Postpartum hemorrhage (PPH) is one of the leading causes of maternal deaths worldwide, making it a critical priority for every nurse, RN nurse, and registered nurse to master. Understanding how to recognize and manage PPH is essential for safe, effective care — and is a frequent topic on the NCLEX and in any nursing bundle of essential skills.
🩺 What Is Postpartum Hemorrhage?
PPH is defined as a blood loss of more than 500 mL after a vaginal delivery or more than 1000 mL after a cesarean section within 24 hours of birth (primary PPH). Secondary PPH occurs between 24 hours and 12 weeks postpartum.
Why it matters for nursing:
✅ Can cause hypovolemic shock
✅ Can be life-threatening in minutes
✅ Needs fast and coordinated team response
⚠️ Causes of Postpartum Hemorrhage
For RN nurses studying for the NCLEX, remember the 4 T’s as the major causes of PPH:
✅ Tone (uterine atony, most common cause)
✅ Tissue (retained placental fragments)
✅ Trauma (lacerations, uterine rupture)
✅ Thrombin (clotting disorders)
🟡 Early Recognition
Nurses must stay alert for:
- Excessive vaginal bleeding (saturating pad in <15 minutes)
- Large clots
- Boggy, soft uterus
- Tachycardia and hypotension
- Pale or clammy skin
Tip for your nursing bundle: Always assess the uterus first — a boggy uterus is often uterine atony, the most common cause of PPH.
🩹 Nursing Interventions
The registered nurse has a critical role in rapid intervention:
✅ Call for help immediately
✅ Start uterine massage to stimulate contraction
✅ Administer prescribed uterotonic drugs (oxytocin, misoprostol, methylergonovine)
✅ Establish IV access for fluids and blood products
✅ Monitor vital signs closely
✅ Prepare for surgical intervention if bleeding persists
✅ Keep accurate documentation of estimated blood loss
NCLEX reminder: Fundal massage is the priority nursing action if uterine atony is suspected.
👩⚕️ Patient and Family Education
PPH can be frightening for patients and families. Nurses should provide:
✅ Calm, clear explanations of what is happening
✅ Reassurance that the team is acting quickly
✅ Instructions on postpartum warning signs after discharge (heavy bleeding, large clots, dizziness, or fainting)
📝 NCLEX Tips
👉 Remember the 4 T’s of PPH causes
👉 Boggy uterus = massage first
👉 Prioritize maintaining perfusion and preventing shock
👉 Uterotonic medications are often next after fundal massage
👉 Always reassess uterine tone after each intervention
💡 Cheat Sheet for Nursing Students
✅ PPH = >500mL vaginal / >1000mL C-section
✅ Think 4 T’s
✅ Massage the uterus
✅ Give uterotonics
✅ Replace blood loss
✅ Communicate with the team
Perfect for your NCLEX review or nursing bundle reference!