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post partal problems
hemorrhage, thromboembolic, puerperal infection
| Question | Answer |
|---|---|
| blood loss greater than 500ml aftrer vaginal birth, or 1000 ml after cesarean birth | postpartum hemorrhage |
| a more measurable defintion is a decrease in hematocrit of 10 percent or more since admission in what two types? | early/late postpartum hemorrhage |
| early | within 24 hours of delivery caused by uterin atony and trauma |
| Uterine atony | 75% to 85% of early hemorrhage, refers to the lack of muscle tone that results in failure of the uterine muscle fibers to contract frily around blood vessels when the placenta separates. bleeding stopped by contraction of fibers |
| normal post partum findings | after birth uterus should be felt as size of a grapefruit,fundus at or slightly below umbilicus, lochia rubra should be dark red, no more than 1 saturated perineal pad in 1 hr, few clots expected |
| presdisposition to uterine atony include | Over-distension of the uterus from causes such as multiple gestations. A large infant. Hydramnios. Intrapartum factors. Augmented labor with oxytocin. DIC. |
| uterine atony positive clinical signs | The woman's uterus is difficult to palpate, and when found, it is boggy (soft). The fundal height above umbilicus. full bladder =, the fundus is high and off midline. Lochia will increase and large clots may be found |
| what is nursing care for initial mgm of uterine atony | If the uterus is not firmly contracted, the first intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. |
| pharmacological measures to maintain firm contractions of the uterus in care of uterine atony? | oxytocin (Pitocin) (rapid infusion). methylergonovine (Methergine(IM) contraindicated in htn. prostaglandin (Hemabate, Prostin) IM, if oxytocin is ineffective. misoprostol (Cytotec) is a less expensive alternative to control bleeding |
| Surgical intervention If all other measures are ineffective includes: | exploration/removal of placental fragments that interfere with uterine contractions. Ligation of the uterine or hypogastric artery may be necessary. Hysterectomy is the last resort to save the life of a woman with uncontrollable postpartum hemorrhage. |
| priority of assessments in nursing care for uterine atony include | Assess the consistency and location of the fundus. Pt shouldn't have full bladder for assessment. always have woman to turn side because blood that pools is not visible when checking pads from the front. VS q 15 min to detect trends |
| what is second most common cause of early postpartum hemorrhage? predisposing factors? | trauma, Many of the same factors that increase the risk of uterine atony predispose a pt to postpartum hemorrhage; Induction and augmentation of labor and the use of assistive devices such as a vacuum extractor increase the risk of tissue trauma |
| Lacerations that occur frequently when the cervix dilates rapidly during the first stage of labor happen in the second stage how? | Lacerations of the vagina, perineum and periurethral area usually occur during the second stage of labor when the fetal head descends rapidly or when assistive devices are used. bright red, meavy or steady trickle |
| predisposing risk factors for lacerations? s/s of lacerations? | Rapid labor. Forceps or vacuum extractor. represented by: Lochia is a brighter red and flows in a continuous trickle. The uterus is usually firm. |
| hematomas resulting from birth trauma are on the vulva or inside of the vagina are represented by ? | s/s of hematoma birth trauma: bulging, bluish or purplish mass of vulva or perineum. Hematomas in vagina s/t not visible. analgesics do not relieve pain. pressure in the vulva, pelvis or rectum. May have s/ occult blood loss w/o increased lochia. |
| Prolonged or rapid labor. Large baby. Use of forceps or vacuum extract. | Predisposing Risk Factors to Hematomas |
| Medical Treatment of hematomas in postpartum hemorrhage | Small hematomas usually resolve without treatment. Large hematomas may require incision and drainage of the clots. Bleeding vessel is ligated or area packed with a hemostatic material to stop bleeding. |
| how is therapeutic tx managed for hematomas of the vagina | surgical repair may be necessary. return the mother to the delivery area where surgical lights are available. Surgical asepsis is required. Small hematomas usually reabsorb naturally. |
| mother c/o deep pelvic pain, what does the nurse do? | Inspect the perineum to determine whether a laceration is visible or if examination of the vaginal walls and cervix is warranted by the provider. |
| why would comfort level assessment lead to inspection while caring for post partum mother? | Assess comfort level. If the mother complains of deep, severe pelvis or rectal pain inspect to determine if there may be concealed bleeding and the formation of a hematoma. |
| Late post partum hemorrhage | Hemorrhage that occurs later than 24 hours after delivery. Typically it occurs without warning 7 to 14 days after delivery. |
| Most Common Causes | Subinvolution (delayed retrn to size and consistency).Fragments of placenta remain attached to the myometrium in placental delivry.Late postpartum hemorrhage by retained placenta is preventable. provider explores uterus and removes retained fragments |
| Late Postpartum Hemorrhage Predisposing Risk Factors | Attempts to deliver the placenta before it separates from the uterine wall. Manual removal of the placenta. Placenta accrete. |
| tx includes: | Oxytocin, Methergine, and prostaglandins are the most commonly used pharmacologic measures.Sonography ID's placental fragments in utero, Dilation and curettage for frag removal, Antibiotics are given if postpartum infection is suspected. |
Created by:
redhawk101
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