Postpartum Complications Flashcards by Amanda D

What are the postpartum complications?

Hemorrhage

Infections
-endometritis
-UTI
-mastitis

Thromboembolic disease (blood clots)

Psychiatric problems
-Postpartum blues
-postpartum depression
-postpartum psychosis

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Define postpartum hemorrhage

Greater than 500ml blood loss following a vaginal delivery

Greater than 1000ml blood loss following C-section

Or 10% drop in hematocrit (hct) from pre-delivery baseline

Or postpartum hemodynamic instability

Or postpartum blood transfusion needed

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When does early or primary postpartum hemorrhage occur?

In the first 24 hours after childbirth and is the most common

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What is late or secondary postpartum hemorrhage?

24 hours after delivery to 12 weeks after birth

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What is the primary cause of postpartum hemorrhage?

Uterine atony

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What are the clinical signs of postpartum hemorrhage?

Decreased blood pressure, increasing pulse, widening pulse pressure

Thirst

Restlessness

Decreasing urinary output

Boggy uterus or fungus that is higher than expected

Excessive or bright red bleeding

Multiple clots expressed during fundal Massage

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What is uterine atony?

Relaxation of the uterus

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What are the risk factors for postpartum hemorrhage?

Over distention of the uterus due to multiple gestation, hydramnios, or a large baby (macrosomia)

Exhaustion of uterus muscle caused by grand multiparity, prolonged or precipitous labour, oxytocin induction, or augmentation of labor

Use of medications which cause the uterus to relax

Placenta problems

Previous history of postpartum hemorrhage doubles, or triples the risk of a repeat occurrence

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What are preventative treatments for postpartum hemorrhage?

Controlled traction on the umbilical cord if prolonged third stage (more than 30 minutes from delivery of baby to delivery of placenta)

Uterine massage after birth

Administration of oxytocin after delivery of placenta either IM or IV

Is estimated that these three interventions can prevent 50% of PPH

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What are the second line medication’s for PPH?

Methylergonovine (methergine)
-contraindicated for women with hypertension, cardiac disease, Raynaud’s disease

Carboprost
-contraindicated for women with asthma, cardiovascular, renal, or liver disease

Misoprostol (cytotec)

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When should we suspect lacerations?

If the uterus is firm and bright red bleeding persists

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Risk factors for hematoma

Episiotomy / Lacerations

Primiparity

Prolonged 2nd stage

Macrosomia

Preeclampsia

Clotting disorders

Vulvar varicosities

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How do you treat hematomas

Ice packs and analgesia

Small ones resolve on their own like less than 3 cm and not expanding

Large ones and ones that are expanding require surgical interventions

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Why do hematomas usually occur?

Injury to a blood vessel from birth trauma or inadequate hemostasis at the side of repair of an incision or laceration

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What causes late postpartum hemorrhage?

Subinvolution (failure to return to normal size)

Retained placental fragments

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Signs of subinvolution

The postpartum fundal height is greater than expected

Lochia fails to progress normally from rubra to serosa to alba

Lochia rubra that persist longer than normal may be suggestive of subinvolution

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Nursing interventions for PPH

Uterine massage

Empty the patient’s bladder

Oxytocin as ordered

Monitor VS, I&O, o2 stat, LOC

If not resolve quickly, contact HCP

Pad count (weigh)

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Define postpartum endometritis

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Infection of the uterine lining

Risk factors for postpartum endometritis

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Cesarean birth

PPROM

Manual removal of placenta

Chorioamnionitis

Compromised health status

Diabetes

How to asses for postpartum endometritis

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Uterine tenderness on palpation

Foul smelling lochia

Tachycardia

Chills

Fever

How to treat postpartum endometritis

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IV antibiotics

If fever persists after 48 hours, additional testing needed

Define postpartum mastitis

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Infection of the interlobular connective tissue of lactating women

Onset typically between 2 to 8 weeks after delivery

Signs and symptoms of postpartum mastitis

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Warm, reddened, painful area on the breast

Fever, chills, headache, flu like aches and malaise (tiredness,discomfort)

How do you prevent postpartum mastitis?

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Handwashing before breast-feeding

Supportive but non-constricting bra

Frequent and complete emptying of breastmilk

Avoid trauma to nipples
-learn correct latch technique
-Keep nipples dry between feedings

How do you treat postpartum mastitis

Keep breastfeeding! Antibiotics! Rest Increased fluid intake Warm or ice packs Pain medication such as ibuprofen

What are risk factors for thromboembolic disease?

Cesarean birth Prolonged immobility Obesity Smoking Varicose veins

Symptoms of a DVT

Leg or calf pain/tenderness Unilateral swelling, warmth, or redness

Symptoms of a PE

Apprehension/anxiety/panic Chest pain Dyspnea Tachypnea/tachycardia Cough and possibly hemoptysis Hypotension/cyanosis/syncope

How do you treat a DVT or PE?

Immediate administration of anticoagulants -Heparin or low molecular weight heparin Maintenance with warfarin it started at 1 to 5 days Strict bed rest and elevation of affected limb are required Avoid massage of extremity Once symptoms have subsided, encourage walking and have patient wear support hose For PE, administer O2

What is the taking in period?

First 2-3 days Preoccupied with own needs, passive, dependent Touches and explores infant Needs to discuss her L&D experience

What is the taking hold period?

Lasts 3 to 10 days Obsessed with body functions, initiates self-care Rapid mood swings Responds to instruction about infant care and self-care

What is the letting go period?

Lasts 10 days to six weeks Mothering functions have been established Sees infant as a unique person

What is postpartum blues?

The mildest out of the three other postpartum psychiatric disorders Also known as adjustment reaction with depressed mood Typically begins 2 to 4 days after delivery and resolves within 10 to 14 days

What is postpartum depression?

Also known as peripartum major mood episodes Typically begins about 4th week after delivery, but can occur anytime in the first year

What is postpartum psychosis?

Most serious of the three Also known as postpartum mood episodes with psychotic features Symptoms usually show up within a few days of delivery Considered an emergency

What are common symptoms of postpartum blues?

Mood swings, difficulty sleeping, anorexia, feeling of let down

Risk factors for postpartum blues

Changing hormone levels, pain, fatigue, an unsupportive environment or insecurity

Symptoms of postpartum depression

Similar to symptoms of postpartum blues, but also include: Feelings of worthlessness Lack of interest in usual activities Lack of concern over personal appearance Irritability or hostility towards baby Thoughts of suicide

Risk factors for postpartum depression

History of depression prior to pregnancy History of bipolar Stressful life events Lack of social support or stable life partner Loss of newborn First pregnancy or young mother

Treatment for postpartum depression

Individual or group therapy plus antidepressants -selective serotonin re-uptake inhibitor (SSRI) -tricyclic antidepressants

Symptoms of postpartum psychosis

Sleep disturbances Depersonalization (unaware of or distant from immediate environment or people within it) Confused, irrational Hallucinations, delusions Psychomotor disturbances: -stupor -agitation -rapid and incoherent speech

Risk factors for postpartum psychosis

History of previous postpartum psychosis History of bipolar Family history of either condition above

Treatment for postpartum psychosis

Keep mom and baby safe Inpatient psychiatric care Anti-psychotic medications Psychotherapy Social support

What are some nursing intervention to assess mom’s mental status?

Observe patient with the baby, by herself, with her family and friends Review history Note adequacy of coping skills Note degree of self-esteem Recognize early signs of problems Support positive parenting behaviors Discuss patients plans for baby and self Refer to social services if necessary

Postpartum Complications Flashcards

(44 cards)