3 Postpartum Complications Flashcards
Postpartum hemorrhage
Classified(3)
> 500ml blood loss for vaginal delivery
1000ml blood loss for c/s
10% change in hct from labor to postpartum
Early vs late PPH
Early: within 24hrs of birth
Late: after 24hrs but less than 6weeks after
PPH causes
Tone
Tissue
Trauma
Thrombin
PPH caused by uterine atony
What is it
Associated with what
Lack of tone
Associated with:
High parity
Polyhydramnios/macrosomia
Multifetal gestation
Prolonged labor
Mg sulfate (muscle relaxer)
PPH caused by tissue
Failure of placenta to expel within 30 mins
Nonadherent fragments
And
Adherent fragments
PPH caused by trauma
Laceration:
Vaginal bleeding with firm fundus
Hematoma:
<3cm (ice and pain control)
PPH caused by thrombin
Thombocytopenia caued by HELLP
DIC: replace coagulation factors
Safety bundle:
- Readiness (equipment and people)
2.recognition and prevention (assessment)
3.response (plan)
4: reporting and systems learning (debriefing)
PPH care management
1st treatment
What todo for clots
Bladder
Med/fluids
Other meds
Initial intervention is firm massage if boggy
Expression of clots
Elimination of the bladder distention (foley)
IV infusion of 10-40 units of oxytocin with 1000ml LR
Uterotonic meds
Monitor for shock
Uterotonic meds
Oxytocin
Methylergonovine
Misoprostol (cytotec)
Carboprost
Oxytocin
Route
Assess
IV or IM
Assess uterine tone and bleeding
Methylergonovine
Route
Assess
Do not give if
Monitor what
IM
Assess uterine tone and bleeding
DO NOT GIVE IF HYPERTENSIVE
Monitor BP and N/V
Misoprostol
Route
CI
Rectal
CI: any comorbidities (heart/lungs/hepatic)
Carboprost
Route
Montiro what s/she
CI
IM
Monitor: fever, chills, HA, N/V (FLU-LIKE)
CI: any comorbities (asthma/lungs, renal, hepatic)
PPH care interventions
type of compression surgeries
Bimanual compression
Surgical man:
-D&C (remove stuff)
-bakri temponade balloon
-uterine artery ligation
-hysterectomy
Hemorrhagic shock
What is happening
Management(6)
Perfusion of organs may become severely compromised
Management:
-Eliminate cause
-O2 10-12L
-fluid and blood replacement
-foley catheter
-H&H,PLT, CLOT FACTORS
-s/s of DIC
VTE
RF
Pregnant
Hx of VTE
C/s
Obesity
Smoking
>35 y/o
Diagnotic test for VTE
Doppler US
CT
VTE meds
Heparin
Warfarin
Heparin
How long
Labs
Antidote
3-5days
PTT- 1.5-2.5 times norm
Antidote: protamine sulfate
Warfarin
Route for how long
Antidote
How aften you have to be tested
Oral for 3 months
Anitdote: VIT K
Constant testing
Postpartum infection
Temp needed
When
Criteria
Fever of 100.4
After 24hrs after childbirth
Occurring on at least 2 of the first 10 days after birth
Excluding the 1st 24 hours
Mastitis
What it is
S/s
Tx
Breast tissue infection
S/s:
Malaise
Flu-like
Sore/painful
Tx:
breast emptying
warm compresses
abx
Endometritis
What is it
S/s
Tx
Infection of the lining of the uterus
S/s:
Foul smell
Lower abd pain
Lethargy
Tx:
Broad spectrum abx
Wound infections
How to assess
Tx
REEDA:
Reddness, edema, echymosis, drainage, approximation
Tx:
Abx
Wound care
UTI
S/s
Tx
Hematuria
+ for nitrates
Tx:
Abx
Push fluids
Postpartum blues vs depression
Blues: resolves in 2 wks
Depression: lasts beyond 5-6 wks
Postpartum depression
Screening
When to do it
Edinburgh postnatal depression
Postpartum depression screening scale
At infant 1wk, 2wk
Postpartum psychosis
When do you get it
Associated with what
S/s
Within 3 wks of giving birth
Associated with: bipolar do
S/s:
Sleep isssues
Paranoia
Depression
Thoughts of homicide and infanticide
Postpartum psychosis tx
Meds
CBT
