Maternal chapter 27 Postpartal Complications
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| 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.
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| Early Postpartum Hemorrhage | Hemorrhage that occurs within 24 hours of delivery. Two main causes are uterine atony and trauma.
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| 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.
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| Predisposing Factors of Uterine Atone | Multiple gestation's, large fetus, hydramnios, intrapartum factors, augmented labor with Oxycontin, DIC.
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| Signs of Uterine Atony | Boggy uterus, high fundal height often above the unbilicus, increased lochia/large clots.
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| Pitocin (ocytocin) | Often increases uterine tone and controls bleeding (rapid infusion).
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| 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.
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| Hemabate/Prostin (postaglandin) | Given IM or into the uterine muscle if oxytocin is ineffective.
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| Cytotec (misoprostol) | A less expensive drug that also may be used to control bleeding.
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| Bleeding from Lacerations will always be? | Bright Red.
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| Late Postpartum Hemmorhage causes: | Subinvolution (delayed return of the uterus to its nonpregnant size and consistency)and fragments of the placenta left in uterus.
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| Three major causes of thrombosis are: | Venous stasis, hypercoagulation, and blood vessel injury.
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| 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.
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| Clinical signs of Superficial Venous Thrombosis | Enlarged, hardened, cord-like vein may be palpated.
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| Clinical signs of Deep Vein Thrombosis | Positive homan's sign, decreased peripheral pulses, chills, and general malaise.
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| Heparin | Is safe in pregnancy. It can be given until labor and delivery and be restarted 4-12 hours after birth. Monitor PTT.
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| Coumadin (warfarin) | Monitor PT and INR. Decrease vitamin K intake.
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| What are some signs and symptoms of a pulmonary embolism? | Sudden chest pain, cough, dyspnea, depressed consciousnesses, and signs of heart failure.
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| Peurperal Infection | A bacterial infection after childbirth, 5-10 time more frequent in cesarean births.
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| 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.
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| Drugs to treat Endometritis | Clindamycin plus gentamicin
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| 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.
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| Postpartum Psychosis | Risk factors include bipolar disorder and manic depressive states. S&S include hallucinations and excessive concern with baby's health. Medical emergency.
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| What might the infant and mother be at risk for if the mother is suffering from major depression? | Death.
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