MIH Chapter 33

Question 1

What defines postpartum hemorrhage

Answer 1

Loss of 500 ml or more of blood after vaginal birth
Loss of 1000 ml or more after cesarean birth
A 10% change in Hct between labor and postpartum

Question 2

what is the leading cause of maternal morbidity and mortality

Answer 2

Postpartum hemorrhage

Question 3

what are the classifications of PPH

Answer 3

early or late

Question 4

what is early PPH

Answer 4

occurs within 24 hrs of the birth

Question 5

what is late or secondary PPH

Answer 5

occurs more than 24 hours but less than 6 weeks after the birth.

Question 6

why does postpartum hemorrhage go unrecognized

Answer 6

because moms think bleeding is normal during labor

Question 7

what are symptoms of postpartum hemorrhage

Answer 7

weakness
fatigue
tachycardia
hypotension
dizziness
pale
loss of consciousness
decreased urine output

Question 8

what are the causes of postpartum hemorrhage

Answer 8

uterine atony
retained placental fragments
lacerations of genital tract
hematomas
subinvolution of uterus
inversion of uterus

Question 9

what is uterine atony

Answer 9

marked hypotonia of uterus , boggy/flaccid uterus

Question 10

what is the cause of uterine atony

Answer 10

high parity
hydramnios - too much fluid causes over distention
macrocosmic fetus
multifetal gestation
can have distention of uterus from clots

Question 11

how does the uterus control bleeding

Answer 11

by contracting

Question 12

how can uterine atony be treated

Answer 12

fundal rubs, oxytocin, breastfeeding

Question 13

types of retained placental

Answer 13

non adherent and adherent

Question 14

what is nonadherent retained placenta ?

Answer 14

its normal and able to remove manually or surgically

Question 15

what are the types of adherent retained placenta

Answer 15

placenta accrete
placenta increta
placenta percreta

Question 16

what is placenta accrete

Answer 16

where placenta is adhering to uterus , slight penetration of myometrium of uterus

Question 17

what is placenta increta

Answer 17

deep penetration of myometrium

Question 18

what is placenta percreta

Answer 18

perforation of myometrium and uterine serosa and can involve adjacent organs

Question 19

what are the risks associated with retained placenta

Answer 19

won’t deliver in 30 min
won’t get it all
risk for bleeding
risk for having hysterectomy

Question 20

what will you see with lacerations

Answer 20

slow steady trickle of blood

Question 21

what are the causes of lacerations

Answer 21

size
presentation
forceps
vacuum
uncontrolled labors (fast)
not stretching

Question 22

what is a hematoma

Answer 22

collection of blood in connective tissue will be painful and visible

Question 23

what is the most common type of hematoma

Answer 23

vulvar

Question 24

what is the most common hematoma

Answer 24

vulvar

Question 25

describe vaginal hematoma

Answer 25

wont be as visible, most often in first babies, deliveries using forceps, and in patients who have had episiotomy

Question 26

describe retroperitoneal hematoma

Answer 26

least common can be life threatening caused by laceration of vessel connected to hypogastric artery pt may complain of perineal or rectal pain may be asymptomatic may not know of symptoms until go into shock

Question 27

what is inversion of the uterus

Answer 27

uterus turns inside out

Question 28

what is the treatment of inverse of uterus

Answer 28

give tocolytics to relax uterus and put back in, will make it contract once back inside

Question 29

what is an incomplete inversion

Answer 29

cannot be seen, but may palpate smooth mass through dilated cervix

Question 30

what is a complete inversion

Answer 30

lining of uterus comes through cervical opening and forms mass in vagina

Question 31

what is a prolapsed uterus

Answer 31

obvious large red mass protrudes outside of vagina

Question 32

what are the possible signs of inversion

Answer 32

all of a sudden bleeding, shock, pain

Question 33

what are important consideration with inversion of uterus

Answer 33

Provider needs to be careful of pulling on cord support neck of uterus when doing fundal rubs

Question 34

what is subinvolution of uterus

Answer 34

Uterus delays the return to nonpregnant size and function

Question 35

what is a common cause of late PPH

Answer 35

subinvolution of uterus

Question 36

what are the causes of subinvolution of uterus

Answer 36

retained placental fragments, pelvic infections

Question 37

what are symptoms of subinvolution

Answer 37

prolonged lochial discharge, irregular, excessive bleeding, hemorrhage

Question 38

what is the treatment of subinvolution

Answer 38

medications to help uterus contract (uterotonic), D&C for retained placenta fragments

Question 39

what is the treatment of postpartum hemrrohage

Answer 39

The initial intervention is firm massage of the fundus. Expression of any clots in the uterus Elimination of bladder distention (straight Cath or foley) Oxytocin infusion Additional uterotonic medications D&C Bakri ballon

Question 40

How does a bakri balloon work

Answer 40

Similar to foley Inserted vaginally into uterus, inflate balloon, applies constant pressure to uterus, helps with PPH Do not do fundal rubs with this Has a reservoir to measure lochia

Question 41

what is hemorrhagic (hypovolemic) shock

Answer 41

Results from hemorrhage Emergency situation in which perfusion of organs may become severely compromised, death may occur

Question 42

what are the primary concerns for hemorrhagic shock

Answer 42

Restore circulating blood volume Monitor pulse and blood pressure Fluid or blood replacement therapy

Question 43

nursing interventions for hemorrhagic shock

Answer 43

Give meds give blood monitor VS monitor UOP cuz decreased in shock , <30ml/hr is concerning

Question 44

what is Idiopathic thrombocytopenic purpura (ITP)

Answer 44

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

Question 45

what is von Willebrand disease (vWD)

Answer 45

A type of hemophilia Deficiency or defect in blood clotting protein (vWD factor)

Question 46

Signs of ITP

Answer 46

thrombocytopenia capillary fragility increased bleeding

Question 47

what are risk associated with ITP

Answer 47

Increased risk for hemorrhage and hematomas, neonatal thrombocytopenia

Question 48

what is the treatment for ITP

Answer 48

may require platelets, if caugh early may treat with steroids and immunoglobulins

Question 49

what is the treatment for vWD disease

Answer 49

treatment of choice is iv desmospressin which promotes release of vWD factor or can administer concentrates of factor 8