← Chapter 8
Maternal-Newborn & Pediatric Nursing · Chapter 8

The First Ten Minutes

A hemorrhage is not a fact to recall, it is an order to execute. Take the bed and act — the pulse will climb, the blood pressure will sit still and lie to you, and every second you spend on the wrong thing costs measurable milliliters. Then switch to the weigh-and-quantify bench and replace the guess with a number.

Take the bed

Bed 3 · 30 minutes after a vaginal birth of twins
The pad is saturated and the fundus is soft
34 years old, 68 kg. Chronic hypertension, on labetalol through the pregnancy. Long labor with an oxytocin infusion for 14 hours. Fundus boggy, above the umbilicus and displaced to the right. Pulse 118, blood pressure 112/70, respirations 22. She says she feels “shaky and a bit strange”. She has not passed urine since the epidural was sited.

Choose actions in the order you would really do them. Every choice advances the clock, and the clock bleeds.

Actions in the right order0 / 11
Active hemorrhageFundus boggy · bladder distended · bleeding brisk
MIDLINE UMBILICUS 2 FB ABOVE 2 FB BELOW BOGGY BLADDER FULL
Pulse
118
/min
BP
112/70
mmHg
Shock index
1.05
HR ÷ SBP
Cumulative QBL
900
mL
Hands on the fundus
Tone causes seven or eight out of every ten postpartum hemorrhages, and massage needs no order and takes no time. Everything else in this list is downstream of it.