Acute Care Nursing

This paper evaluates management of a midwifery case of a 29-year old who after presenting bleeding at 35.5 weeks of pregnancy undergoes an emergency caesarean section (C/S) and in the recovery room for post-surgery, bleeding continues despite IV infusion. After four hours, the woman is pale and responds poorly to non-verbal cues.

The midwife has to assess Yee to ensure that her bleeding is not due to any other underlying risk factor but for cesarean section in her third stage of labor (Jacob, 2012, p. 415). Yee has experienced postpartum hemorrhage even though her blood loss after the cesarean birth is 700mL just four hours after the operation and there is a possibility of retained placenta fragments in her uterus given that her fundus is boggy and non-contracted (Yogev, 2004, p. 486). For accurate assessment of the fundus, the mother should be required to empty her bladder to eliminate interference with the uterine and lie flat on her back while flexing her knees. If the fundus is still soft and boggy, massaging should be performed gently until it gets firm. Retained fragments are ranked as one of the main cause of late postpartum hemorrhage and in the case of Yee, shock, continued bleeding, and boggy uterus are some main signs and symptoms. Further, the midwife must also ensure that fundus palpitation is done frequently to determine ongoing muscle tone but this should not involve over massage as it fatigues the muscles (B-Lynch, 2006, p. 396). Since effective uterine contraction is the goal, bladder distention must be prevented since it displaces the uterus. Besides the administration of intravenous fluid, a physician can provide manual removal especially if the cause is incomplete separations of the placenta.

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The midwife must use communication to manage Yee’s feelings of faintness and dizziness that makes her not to respond to verbal cues (Confidential Enquiry into Maternal and Child Health (CEMACH), 2010). Sub-consciousness is due to orthostatic hypotension after birth and cautions the midwife of the patient’s safety. Hypotension arises from blood results loss causing blood pressure to lower to about 90/50 and a heart rate of 120 in attempts to circulate the blood in the body.

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