The nurse is caring for a postpartum patient who had an estimated blood loss of 500 ml following a vaginal birth. What is the best clinical measure of the patient's actual blood loss?
1. The clinical estimation of blood loss at time of birth
2. A decrease in the hematocrit of 10 points between the time of admission and the time of postbirth
3. The amount of saturation of the linens during and after the birth
4. A decrease in blood pressure and increase in pulse after birth
2
Rationale 1: The clinical estimation of blood loss at the time of birth often is obscured by blood mixing with amniotic fluid and oozing onto the sterile drapes or getting sponged away.
Rationale 2: A decrease in the hematocrit of 10 points between the time of admission and the time of postbirth is seen by many clinicians as most reliable in estimating the actual blood loss.
Rationale 3: The saturation of the linens during and after the birth represents a mixture of blood and amniotic fluid, and would not be accurate.
Rationale 4: A decrease in blood pressure and an increasing pulse rate after birth do not appear until as much as 1000–2000 ml have been lost, and shortly before the woman becomes hemodynamically unstable.
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