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Gender And Reproductive Health Finals > 4500 Class 8 — Postpartum Hemorrhage > Flashcards

4500 Class 8 — Postpartum Hemorrhage Flashcards

1
Q

3 main topics covered in Complications in Postpartum

A
  1. PP Hemorrhagr
  2. PP Depression
  3. PP Infection (Madtoitis & Endometritis)
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2
Q

What are VTE Disorders (according to readings?) p. 539-541

A
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3
Q

What is thrombophlebitis? p. 539

A
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4
Q

What is superficial venous thrombosis? p. 539

A
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5
Q

What is DVT? p. 539

A
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6
Q

What is pulmonary embolism? p. 539

A
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7
Q

Who is most at risk developing VTE disorders?

A
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8
Q

What are clinical manifestations of DVT?

A
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9
Q

What are clinical manifestations of PE?

A
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10
Q

What are you looking for during assessment to identify DVT or PE?

A
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11
Q

Nursing interventions to help prevent DVT or PE from occuring postpartum period?

A
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12
Q

What is the main medical treatment fro DVT and PE?

A
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13
Q

Ebl in vaginal delivery

A

> 500 mL

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14
Q

Ebl in caesarean birth

A

> 1000 mL

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15
Q

What is considered early/primary/acute PPH

A

within 24 hours of delivery

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16
Q

What are the top causes of POSTPARTUM HEMORRHAGE? (4 Ts)

A
  1. TONE — Uterine Atony
  2. TISSUE — Retained Placenta, Placenta accrete / Increta / Percreta (MAL ATTACHMENT OF PLACENTA)
  3. TRAUMA — Uterine Inversion, Uterine Rupture, Laceration, Hematoma, Episiotomy
  4. THROMBIN — Coagulopathies
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17
Q

What are trauma that could cause PPH

A
  1. UTERINE INVERSION
  2. UTERINE RUPTURE
  3. LACERATION
  4. HEMATOMA
  5. EPISIOTOMY
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18
Q

What are active management in 3rd stage of labor that can prevent PPH?

A
  1. OXYTOCIN - uterotonics as ordered
  2. FUNDAL MASSAGE
    2, GENTLE CORD TRACTION - done by physician. Can consider delayed cord clamping

Inspect placenta
Prevent full bladdrr

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19
Q

It is hypotonia, or relaxation of the uterus
- uterus not contracting well

A

UTERINE ATONY

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20
Q

Manifestion of uterine atony

A

Blood loss of 500 ml per minute
- boggy uterine, 2-3/u

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21
Q

WHAT ARE RISK FACTORS AND CAUSES FOR POSTPARTUM HEMORRHAGE

A
  1. Often results when the uterus is “overstretched” or overdistended from..
    a. Fetal macrosomia / large fetus
    b. Polyhydramios
    c. distention with clots
  2. HIG PARITU
  3. Hx of uterine atony
  4. OVERTIRED UTERUS - prolonged labour and induction/augmentation with oxytocin
  5. Birth Trauma — vacuum- or forceps-assisted delivery
  6. Magnesium sulphate administration during labor or postpartum period
  7. Anaesthesia and analgesia —
  8. Chorioamnitis
  9. Uterine suninvolutiom
  10. Obesity
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22
Q

Uterine Atony NURSING MANAGEMENT

A
  1. Uterine/fundal massage
  2. EMPTY BLADDER — indwelling cath may se inserted, rationale: a full bladder pushes an uncontracted uterus into an even more i]uncontracted state
  3. ENSURE LARGE BORE IV ACCESS
  4. Administer UTEROTONIC MEDICATIONS
  5. Administer BLOOD COMPONENTS as ordered

— may require more extesive procedures (bimanual compression/surgical procedures)

— ** DO ACCURATE ins and outs when person is bleeding

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23
Q

Name top 4 UTEROTONIC DRUGS

A
  1. OXYTOCIN
  2. MISOPROSTOL
  3. CARBOPOST
  4. ERGOMETRINE (ERGONOVINE)
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24
Q

OXYYYYY TOCIN

A
  1. It is the 1st line drug for uterine atony
  2. Different dosing compared to labour
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25
Q

How do we give Oxytocin as uterotonic drug during a PPH?

A

10-40 units in ringers lactate

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26
Q

It is a uterotonic drug that
- is also used as a cervical ripening agent
- given orally / rectally
- can cause increase in temp

A

MISOPROSTOL

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27
Q

It stimulates muscle layers of uterus.
Given IM or directly to uterus during c-section.

