Post Partal Complications
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| 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.
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| What is early postpartal hemmorhage? | Hemorrhage that occurs within 24 hours of delivery
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| What are the two causes of postpartal hemmorhage? | *Uterine Atony *Trauma
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| What accounts for 75% to 85% of early hemorrhage? | Uterine atony
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| How long do Uterine atony bleedings occur? | Bleeding continues until the fibers contract to stop the flow of blood
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| How should the uterus feel on palpation after birth? | a firm mass about the size of a grapefruit
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| Where should the fundus of the uterus be immediately after birth? | about the level of the umbilicus or slightly lower
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| 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
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| 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
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| What drug is given to increase uterine tone and decrease bleeding in a PT with uterine atony? | oxytocin (Pitocin)
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| What drug is given for uterine atony if oxytocin is ineffective? | prostaglandin (Hemabate, Prostin)
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| 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)
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| How often should vital signs be checked in a woman suffering bleeds from uterine atony to detect trends? | Every 15 minutes
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| When do cervical lacerations frequently occur? | when the cervix dilates rapidly during the first stage of labor
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| 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
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| Where are hematomas resulting from birth trauma usually located? | on the vulva or inside the vagina
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| 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
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| When does late postpartum hemorrhage typically occur? | without warning 7 to 14 days after delivery
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| When does late postpartum hemorrhage occur? | later than 24 hours after delivery
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| 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
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| What form of late postpartum hemorrhage is generally preventable? | Late postpartum hemorrhage caused by retained placenta
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| What can be used to identify placental fragments that remain in the uterus? | Sonography
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| What is placenta accreta? | placenta attaches itself too deeply into the wall of the uterus
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| What is subinvolution of the uterus? | A slower than expected return of the uterus to its non-pregnant size after delivery
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| 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
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| What color is lochia rubra? | Dark red
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| What are the S/Sx of hemorrhage? | *Persistent red bleeding *Return of red bleeding after it has changed to serosa or alba
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| What are the three major causes of thrombosis? | *Venous Stasis *Hypercoagulation *Blood Vessel Injury
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| 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
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| 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
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| 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
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| How is DVT Dx'd? | *Ultrasonography with vein compression *Doppler flow analysis *MRI may be used for pelvic veins
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| What anticoagulant is safe during pregnancy? | Heparin
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| Fill in the blanks: Heparin can be given until ______ and _______ and be restarted ________ hours after birth | Labor, Delivery, 4 to 12
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| When can heparin be changed to warfarin? | Postpartum
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| What are Puerperal Infections? | Bacterial infection after childbirth
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| Fill in the blanks: Puerperal infections are ___ to ___ times more frequent in those who have had cesarean births | 5, 10
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| 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
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| What is endometritis? | An infection of the uterine lining, often at the site of the placenta
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| What kind of birth is endometritis more common in? | Cesarean
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| When do the S/Sx of endometritis usually occur? | within the first 24 to 48 hours after delivery
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| 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
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| How long are antibiotics for endometritis given? | until the woman has been afebrile for 48 hours
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| How should a woman with endometritis be positioned? | Keep patient in Fowler's position to facilitate drainage of infected lochia
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| What are the three types of mood disorders related to the postpartum period? | Postpartum blues, depression & psychosis
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