Postpartum Complications & Childbearing Family With Special Needs Flashcards by Jade Ring

Typically postpartum complications (4)

Hemorrhage
Infection
Thromboembolic disease
Postpartum Affective Disorder

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PPH

Vag delivery ____

CS delivery _____

Any amount that causes hemodynamic instability

Vag <500

CS <1000

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4 Ts of Pathophysiology of PPH

Tone
Tissue
Trauma
Thrombin

Tone: Uterine tone most common cause 80%

Tissue: Retained placental fragments

Trauma: Lacerations, Episiotomy, Uterine Inversion

Thrombin: Coagulation Disorders

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Grand multipara….

4 or more previous pregnancy and deliveries

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Maternal Factors
(Macrosomia, Grand Multipara, Multiple fetal pregnancy, Over Distention)

Preexisting clotting disorder

Long labor

Tocolytics/ Uterotonics

Use of forceps

Cesarean

General Anesthesia

Manual removal of Uterus

All risk factors for….

PPH

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Soft boggy uterus

2 most important interventions

Massage Fundus

Call for help

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Hemorrhage

Increase IV fluids containing Oxytocin

False

Increase IV without Oxytocin

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Hemorrhage

Methylergonovine (Methergine)
0.2 mg IM (may repeat)

Avoid with…

HTN

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Carboprost (Hemabate)

250 micrograms IM

May repeat q15min Max 8 doses

Avoid with….

Asthma

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Stage 1 PPH

Define

CS >1000 mL

Vag >500 mL

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Stage 2 Hemorrhage

Define

EBL up to 1500 mL
Use to 2 Uterine tonics (Not effective)

Oxytocin 10 - 40 U

Methylergonovine 0.2 mg IM May repeat

Carboprost 250 micrograms May repeat q15m Max 8 doses

Misoprostol 800-1000 micrograms Per Rectum

Vital signs Normal

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Stage 2 Hemorrhage

Define

EBL up to 1500 mL

Use to 2 Uterine tonics (Not effective)
Oxytocin 10 - 40 U

Methylergonovine 0.2 mg IM May repeat

Carboprost 250 micrograms May repeat q15m Max 8 doses

Misoprostol 800-1000 micrograms Per Rectum

Vital signs Normal

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During the Stage 2 PPH (EBL upto 1500ml or atleast 2 uterotonics used & normal VS)

Consider this medication….

Describe administration…

Tranexamic Acid (TXA)

1 G over 10 minutes

Add 1 G to 100mL NS IV & give over 10 minutes. Maybe repeated once after 30 minutes

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Possible interventions for STAGE 2 PPH

Bakri balloon

Compression suture/B-Lynch suture

Uterine artery ligation

Hysterectomy

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Stage 3 PPH

Define…

EBL >1500mL

2 RBC givn

At risk for Occult bleeding/Coagulopathy

Any patient with abnormal VS/labs/ oliguria

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Stage 4 PPH

Define…

Cardiovascular collapse (massive hemorrhage, profound Hypovolemic shock, amniotic fluid embolism)

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1st line of intervention for Stage 2 PPH

Bakri Balloon: Uterine Tamponade

Stays in for 24 hours

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If Uterine Artery Embolization fails what is the next treatment…

Hysterectomy

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Care for a Hematoma…

Surgically drained & Blood vessels ligated

Presents as a very painful perineal lump

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Lacerations

Describe the degrees..

1st
2nd
3rd
4th

1st
Superficial vaginal mucosa or perineal skin

2nd
Above plus, deeper tissues may include muscles

3rd
2nd degree plus sphincter

4th
3rd degree plus, rectal mucosa

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Sub Involution…

Slower than expected return of the uterus to its non-pregnancy size.

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Subinvolution

Involves the uterus retuning to its pre pregnancy size slower than expected.

How fast should the uterus descend?

When should it be no longer palpable

Descend 1 cm daily

No longer palpable in 2 weeks time

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Cause…

SS…

TX….

Subinvolution

Causes: Placental fragments & Pelvic Infection

SS Prolonged lochia, excessive bleeding, Pelvis pain, large & soft uterus

Tx: Methergine, antibiotics (if Infected), removal of retained tissue

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Thrombus vs Thrombophlebitis

Thrombus = Blood clot

Thrombophlebitis = inflammation of the vessel wall

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Lovenox is given during pregnancy and Coumadin is given postpartum to prevent DVT. WHY?

Coumadin is Contradicted during pregnancy

Varicosities ( Varicose Veins) Tx...

Compression Hose

Puerperal Infection (Postpartum Infection) Risk factors: CS, Prolonged ROM, Bladder catherization, hemorrhage, Poor nutrition, DM Describe Fever criteria....

