postpartum health challenges

Question 1

what are some postpartum health challenges?

Answer 1

• postpartum hemorrhage
• thrombosis
• infection
• mental health

Question 2

what time frame is considered an early postpartum hemorrhage?

Answer 2

-birth to 24 hours

Question 3

what time frame is considered late postpartum hemorrhage?

Answer 3

-after 24 hours up to and including 6 weeks

Question 4

how frequently does postpartum hemorrhage occur?

Answer 4

-in 5-15% of deliveries

Question 5

what are risk factors for a postpartum hemorrhage?

Answer 5

• precipitous labor (less than 3 hours)
• uterine atony
• placenta previa or abruptio placentae
• labour induction or augmentation
• operative procedures (vacuum, forceps, C/S)
• retained placental fragments
• prolonged third stage of labour (more than 30 minutes)
• multiparity, more than 3 births closely spaced
• uterine overdistention (large infant, twins, hydraminos)

Question 6

what is given after the anterior shoulder is delivered and why?

Answer 6

• oxytocin

- given to prevent pph

Question 7

why can it be difficult to define a postpartum hemorrhage?

Answer 7

• estimation of blood loss can be challenging
• normal for vaginal is less than 500mL
• normal for c/s is less than 1000mL

Question 8

what are the 4 Ts that can cause a postpartum hemorrhage?

Answer 8

Tone (70%)
Trauma (20%)
Tissue (10%)
Thrombin (<1%)

Question 9

Tone is the most common reason for a postpartum hemorrhage, how commonly is it the cause and what does it mean?

Answer 9

• 70% of pph are r/t tone

- means there is uterine atony or a lack of uterine muscle tone

Question 10

what are possible causes of uterine atony?

Answer 10

• over-distended uterus
• multiple pregnancies
• carrying multiples
• previous history of pph
• induction of labour, prolonged labour, augmented labour
• some placental tissue remaining or manual removal of placenta
• age greater than 35 years
• obesity
• antepartum hemorrhage (placental abruption or previa)

Question 11

what are some treatments for uterine atony?

Answer 11

• fundal massage
• empty bladder
• administer uterine stimulants (oxytocin, cytotec aka misoprostil, carbetocin if c/x, hemabate)

Question 12

how frequently are postpartum hemorrhages caused by trauma and what are some examples of trauma that may cause a pph?

Answer 12

• 20% of the time
• cervical, vaginal, perineal lacerations
• hematoma
• uterine inversion
• uterine rupture

Question 13

what is one way a hematoma can be prevented in a postpartum woman?

Answer 13

-applying ice packs

Question 14

how frequently are postpartum hemorrhages caused by tissue and what are some examples of this?

Answer 14

• 10% of the time
• retained placental lobes or membranes
• retained blood clots
• commonly the cause of late pph

Question 15

how frequently does retained placenta occur in vaginal births?

Answer 15

2-3% of the time

Question 16

what is defined as retention of the placenta?

Answer 16

• not delivering the placenta within 30 minutes after birth of child
• if not expelled, manually removed (this required general anesthesia if no epidural)

Question 17

how frequently are postpartum hemorrhage caused by thrombin and what is this usually related to?

Answer 17

• less than 1% of the time

- related to pre-existing or acquired bleeding disorders

Question 18

what is included in the initial treatment of postpartum hemorrhage?

Answer 18

• early recognition
• prompt attention to any needed resuscitation (ABCs)
• identification of the cause of the bleeding
• appropriate treatment based on etiology
• fundal massage to stimulate contraction and evacuation
• identify and suture any lacerations

Question 19

what can be done if bleeding from a pph doesn’t stop?

Answer 19

• give 20-40 units IV oxytocin in 1000mLs at 125mL/hr in a large bore IV (like 18 gauge)
• give uterotonic medications (cytotec, ergometrine, hemabate, carbetocin)
• take a CBC, do a crossmatch, prep a blood transfusion
• foley, oxygen, NPO
• vital signs to watch for signs of shock
• pack uterus/bakri ballon
• cauterization
• finally - hysterectomy

Question 20

why are postpartum women at risk of thrombosis?

Answer 20

• venous stasis

- hypercoagulation state created during pregnancy

Question 21

what is the risk of a pulmonary embolism postpartum?

Answer 21

5/1,000,000

Question 22

what are ways to prevent thrombosis?

Answer 22

• avoid smoking
• encourage early activity
• leg exercises
• compression devices
• avoid sitting/standing in one place for long periods
• avoid oral contraceptives
• anticoagulant therapy (especially in C/S moms)

Question 23

what are some postpartum danger signs that should be watched for/ a woman should seek medical attention for?

Answer 23

• fever greater than or equal to 38 degrees
• foul odor to lochia or unexpected change in colour or amount
• soaking more than 2 pads in an hour with lochia
• visual changes or headaches
• calf pain
• swelling, redness, discharge at incision site
• dysuria, burning on voiding
• SOB or difficulty breathing
• depression or extreme mood swings

Question 24

what are some infections that postpartum women are at risk for?

Answer 24

• metritis (inflammation of the uterus)
• wound infection to laceration, episiotomy or surgical site
• UTI
• mastitis