N5 · Risk of heavy bleeding after birth
Risk ⚠ URGENT Maternal and newborn
Definition
Blood loss after delivery may be higher than expected.- Uterus not contracting
- tears
- retained tissue
- long labor
- Heavy bleeding
- soaked pads
- fast pulse
- dizziness
📋 Scenario
A mother has just delivered after a long labor and has a perineal tear.
Subjective (S): "I feel tired but okay."
Objective (O): Delivery 20 minutes ago; labor lasted 20 hours; perineal tear; uterus firm; pad lightly stained; pulse 82/min; blood pressure 118/74.
Assessment tools for this scenario: CP-MOTHER Mother & Newborn Check CP-SKIN Skin & Wound Score CP-BREATH Breathing & Circulation Check
Validated scales to consider: MEOWS, APGAR, Braden Scale, TIME wound chart, NEWS2, SpO₂, ECG
**CarePath diagnosis:** Risk of heavy bleeding after birth related to long labor and a perineal tear (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check bleeding, uterus firmness and vital signs at ordered times. | Regular checks of bleeding, uterine firmness and vital signs catch early blood loss, since a soft uterus and a rising pulse are warning signs. |
| Massage the uterus if it feels soft. | A soft uterus cannot clamp the blood vessels where the placenta was attached, and massage encourages it to contract and slow bleeding. |
| Check pads and weigh them if bleeding seems heavy. | Checking and weighing pads gives a more accurate measure of blood loss than guessing, which is often underestimated. |
| Give uterus-contracting medicine as ordered. | Medicines that make the uterus contract help it stay firm and reduce bleeding, and they are given only as ordered because dose and timing matter. |
| Call for help at once if pads soak quickly, the uterus stays soft, pulse rises or the mother feels faint. | Heavy bleeding can cause shock within minutes, so calling for help at once brings extra staff and treatment before the mother becomes unstable. |
**Expected outcomes**
- Within 2 hours: uterus firm and bleeding light.
- Pulse and blood pressure stay normal.
- Heavy bleeding, if it occurs, is reported and treated within minutes.
**Linking the data to the diagnosis**
The mother delivered 20 minutes ago after a 20-hour labor and has a perineal tear. Her uterus is firm, the pad is lightly stained, her pulse is 82/min and her blood pressure is 118/74, and she says, "I feel tired but okay." This is a risk diagnosis because heavy bleeding has not happened; the long labor and tear raise the chance. Because bleeding can become dangerous quickly, help is called first if signs appear. The plan aims for a firm uterus with light bleeding within 2 hours, normal pulse and pressure, and fast treatment if heavy bleeding occurs.
CarePath diagnosis
Risk of heavy bleeding after birth related to long labor and a perineal tear (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order — for urgent statements the first action is to get help.
| Intervention | Rationale |
|---|---|
| 1. Check bleeding, uterus firmness and vital signs at ordered times. | Regular checks of bleeding, uterine firmness and vital signs catch early blood loss, since a soft uterus and a rising pulse are warning signs. |
| 2. Massage the uterus if it feels soft. | A soft uterus cannot clamp the blood vessels where the placenta was attached, and massage encourages it to contract and slow bleeding. |
| 3. Check pads and weigh them if bleeding seems heavy. | Checking and weighing pads gives a more accurate measure of blood loss than guessing, which is often underestimated. |
| 4. Give uterus-contracting medicine as ordered. | Medicines that make the uterus contract help it stay firm and reduce bleeding, and they are given only as ordered because dose and timing matter. |
| 5. Call for help at once if pads soak quickly, the uterus stays soft, pulse rises or the mother feels faint. | Heavy bleeding can cause shock within minutes, so calling for help at once brings extra staff and treatment before the mother becomes unstable. |
Expected outcomes
- Within 2 hours: uterus firm and bleeding light.
- Pulse and blood pressure stay normal.
- Heavy bleeding, if it occurs, is reported and treated within minutes.
Linking the data to the diagnosis
The mother delivered 20 minutes ago after a 20-hour labor and has a perineal tear. Her uterus is firm, the pad is lightly stained, her pulse is 82/min and her blood pressure is 118/74, and she says, "I feel tired but okay." This is a risk diagnosis because heavy bleeding has not happened; the long labor and tear raise the chance. Because bleeding can become dangerous quickly, help is called first if signs appear. The plan aims for a firm uterus with light bleeding within 2 hours, normal pulse and pressure, and fast treatment if heavy bleeding occurs.