Gushing Gwen — Postpartum Hemorrhage & Uterine Atony
Boggy fundus, soaked pad in 15 min — fundal massage first, always
Gwen delivers a big, healthy boy after twelve hours of labor and an oxytocin drip. Twenty minutes later her nurse lifts the blanket to a spreading, dark pool.
Gwen delivers a 9-lb baby after a long labor augmented with oxytocin, and her uterus is too tired to clamp down. A boggy, displaced fundus lets the open vessels at the placental site keep bleeding. Massage the fundus first, then empty the bladder, then give uterotonics — atony causes roughly 80% of postpartum hemorrhage. Blood loss over 500 mL vaginally or 1000 mL after cesarean, or any bleeding with signs of shock, defines the emergency.
Read Gushing Gwen's full story →The story arc
The setup
A macrosomic baby, prolonged labor and augmented contractions leave Gwen's uterus overstretched and exhausted.
The turn
Her fundus is soft and rises above the umbilicus, shifted to the right side of her abdomen.
The crisis
A pad soaks through in fifteen minutes, her uterus stays soft despite massage, and her heart rate climbs to 128 while her pressure drifts down.
The save
The nurse massages the fundus, straight-catheterizes her bladder, and the provider orders IV oxytocin, then methylergonovine, while a second IV line and type and crossmatch are prepared.
NCLEX study section — Postpartum Hemorrhage & Uterine Atony
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.