Ch. 21 postpartum complication

Question 1

Define postpartum hemorrhage

Answer 1

Loss of 500ml or more of blood for vaginal birth

Loss of 1000ml or more of blood for cesarean birth

Question 2

Define uterine Antony

Answer 2

Marked hypotonia (relaxation) of the uterus

Question 3

What is the leading cause of early postpartum hemorrhage

Answer 3

Uterine atony

Question 4

What happens if the uterus is flaccid after detachment of all parts of the placenta

Answer 4

Brisk venous bleeding occurs and normal coagulation of the open casulature is impaired and continues until the uterine muscle is contracted

Question 5

What are some of the common associations of uterine atony

Answer 5

High parity, polyhydramnios, fetal macrosomia, multifetal gestation

Uterus is overstretched and contracts poorly

Question 6

When is the placenta said to be retained

Answer 6

If it has not been expelled within 30min after birth

Question 7

Define pelvic hematomas

Answer 7

Collection of blood in the connective tissue

Question 8

Vaginal hematomas are commonly associated with

Answer 8

Forceps-assisted birth
episiotomy
primigravidity

Question 9

Retroperitoneal hematomas are commonly associated with

Answer 9

Laceration of the vessels, rupture of cesarean scar

Question 10

How are hematomas corrected

Answer 10

Surgically evacuated, pain relief, monitor bleeding, replace fluids, review labs

Question 11

Define uterine inversion

Answer 11

Turning inside out

Question 12

What are some of the contributing factors to uterine inversion

Answer 12

Fungal implantation of placenta, vigorous fungal pressure, excessive traction applied to cord, fetal macrosomia, short umbilical cord, tocolysis, prolonged labor, uterine atony

Question 13

What are the presenting signs of uterine inversion

Answer 13

Sudden hemorrhage, shock, pain, uterus is not palpable abdominally

Question 14

Why are tocolytics given before attempting to replacing uterus when inversion is suspected

Answer 14

To relax the uterus

Question 15

What medications are given after uterine involution has been corrected

Answer 15

Oxytocin, and antibiotics

Question 16

Define subinvolution

Answer 16

Delayed return of the enlarged uterus to normal size and function

Question 17

What are the common causes of subinvolution

Answer 17

Retained placenta fragments and pelvic infection

Question 18

What are the signs and symptoms of subinvolution

Answer 18

Prolonged lochia discharge, irregular or excessive bleeding, hemorrhage

Question 19

How do we treat subinvolution

Answer 19

ergotrate or methergine

These drugs will contract the uterus

Question 20

What is the initial management for excessive postpartum bleeding due to uterine atony

Answer 20

Fungal message

Question 21

T/F ergonovine and methergine are contraindicated in the presence of hypertension or cardiovascular disease

Answer 21

true

Question 22

Define hypovolemic shock

Answer 22

It is a physiological compensatory mechanisms that are activated in response to hemorrhage.

Question 23

What is the circular pattern of hypovolemic shock

Answer 23

Decreased profusion, increased tissue anoxic, acidosis, edema formation, pooling of blood further decreasing perfusion. Cellular death

Question 24

What are the characteristics of hypovolemic shock

Answer 24

Rapid shallow respiration
Rapid weak and irregular pulse
Decreasing BP
Cool, pale, clammy skin
Decreased urinary output
Lethargy, anxiety ---> coma
Decreased central nervous pressure

Question 25

What interventions need to be initiated when hypovolemic shock is suspected

Answer 25

Call for assistance
Start IV
Ensure patent airway give oxygen 10-12L
Monitor vitals

Question 26

What is idiopathic immune thrombocytopenic purpura

Answer 26

Autoimmune disorder in which antiplatelet, antibodies decrease the life span of the platelets

Question 27

What are the common diagnostics findings of ITP

Answer 27

Thrombocytopenia, capillary fragility, increased bleeding time

Question 28

How do we treat ITP

Answer 28

Corticosteroids, IV immune globulin, platelet transfusion

Question 29

What is disseminated intravascular coagulation

Answer 29

An imbalance between the body’s clotting and fribrinolytic systems

Question 30

DIC can occur as a result

Answer 30

Hemorrhage, abruption placentae, amniotic fluid embolism, dead fetus syndrome, preeclampsia, sepsis, saline abortion, acute fatty liver

Question 31

Diagnosis of DIC is made by which presenting clinical findings

Answer 31

Excessive bleeding, spontaneous bleeding, tachycardia, diaphoretic

Question 32

How do we manage DIC

Answer 32

Correcting cause, volume replacement, optimizing oxygenation and perfusion

Question 33

Because renal failure is one consequence of DIC, unitary output is

Answer 33

Closely monitored and must be maintained at more than 30ml/hr

Question 34

Describe what a venous thromboembolism

Answer 34

Formation of a blood clot inside a blood vessel and is caused by inflammation or partial obstruction of the vessel

Question 35

What is the medical management for DVT

Answer 35

Initial IV therapy w/ heparin
bedrest
Legs elevated
Oral warfarin for 3months

Question 36

Are pregnant women allowed to take Coumadin (warfarin)

Answer 36

No, it is contraindicated

Lactating women can

Question 37

What is endometritis

Answer 37

Infection of the lining of the uterus

Question 38

What is a genital fistulas

Answer 38

Abnormal passageways b/w genital tract organs

Question 39

What are the common signs and symptoms of vaginal fistulas

Answer 39

Presence of urine, flatus, feces in the vagina, odors, irritation

Question 40

T/F Women with a history of asthma should not receive Methylprostaglandin (Carboprost (hemabate) because it causes bronchoconstriction

Answer 40

True