TABLE 27.1 The “Four T’s” Mnemonic Device for Causes of Postpartum Hemorrhage
is concern for retained products, perform a manual sweep inside the uterus to clear out any clots or products that may still be inside. If the placenta is not separating easily, call for help because an abnormally adherent placenta may require an urgent hysterectomy.
TABLE 27.2 “Risk Factors for Uterine Atony”
into the vagina and through the cervical opening to clear any vaginal clots or clots from the uterus, particularly if they are in the lower uterine segment and preventing uterine contraction. Assess the uterine tone, including the lower uterine segment, by using the nondominant hand to massage the uterus externally and feel the uterine tone between both hands. Clearing clots out of the lower uterine segment and massaging the uterus help the uterus contract down and stop bleeding. A full bladder can prevent the lower uterine segment from contracting and can shift the uterus off to one side or another. Placement of a Foley catheter assists in ongoing monitoring of maternal hemodynamic status and may promote adequate uterine contraction.7,12