gyn was in house doing a delivery and she came over- gave me a hard time about my assement of the womans fundus- but once i explained the patients increase pain and the fact that she has had NO bleeding she remarks "well i'll go ahead and check her inside even though she's firm @U".... (i'm thinking- screw you- no she's not). anyways after digging around a bit, and finally putting her finger through the os- POP-GUSH......... 500cc blood loss on the bed......... needless to say she didnt say much to me- i'm thinking its a doctor thing - that maybe she screwed up somewhere along the line. I heard later on that the next night she was telling the nurses that this should've gotten caught very early on (l&D, and certainly before the passing of a 12 hour shift before I got there in the evening). apparently when they do unlabored c/s- the doc manually dilates the cervix to allow for the passing of any bleeding after surgery. She never did this as she was called to another case emergently. Just one of those things you dont read in your nursing books anywhere or that they dont teach you in orientation. needless to say something you dont see very often. But just to say- in the future- if your c/s patient has NO bleeding post op- call right away. Hope this helps someone............ smile.gif

thanks for the heads up, I have found that on occasion no blood is bad, somewhat ominous...A sign that somewhere along the line some mother clots are coming, along with a 500cc gush if you know what i mean.

Don't feal bad it sounds like the doc failed to round on her pt. or at least to read the nurses note and get a clue...

Todd from Tulsa...See my posting

Women need only apply...a male perspective...

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Thank you very much for sharing this info. Do you realize you are a hero, that young mother could have bled to death. I will never use the info but found it interesting. I have never done OB nursing but I am no stranger to the way some docs will shift the blame to nursing when they screw up. Nursing saved her A-- and all she could do was say nursing should have found it sooner. I do have one question though, do they get routine H&H on these patients and could the bleeding been picked up by a drop in labs?

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They do an H&H in the am. about 24 hours after surgery. lot of help that would've been by then. I feel sorry for some of the girls that come to maternal child without any med-surg experience before hand. That's what has helped me (about 10 years of it) and also saved the life of my patient. Needles to say the afore mentioned doctor who usually walks around with a snub nose actually conversated with me the next time i saw her and actually made somewhat of a joke. I guess she realized i saved her A** as well.

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Specializes in Med-Surg, ER, OB.

That sounds exactly what I'm going through with my pt right now. I did check the cervex and she's about 1cm 50% effaced and still nothing, I even tried a little searching higher to see if I could get anything that needed to not be there (ie: large clot) still nothing. Dr knows he's not worried and now she won't pee after 2500ml iv fluids and a drop in BP (80/45). I'm just kinda stuck, she's asymptomatic besides the BP (got back up to 93/53). Going to straight cath here in a bit if she still can't void. Guess we will see how it turns out. Thanks though for the info, I do feel better knowing this happens. Any ideas from anyone else?

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