pp complications

Question 1

Traditionally, postpartum
hemorrhage (PPH) has been
defined as greater than _______
mL estimated blood loss associated
with vaginal delivery or greater
than ________estimated blood loss
associated with cesarean delivery.

Answer 1

500 ml and 1000 ml

Question 2

Meds Route
* oxytocin (Pitocin * BRAND*):
* methogonovine (Methergine):
* carboprost (Hemabate):
* misoprostol (Cytotec):

Answer 2

IV, oral

IM

IM

RECTAL/ ANTI ULCER

Question 3

UTERINE TAMPONADE & CURETTE

DNC

Answer 3

stop post-partum hemorrhage due to a relaxed uterus
& to remove the uterine tissues during surgical procedures.

scrapping

Question 4

Bimanual Compression done by:

Answer 4

Physician

Question 5

1gm = _____ ml blood loss

dry-wet

Answer 5

1ml

Question 6

hematoma

Answer 6

a bad bruise. It happens when an injury causes blood to collect and pool under the skin

Question 7

PUERPERAL INFECTION

postpartum infection

Answer 7

infection of the genital tract occurring at labour or within 42 days of the postpartum period
.bacteria infect the uterus and surrounding areas after a female gives birth. It’s also known as a postpartum infection.

Question 8

postion to put pt in shock in

Answer 8

trendelenburg position

Question 9

CYSTITIS
* Prevention!!!
* Hand washing – NURSE and Patient

Answer 9

Cystitis is inflammation of the bladder, usually caused by a bladder infection
There is also increased pressure on your bladder, which can reduce the flow of your urine and lead to an infection.

Question 10

GESTATIONAL HTN ( this is the base) * when can you diagnosis/ values*

Answer 10

After 20 weeks in normotensive women
140/90 x 2 taken at least 4 hrs apart

Question 11

PRE-ECLAMPSIA ( branch of gestational diabetes)
( when/ how long/ signs)

Answer 11

After 20 weeks

Can happen up to 6 weeks PP

Warning signs: Severe headache, visual
changes, epigastric pain, Proteinuria, swelling

Question 12

Mild VS Severe PRE-ECLAMPSIA

Answer 12

BP>140/90 , Proteinuria>300mg/24
hr or 30 dipstick

BP > 160/110, Proteinuria>2
g/24hr

Question 13

Risk Factors

preeclampsia/ 11

Answer 13

HISTORY OF :
-HIGH BLOOD PRESSURE,
- KIDNEY DISEASE
- DIABETES
-EXPECTING MULTIPLES
FAMILY HISTORY OF PREECLAMPSIA
*AUTOIMMUNE CONDITIONS
*AMA
*AFRICAN AMERICAN
*1ST PREGNANCY
*IVF
*PCOS
*OBESITY

Question 14

Taking a baby aspirin

purpose…think about major complications

Answer 14

daily starting
in early pregnancy (by 12 weeks
gestation) has been demonstrated
to decrease the risk of developing
preeclampsia by approximately 15% .

Question 15

MAP –MEAN ARTERIAL Pressure

Answer 15

Systolic BP + 2 (diastolic BP)
3
120/80 = 120 + 160 = 93

Preeclampsia  MAP > 105

Question 16

Normal pregnancy is a vasodilated state

Answer 16

50% >blood volume
30% cardiac output
> GFR
Pre-eclampsia
Vasoconstriction
Can affect all organ systems
Renal, hepatic, coagulation, CNS

Question 17

Hyperreflexia with pre-eclampsia

Answer 17

a person’s reflexes become unusually active. Increasing blood pressure will lead to increasing hyperreflexia (overactive reflexes), until eventually uncontrollable seizures result

Question 18

Normal reflex is

Answer 18

+2

Question 19

ECLAMPSIA (whats the sign to say this is eccmaplmsia)

Answer 19

Signs- Headache, blurred vision, severe
epigastric/abdominal pain, altered LOC

Convulsions
Maintain airway
Fetal monitoring

Question 20

Magnesium Sulfate (MgS04) ; IV
* Toxicity
* Level >

• anditote for mg toxicity =

Answer 20

Level > 9.6 mg/dl
< RR, hyporeflexia, fetal distress

• Antidote; calcium gluconate Calcium
  antagonizes the action of magnesium at a cellular
  level. It is very effective in reversing the clinical
  effects of magnesium toxicity

