📌 NCLEX Topic: Postpartum Hematoma

📌 NCLEX Topic: Postpartum Hematoma

NCLEX Topic: Postpartum Hematoma

Description:

A hematoma is a localized collection of blood in the tissues due to trauma or injury to a blood vessel during labor and delivery. The most common type is a vulvar hematoma, but vaginal and retroperitoneal hematomas can also occur.

Predisposing Factors:

  • ✔️ Operative delivery (forceps or vacuum-assisted birth)
  • ✔️ Episiotomy or perineal laceration
  • ✔️ Prolonged second stage of labor
  • ✔️ Blood vessel rupture during birth

Assessment Findings (Signs & Symptoms):

  • ✅ Severe, persistent perineal pain (not relieved by usual pain relief measures).
  • ✅ Pressure in the perineal area (client may report feeling like they need to have a bowel movement).
  • ✅ Sensitive, bulging mass in the perineal area with discolored skin (bluish or purplish).
  • ✅ Inability to void due to pressure from the hematoma.
  • ✅ Decreased hemoglobin and hematocrit levels (if blood loss is significant).
  • ✅ Signs of shock (if large hematoma present):
    • Pallor
    • Tachycardia
    • Hypotension
    • Restlessness

Nursing Interventions for Postpartum Hematoma:

🚨 Priority: Control pain, monitor for excessive blood loss, and prevent complications.

  1. Monitor vital signs closely for signs of shock (hypotension, tachycardia, pallor, restlessness).
  2. Assess the perineal area visually for swelling, discoloration, and signs of hematoma formation.
  3. Apply ice packs to reduce swelling and minimize hematoma growth.
  4. Administer prescribed analgesics for pain relief.
  5. Monitor urinary output and encourage voiding; prepare for catheterization if the client is unable to void.
  6. Monitor hemoglobin and hematocrit levels for blood loss.
  7. Administer IV fluids and blood products as needed to prevent hypovolemia.
  8. Monitor for signs of infection (fever, increased WBC count, redness, warmth at hematoma site).
  9. Administer antibiotics if prescribed, as infection is common after hematoma formation.
  10. Prepare for surgical intervention (incision and drainage) if the hematoma is large or expanding.

NCLEX Test-Taking Strategy:

  • “Severe perineal pain not relieved by usual pain relief measures”
  • “Firm, bulging, bluish or purplish mass in perineal area”
  • “Signs of shock (hypotension, tachycardia, pallor, dizziness)”

💡 Remember:

  • Small hematomas may resolve on their own.
  • Large hematomas may require surgical drainage.
  • Assess for signs of shock! If the client is hypotensive and tachycardic, immediate intervention is needed!

Summary for NCLEX:

  • 🩸 Postpartum hematoma = Localized blood collection in the perineal or vaginal area after delivery.
  • 🚨 Severe perineal pain + Pressure feeling + Bluish mass = Think Hematoma!
  • ⚠️ PRIORITY interventions: Apply ice, monitor vital signs, and assess for shock.