high risk postpartum Flashcards
(36 cards)
s/sx of hemorrhage
- decreased BP
- increased pulse
- restlessness, decrease LOC
- decreased UOP
early (primary) postpartum hemorrhage
occurs within 24 hrs following delivery
what is primary PP hemorrhage r/t?
- poor uterine tone (atony)
- lacerations
- episiotomy
- retained placental fragments
- hematoma
- uterine rupture
- problems w/ placental implantation
- coag disorders
uterine atony can be r/t?
- over distention (polyhydramnios, LGA, multiples)
- prolonged labor (dystocia)
- mag
- > 30 min to deliver placenta
- preeclampsia
- forceps or vacuum use
- retained placental fragments
management of atony r/t hemorrhage
- massage
- blood products
- pitocin, methergine
- D&C
- hysterectomy if all fails
indications of risk for lacerations
- nulliparity
- epidural
- precipitous delivery
- macrosomia
- operative delivery
- pitocin
risks for a hematoma
- preeclampsia
- first full term delivery
- precipitous labor
- operative delivery
- vulvar varicosities
management of hematomas
- < 3 cm = ice packs and analgesia
- > 3 cm = may consider I&D
- antibiotics
risks for uterine rupture
- prior c/s (scar makes muscle thinner)
- fetal malpresentation
- grandmultiparity
what would a patient report if she’s experiencing a uterine rupture?
intense abdominal pain, minimal/diffused bleeding
management of a uterine rupture
surgery, fluids, blood replacement
late (secondary) postpartum hemorrhage
occurs between 24 hours and 6 weeks PP
- less common
what is secondary postpartum hemorrhage r/t?
- retained placenta
- subinvolution
what would the PP OB assessment for a patient with subinvolution likely reveal?
- fundal height would be greater than expected
- rubra lochia may persist for longer than 2 weeks
- brown lochia or heavy bleeding
- backache
management of secondary postpartum hemorrhage
- methergine
- antibiotics
- possible D&C
puerperal infection
infection of the reproductive tract occurring w/in 6 weeks following delivery
puerperal morbidity
38C or > for any 2 of the first 10 days PP, exclusive of the first 24 hrs
endometritis
inflammation of the endometrial lining
how would a patient present with endometritis?
- bloody vaginal discharge
- foul smelling vaginal discharge
- uterine tenderness
- fever
- tachy
what are the causative agents of endometritis?
GBS, chlamydia, e.coli
how do we treat endometritis?
broad spectrum antibiotics
peritonitis
reproductive tract infection can spread to the entire peritoneal cavity; can be serious and life threatening
peritonitis can get into…
blood, lymph, and spread
cystitis
lower UTI (bladder)
- urgency, frequency, burning