Question 21

MAGNESIUM SULFATE
*

Answer 21

Prevents convulsions by depressing the
central nervous system and blocking the
transmission of nerve signals to the
muscles to make them contract
* Reduces the release of acetylcholine, a
chemical that nerve cells secrete to
make muscles contract

Question 22

MAINTAIN UTERINE PERFUSION

Answer 22

Left side lying
* O2 if Pulse ox < 95%
* FHT with doppler

Question 23

HELLP SYNDROME

• Hemolysis
  Hbg <
• Low Platelet Count
  <

Answer 23

• Hemolysis
  Hbg <6
• Elevated Liver Enzymes
  AST/LST (MIRCO THROBMIN IN LIVER DAMAGE HEPATIC CELLS)
• Low Platelet Count
  < 100,000

Question 24

INTERVENTIONS Preeclampsia

Answer 24

Deliver if still pregnant
Assess for hemorrhage if newly PP

Plasma volume expander
* Antihypertensive – labetalol
* Weekly BP x6weeks PP
* Liver function tests up to 3-6weeks PP

Question 25

lassitude

Answer 25

It's a signal from your body to slow down and give it time to adjust to the incredible changes happening inside.

Question 26

Coagulation Disorders( causes 5)

Answer 26

Coagulation pathways are hyperstimulated Depletes clotting factors leading to hemorrhage * Causes: * Abruptio placenta (primary cause) * HELLP * Amniotic Fluid Embolism (AFE) * Anaphylactic syndrome of pregnancy * Sudden Dyspnea * Can occur during pregnancy, labor, birth or within the first 24hours of PP period * Two stage process when amniotic fluid that contains fetal cells enters the maternal vascular

Question 27

Abruptio placenta

Answer 27

a serious condition in which the placenta separates from the wall of the uterus before birth.

Question 28

Disseminated (all over the place) intravascular (within the blood vessels) coagulation (blood clots). ( s/s , whats going on)

Answer 28

Coagulation Disorders: coagulation pathways hyper-stimulated and woman’s body breaks down clots faster than can form them- quickly depletes body of clotting factors, leading to massive hemorrhage and deat Purpura at pressure sites Abnormal clotting study * Anxious * Signs of shock r/t to blood loss * Panic, Pale and clammy skin, tachycardia, tachypnea, hypotension

Question 29

INTERVENTIONS DIC

Answer 29

* Emergency- treat for shock * VS * Foley, I&O * Oxygen * Fluids/Blood * D-Dimer * IV Heparin

Question 30

POSTPARTUM CARDIOMYOPATHY

Answer 30

Can be due to fluid volume overload during labor * Risk factors

Question 31

BABY BLUES

Answer 31

* Education needs to start in the prenatal period * The baby blues can be affected by lack of sleep, stress and hormonal changes * Baby blues tend to peak in that first week after delivery and resolve within the first two weeks * The key is severity

Question 32

early hemorrhage vs late

Answer 32

early: 1 to 24 hrs late: after 24 hrs

Question 33

PRIMARY CAUSES OF PPH - 4 T’S Tone- Tissue- Trauma- Thrombin disorders-

Answer 33

* Tone- Uterine Atony * Tissue- Retained tissue fragments * Trauma- Lower genital tract lacerations * Thrombin disorders- Disseminated Intravascular Coagulation (DIC)

Question 34

Anaphylactoid syndrome of pregnancy

Answer 34

is a rare emergency with significant mortality and morbidity, in which the amniotic fluid and fetal cells enter the maternal circulation leading to respiratory failure, altered mental status, hypotension, and disseminated intravascular coagulation

Question 35

endometriumitis

Answer 35

. Inflammation of the uterus can cause scarring

Question 36

mastitis

Answer 36

Mastitis is inflammation (swelling) in the breast, which is usually caused by an infection. It is most common when a woman is breastfeeding, but it can happen at other times as well. A clogged milk duct that doesn't let milk fully drain from the breast, or breaks in the skin of the nipple can lead to infection.

Question 37

MAP

Answer 37

SBP + 2 (DBP)/ 3

Question 38

medication to avoid :

Answer 38

aspirin

Question 39

Imminent Convulsion

Question 40

subcapsular hemorrhage

Answer 40

an accumulation of blood between Glisson's capsule and the liver parenchyma;