38 or 100.4 with in first 24-hour and up to 10 days postpartum

Metritis (Infection of the Uterus) Onset: with in 2 - 7 days postpartum Labs WBC >20,000 TX: Ampicillim, cephalosporin, clindamycin, gentamycin Could spread to....

Salpingitis, oophoritis, peritonitis

Wound infection at episiotomy or CS Can baby stay with mom? Most important teaching

Yes Teach mom Hand Hygine

Don't dispel milk when mastitis is present

False Empty chest of milk

Baby Blues goes away how quickly... If it doesn't go away? Why baby blues...

2 weeks It's called postpartum depression Drop of estrogen & progesterone

Postpartum Depression Onset with in first year Postpartum Last how long?

Atleast 6 weeks

Can you take Zolfot while breast feeding

Yes

Use this screening for postpartum affective disorders

Edinburgh

Postpartum Patient is out of touch with reality. When is it safe to leave them alone?

Never Don't leave them alone

Teen moms growth needs compete with her growing baby

True

Neonatal increased risk with teen pregnancy (4)

Premature Low birth weight Low APGAR Neonatal death

2 goals of sex education

Teach how to set limits Instruct in effective contraceptive & prevent STIs

Most common form of substance abuse in pregnancy? Maternal Effects? Infant Effects?

Tobacco Decreased placental perfusion, anemia, PROM, Preterm labor, spontaneous abortion Premature, LBW,death, dev delays, SIDS, pneumonia

Leading cause of preventable retardation

Alcohol when preggers

FAE...

Milder form of FAS Fetal Alcohol Syndrome Fetal Alcohol Effects

Born with congenital anomalies How should nurses speak of infant? When should parents hold infant?

Praise and call it special Hold ASAP

Percent of women who are physically or sexual abused by partner... High incidences in teenagers White women most likely

31.5

Human trafficking How many annually... Average age....

2.5 million 12 - 14

Stages of Greif 1st stage during first 2 weeks

Denial

Stage 2 Searching & Yearing Duration....

2nd week - 4th month

Stage 3 Disorientation Duration....

5th - 9th month

Stage 4 Reorganization / Resolution Duration...

18th - 24th month

Do you present a stillborn to their parents?

Yes, just as you would any infant

Communication interventions for a Still Born Listen more than talk Call baby by its name. Focus on positive traits

🥺

Methergovine 2nd choice for hemorrhage med. Contradicted with ...

HTN / preE

Carboprost hemorrhage Contradicted with this problem...

Asthma

Which hemorrhage medication is considered last choice but no SE

TXA

Longest time you can leave Bakri Balloon in...

24 hrs

Newest intervention for PPH

Jada Uses vacuum to increase tone

How long is Postpartum bleeding normal...

4 - 6 weeks

Why is stool used in shoulder dystocia...

To stand on to allow Suprapubic pressure

FFN Test results Postive / Negative

Negative result means there's less than a 1% chance of delivering within the next two weeks. A positive result indicates a higher risk of preterm delivery

Everyone who has HELLP has preE but not everyone with preE has HELLP T / F

HELLP Meds (mother) Fetus. Meds & test

Mag & Antihypertensive Steroids/ BPP

Cure for HELLP & preE

Delivery

What are the urine test looking for in mom....

Protein & Bacteria

TORCH Test...

Toxoplasmosis, rubella, cytomegalovirus, and herpes simplex. The TORCH test detects antibodies to the various diseases

Use a speculum to inspect for lesions of Herpes before vag birth

True

Acyclovir how long before giving vag birth with Herpes

30 days

Fetus is viable at ___ weeks

Marginal cord insertion = risk of...

Tearing

Myomectomy is...

Removal of fibroids (noncancerous growths) from uterus

How long after CS to get pregnant? Min... Preferred...

18 months 2 - 3 years

Contractions suddenly stop with this problem...

Uterine Rupture

What does station receding mean...

It goes up.

Describe what happens in Anaphylactoid Syndrome. How dangerous is it...

An embolism of amniotic fluid enters moms blood vessels. Deadly

How long to monitor fetus min. After trauma to momma

4 hrs min

How long after ROM does the risk of infection increase

18 hrs

Can a distended bladder cause uterine atony...

Yes

When giving a fundal massage ensure that...

You support the nexk of the uterus

Hcg is secreted by...

Trophoblast

(This hormone) Keeps the pregnancy going and thickens the cervix

Progesterone

Is there a fetus with a Molar pregnancy...

Can metformin/ glyburide be used safely during pregnancy

Yes

Changing partners can increase the risk of preeclampsia in a subsequent pregnancy, especially for women who haven't had preeclampsia before. However, changing partners can reduce the risk for women who've had preeclampsia before T or F

Postpartum Complications & Childbearing Family With Special Needs Flashcards

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