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68wm6 Pos Par Com

Post Partal Complications

QuestionAnswer
Define Postpartum Hemorrhage: blood loss greater than 500 ml after vaginal birth, or 1000 ml after cesarean birth, or a decrease in hematocrit of 10 percent or more since admission.
What is early postpartal hemmorhage? Hemorrhage that occurs within 24 hours of delivery
What are the two causes of postpartal hemmorhage? *Uterine Atony *Trauma
What accounts for 75% to 85% of early hemorrhage? Uterine atony
How long do Uterine atony bleedings occur? Bleeding continues until the fibers contract to stop the flow of blood
How should the uterus feel on palpation after birth? a firm mass about the size of a grapefruit
Where should the fundus of the uterus be immediately after birth? about the level of the umbilicus or slightly lower
Clinical signs of uterine atony: *Uterus difficult to palpate, boggy when found *Fundus is often above umbilicus *Fundus high and off to side if bladder is full *Increased Lochia and large clots possible
What is the first nursing intervention for uterine atony? massage the fundus until it is firm and to express clots that may have accumulated in the uterus
What drug is given to increase uterine tone and decrease bleeding in a PT with uterine atony? oxytocin (Pitocin)
What drug is given for uterine atony if oxytocin is ineffective? prostaglandin (Hemabate, Prostin)
If all other noninvasive measures to control uterine atony fail, what may be done? *Exploration of uterine cavity and removal of placental fragments that interfere with uterine contractions *Ligation of uterine or hypogastric artery *Hyterectomy (LAST RESORT)
How often should vital signs be checked in a woman suffering bleeds from uterine atony to detect trends? Every 15 minutes
When do cervical lacerations frequently occur? when the cervix dilates rapidly during the first stage of labor
Lacerations of the vagina, perineum and periurethral area usually occur when? during the second stage of labor when the fetal head descends rapidly or when assistive devices are used
Where are hematomas resulting from birth trauma usually located? on the vulva or inside the vagina
If the mother complains of deep, severe pelvis or rectal pain that is not relieved by analgesics after birth, what should be suspected? there may be concealed bleeding and the formation of a hematoma
When does late postpartum hemorrhage typically occur? without warning 7 to 14 days after delivery
When does late postpartum hemorrhage occur? later than 24 hours after delivery
What are the most common causes of late postpartum hemorrhage? *Subinvolution (delayed return of uterus to nonpregnant size/consistency) *Fragments of placenta that remain attached to myometrium when placenta is delivered
What form of late postpartum hemorrhage is generally preventable? Late postpartum hemorrhage caused by retained placenta
What can be used to identify placental fragments that remain in the uterus? Sonography
What is placenta accreta? placenta attaches itself too deeply into the wall of the uterus
What is subinvolution of the uterus? A slower than expected return of the uterus to its non-pregnant size after delivery
What are S/Sx of uterine subinvolution? *Prolonged discharge of lochia *Irregular or excessive uterine bleeding *Pelvic pain or feelings of pelvic heaviness *Backache, fatigue and persistent malaise
What color is lochia rubra? Dark red
What are the S/Sx of hemorrhage? *Persistent red bleeding *Return of red bleeding after it has changed to serosa or alba
What are the three major causes of thrombosis? *Venous Stasis *Hypercoagulation *Blood Vessel Injury
S/Sx of superficial veinous thrombosis: *Swelling of involved extremity *Redness, tenderness and warmth *Enlarged, hardened, cordlike vein may be palpated *Pain when walking *Often there are no signs at all
Management of superficial veinous thrombosus: *Analgesics, rest, and elastic support *Elevation of lower extremity improves venous return *Warm packs applied to promote healing *Avoid standing for long periods and continue to wear support hose to prevent subsequent episodes
S/Sx of DVT: *Swelling of leg *Erythema, heat or tenderness *Pedal edema *Positive Homan’s Sign *Leg may become pale and cool to touch with decreased peripheral pulses *Pain on ambulation *Chills, general malaise
How is DVT Dx'd? *Ultrasonography with vein compression *Doppler flow analysis *MRI may be used for pelvic veins
What anticoagulant is safe during pregnancy? Heparin
Fill in the blanks: Heparin can be given until ______ and _______ and be restarted ________ hours after birth Labor, Delivery, 4 to 12
When can heparin be changed to warfarin? Postpartum
What are Puerperal Infections? Bacterial infection after childbirth
Fill in the blanks: Puerperal infections are ___ to ___ times more frequent in those who have had cesarean births 5, 10
Risk factors for Puerperal Infection: *Childbirth *Breastfeeding *Cesarean birth *Use of forceps or vacuum extractor *Prolonged rupture of membranes *Urinary catheterization *Repeated vaginal examinations *Retained placental fragments *Anemia *Poor nutrition
What is endometritis? An infection of the uterine lining, often at the site of the placenta
What kind of birth is endometritis more common in? Cesarean
When do the S/Sx of endometritis usually occur? within the first 24 to 48 hours after delivery
S/Sx of endometritis: *Foul-smelling lochia *Fever, chills, malaise, lethargy and anorexia *Uterine tenderness *Abdominal pain and cramping *Leukocytosis after first day that is not decreasing
How long are antibiotics for endometritis given? until the woman has been afebrile for 48 hours
How should a woman with endometritis be positioned? Keep patient in Fowler's position to facilitate drainage of infected lochia
What are the three types of mood disorders related to the postpartum period? Postpartum blues, depression & psychosis
Created by: Shanejqb