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N330 > 3 Postpartum Complications > Flashcards

3 Postpartum Complications Flashcards

1
Q

Postpartum hemorrhage

Classified(3)

A

> 500ml blood loss for vaginal delivery
1000ml blood loss for c/s
10% change in hct from labor to postpartum

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2
Q

Early vs late PPH

A

Early: within 24hrs of birth

Late: after 24hrs but less than 6weeks after

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3
Q

PPH causes

A

Tone
Tissue
Trauma
Thrombin

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4
Q

PPH caused by uterine atony

What is it
Associated with what

A

Lack of tone

Associated with:
High parity
Polyhydramnios/macrosomia
Multifetal gestation
Prolonged labor
Mg sulfate (muscle relaxer)

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5
Q

PPH caused by tissue

A

Failure of placenta to expel within 30 mins

Nonadherent fragments
And
Adherent fragments

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6
Q

PPH caused by trauma

A

Laceration:
Vaginal bleeding with firm fundus

Hematoma:
<3cm (ice and pain control)

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7
Q

PPH caused by thrombin

A

Thombocytopenia caued by HELLP

DIC: replace coagulation factors

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8
Q

Safety bundle:

A
  1. Readiness (equipment and people)

2.recognition and prevention (assessment)

3.response (plan)

4: reporting and systems learning (debriefing)

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9
Q

PPH care management
1st treatment
What todo for clots
Bladder
Med/fluids
Other meds

A

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

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10
Q

Uterotonic meds

A

Oxytocin
Methylergonovine
Misoprostol (cytotec)
Carboprost

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11
Q

Oxytocin

Route
Assess

A

IV or IM

Assess uterine tone and bleeding

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12
Q

Methylergonovine

Route
Assess
Do not give if
Monitor what

A

IM

Assess uterine tone and bleeding

DO NOT GIVE IF HYPERTENSIVE

Monitor BP and N/V

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13
Q

Misoprostol

Route

CI

A

Rectal

CI: any comorbidities (heart/lungs/hepatic)

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14
Q

Carboprost

Route
Montiro what s/she
CI

A

IM

Monitor: fever, chills, HA, N/V (FLU-LIKE)

CI: any comorbities (asthma/lungs, renal, hepatic)

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15
Q

PPH care interventions

type of compression
surgeries
A

Bimanual compression

Surgical man:
-D&C (remove stuff)
-bakri temponade balloon
-uterine artery ligation
-hysterectomy

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16
Q

Hemorrhagic shock

What is happening
Management(6)

A

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

17
Q

VTE
RF

A

Pregnant
Hx of VTE
C/s
Obesity
Smoking
>35 y/o

18
Q

Diagnotic test for VTE

A

Doppler US
CT

19
Q

VTE meds

A

Heparin
Warfarin

20
Q

Heparin

How long
Labs
Antidote

A

3-5days
PTT- 1.5-2.5 times norm

Antidote: protamine sulfate

21
Q

Warfarin

Route for how long
Antidote
How aften you have to be tested

A

Oral for 3 months

Anitdote: VIT K

Constant testing

22
Q

Postpartum infection

Temp needed
When
Criteria

A

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

23
Q

Mastitis

What it is
S/s
Tx

A

Breast tissue infection

S/s:
Malaise
Flu-like
Sore/painful

Tx:
breast emptying
warm compresses
abx

24
Q

Endometritis

What is it
S/s
Tx

A

Infection of the lining of the uterus

S/s:
Foul smell
Lower abd pain
Lethargy

Tx:
Broad spectrum abx

25
Q

Wound infections

How to assess
Tx

A

REEDA:
Reddness, edema, echymosis, drainage, approximation

Tx:
Abx
Wound care

26
Q

UTI

S/s
Tx

A

Hematuria
+ for nitrates

Tx:
Abx
Push fluids

27
Q

Postpartum blues vs depression

A

Blues: resolves in 2 wks

Depression: lasts beyond 5-6 wks

28
Q

Postpartum depression

Screening
When to do it

A

Edinburgh postnatal depression
Postpartum depression screening scale

At infant 1wk, 2wk

29
Q

Postpartum psychosis

When do you get it

Associated with what

S/s

A

Within 3 wks of giving birth

Associated with: bipolar do

S/s:
Sleep isssues
Paranoia
Depression
Thoughts of homicide and infanticide

30
Q

Postpartum psychosis tx

A

Meds

CBT

N330 (17 decks)

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