Postpartum Perineal Hematoma
Francisca is a 20-year-old Mexican American gravida 1, para 1 who gave birth to a term, healthy baby boy, weighing 9 lb 1 oz (4.1 kg) at 23:32 hours. She received an epidural for labor pain control, pushed for 3 hours, and required a vacuum-assisted delivery. Her perineum required repair of a third-degree laceration. After birth, the nurse discontinued the continuous epidural pump, placed ice on the perineum, completed the required 15-minute checks (× 5), helped Francisca breastfeed, and assisted Francisca’s boyfriend in holding the baby and taking pictures. On arrival to the mother-baby unit, Francisca requests pain medication and states that the ice is helping some but that she wants to “stay on top of it.” She rates the pain as a 5 on a 10-point scale. The admission vital signs and fundal location are within normal limits. An examination of Francisca’s perineum reveals mild swelling and a normal amount of vaginal bleeding. Francisca is tired and asks that she be allowed to sleep. Her boyfriend goes home to sleep, and the baby is taken to the nursery.
Two hours later, Francisca calls for her nurse and complains of intense burning, pain, and pressure “where I had my stitches.” You examine her perineum and note an 8-cm bulging mass on her left vulva. When you touch it with a gloved hand, Francisca says, “Oh, that is so tender! That hurts!”
CRITICAL THINKING QUESTIONS (Initial Post)
- What factors during birth placed Francisca at risk for development of a hematoma?
- Name two appropriate nursing diagnoses for Francisca.
- What are the expected outcomes for Francisca?
- List four nursing interventions along with rationales.
The use of vacuum-assisted delivery, third-degree perineal laceration, and prolonged pushing during labor placed Francisca at risk for the development of a hematoma.
Two appropriate nursing diagnoses for Francisca could be:
Acute Pain related to perineal trauma and hematoma formation
Risk for Infection related to perineal laceration and surgical repair
The expected outcomes for Francisca include:
Relief of pain and discomfort in the perineal area
Absence of infection in the perineal area
Restoration of perineal anatomy and function
Four nursing interventions for Francisca could be:
Administer prescribed pain medication: This will help relieve her pain and discomfort, allowing her to rest and recover.
Apply ice packs to the perineal area: This will help reduce swelling and inflammation, promoting healing and reducing the risk of infection.
Monitor vital signs and assess for signs of infection: This will allow for early detection and treatment of any potential complications.
Educate Francisca on perineal care and wound healing: This will help her understand how to care for herself at home and prevent infection or other complications. It will also help her understand what to expect during the healing process.