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RED ALERT: Perinatal Hemorrhage

MacMullen, Nancy J. PhD, APN/cCNS; Dulski, Laura A. MSN, APN/cCNS; Meagher, Barbara MSN, RN, CNM, PNNP, RDMS

MCN, The American Journal of Maternal/Child Nursing: January-February 2005 - Volume 30 - Issue 1 - p 46-51
Feature articles

The purpose of this article is to help nurses understand how to quickly and effectively manage the nursing care of patients with perinatal hemorrhage. The etiology, symptoms, medical management, and nursing care of the patient experiencing a perinatal hemorrhage are discussed.

Hemorrhage during the antepartum, intrapartum, or postpartum period is a life-threatening emergency for the mother and/or fetus. Early antepartum hemorrhage (before 20 weeks gestation) can be related to abortion/miscarriage, ectopic pregnancy, or gestational trophoblastic disease; late antepartum hemorrhage (after 20 weeks gestation) may result from placental abruption and placenta previa. Intrapartum hemorrhage is most commonly due to placental abruption, or to uterine rupture, uterine inversion, invasive conditions of the placenta, or complications of Cesarean birth. Postpartum hemorrhage is defined as blood loss greater than 500 ml in a vaginal delivery or 1000 ml in a Cesarean birth; early postpartum hemorrhage occurs during the first 24 hours after delivery; late postpartum hemorrhage occurs after the first 24 hours after delivery. The most common cause of postpartum hemorrhage is uterine atony; however, lacerations, hematomas, and subinvolution of the uterus can also cause postpartum hemorrhage. Nurses who understand how to assess, plan, intervene, and evaluate outcomes for perinatal hemorrhage are in the position to prevent the major tragedies that can accompany hemorrhage in pregnancy and shortly afterward.

When it happens, it’s a true emergency. Why do pregnant and postpartum women hemorrhage? What nursing actions need to be taken?

Nancy J. MacMullen is a University Professor, Governors State University, University Park, IL. She can be reached via e-mail at

Laura A. Dulski is a Nursing Instructor, West Suburban College of Nursing, Oak Park, IL.

Barbara Meagher is a Midwife/Nurse Practitioner, The University of Chicago Hospitals, IL.

© 2005 Lippincott Williams & Wilkins, Inc.