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68WM6 P2 Maternal 3

Maternal chapter 27 Postpartal Complications

Postpartum Hemorrhage Blood loss greater than 500 ml after vaginal birth, or 1000 ml after cesarean birth. Also a decrease in hematocrit of 10 or more percent since admission.
Early Postpartum Hemorrhage Hemorrhage that occurs within 24 hours of delivery. Two main causes are uterine atony and trauma.
Uterine Atony Accounts for 75-85% of early hemorrhage, refers to the lack of muscle tone that results in failure of the uterine muscle fibers to contract firmly when the placenta separates.
Predisposing Factors of Uterine Atone Multiple gestation's, large fetus, hydramnios, intrapartum factors, augmented labor with Oxycontin, DIC.
Signs of Uterine Atony Boggy uterus, high fundal height often above the unbilicus, increased lochia/large clots.
Pitocin (ocytocin) Often increases uterine tone and controls bleeding (rapid infusion).
Methergine (methylergonovine) Raises the blood pressure and should not be given to a woman who is hypertensive (IM). Contraindicated if S-BP is at or above 136.
Hemabate/Prostin (postaglandin) Given IM or into the uterine muscle if oxytocin is ineffective.
Cytotec (misoprostol) A less expensive drug that also may be used to control bleeding.
Bleeding from Lacerations will always be? Bright Red.
Late Postpartum Hemmorhage causes: Subinvolution (delayed return of the uterus to its nonpregnant size and consistency)and fragments of the placenta left in uterus.
Three major causes of thrombosis are: Venous stasis, hypercoagulation, and blood vessel injury.
Venous Stasis The result of compression of the large vessels of the legs and pelvis by the enlarging uterus. Increased risk with oral contraceptives and obesity.
Clinical signs of Superficial Venous Thrombosis Enlarged, hardened, cord-like vein may be palpated.
Clinical signs of Deep Vein Thrombosis Positive homan's sign, decreased peripheral pulses, chills, and general malaise.
Heparin Is safe in pregnancy. It can be given until labor and delivery and be restarted 4-12 hours after birth. Monitor PTT.
Coumadin (warfarin) Monitor PT and INR. Decrease vitamin K intake.
What are some signs and symptoms of a pulmonary embolism? Sudden chest pain, cough, dyspnea, depressed consciousnesses, and signs of heart failure.
Peurperal Infection A bacterial infection after childbirth, 5-10 time more frequent in cesarean births.
Signs and Symptoms of Endometritis An infection of the uterine lining, often at the site of the placenta and caused by group B strep, enterococci, and klebsiella pneumonia. Characterized by foul-smelling lochia and leukocytosis after the first day that is not decreasing.
Drugs to treat Endometritis Clindamycin plus gentamicin
Postpartum Depression Most common affective disorder of the postpartum period characterized by lack of enjoyment in life and food, disinterest in other including the newborn, and feelings of inadequacy.
Postpartum Psychosis Risk factors include bipolar disorder and manic depressive states. S&S include hallucinations and excessive concern with baby's health. Medical emergency.
What might the infant and mother be at risk for if the mother is suffering from major depression? Death.
Created by: djv