A

CARBOPROST

28
Q

A uterotonic drug that can cause diarrhea

A

CARBOPROST

29
Q

Ot is a uterotonic drug that can cause bronchospasm

A

Carboprost

30
Q

A uterotonic drug that we must avoid giving to people with asthma

A

Carboprost

31
Q

A uterotonic drug that is NOT for people with high BP or Hx of HTN

A

ERGOMETRINE (ERGONOVINE)

32
Q

What are issues in TISSUE that may cause PPH???! Name four!

A
  1. Retained placental fragments — Succenturiate lobe-jagged edge of placenta
  2. Placental abruption
  3. Placenta previa
  4. PLACENTA ACCRETE, INCRETA, PERCETA (mal-attachment of placenta)
33
Q

problem during pregnancy when the placenta completely or partially covers the opening of the uterus (cervix)

A

PLACENTA PREVIA

34
Q

Adnormal sdherance of placenta that may cause PPH

A

Placenta accreta/ increta/ perceta

35
Q

How is placenta accreta/increta/perceta confirmed?

A

MRI

36
Q

When to intervene in placenta increta/accreta/perceta???

A

If pass e0 minutes, manual removal of placenta

— there will be lots of bleeding, hard to pull off the wall

37
Q

Nursing management of RETAINED PLACENTA

A

VS
Astute assessments
1. Could require manual removal of placenta — by obstetrical care provider
Pain control.
IV access with large bire IV (18G)
Ensure correct sponge and needle count.
Tocolytic may be required/
2. Labs
3. Blood components as ordered
4. Uterotonics as ordered

** HYSTERECTOMY may be indicated in the case of ACRETA/ INCRETA/ PERCRETA

38
Q

What are considered trauma that could cause PPH

A
  1. Lacerations
  2. Trauma during labour and birth — forceps-assissten and vacuum-assissted
  3. Trauma during caesarean
  4. Rupture uterus
  5. Inversion of uterus
  6. Manual removal of a retained placenta
39
Q

What happens in the inversion of the uterus

A

Uterus turns inside out. It is potentially life threatening

40
Q

Uterus cannot be seen, but felt.

A

Incomplete inversion of uterus

41
Q

Lining of uterus protrudes

A

Complete inversion

42
Q

When uterus protrude 20-30 sm, round large mass in place***?

A

Prolapse

43
Q
  1. Fundal implantation of the placenta
  2. Vigorous fundal pressure
  3. Excessive traction applied to cord
  4. Fetal macrosomia
  5. Tocolysis
  6. Prolonged labor
  7. Uterine atony
  8. Abnormally adherent placental tissue
A

causes of inversion of uterus

44
Q

Inversion of the uterus NURSING INTERVENTION

A
  1. Call for help! It is an emergency situation
  2. Ensure large bore IV 918G) is in place
  3. Fluid resus as ordered
  4. Uterus must be placed into the pelvic cavity by the obstetrical health care provider
  5. Tocolytics or halogenated anesthetics may be given to relax the uterus before attempting to replace
  6. Uterotonics generally administered after uterus is replaceed

Avoid aggressive fundal massage

45
Q

It is often described as a “slow-trickle” or oozing — a constant flow
It usually a result of
a. Difficult or precipitous (fast) births
b. Fetal size, abnormal presentation, position
c. Operative assisted vaginal birth (vacuum or forceps)

A

LACERATION

46
Q

Nursing management of LACERATION

A
  1. IV as needed
  2. Assis pain management and repair
  3. Ensure correct sponge and needle count during repair
  4. If packing is inserted, clearly document including the time insetted, how much, amd where
  5. Pt education
  6. Labs as needed
47
Q

What is the simplest definition of a hematoma

A

It is the collection of blood in the connective tissue — concealed!

48
Q

What is the most common form of hematoma

A

Vulvar

49
Q

It is rare, life threatening, can happen in caesarean. Patient will feel rectal pain! Pt in significant pain. May require surgical evacuation.

A

Retroperitoneal HEMATOMA

50
Q

Differentiate Uterine Atony VS. Trauma

A

In uterine atony
1. UTERINE IS BOGGY
2. Bleeding is INTERMITTENT
3. CLOTS & DARK blood

In trauma
1. Uterus is FIRM
2. CONTINOUS BLEEDING
3. Blood is BRIGHT RED (arterial)

51
Q

What are Thrombin - COAGULOPATHIES that can cause PPH

A
  1. ITP (Idiopathic Thrombocytopenia Purpura)
  2. Von Willebrand Disease
  3. DIC (Disseminated Intravascular Coagulation)
52
Q

ITP. What is it?

A

Idiopathic Thrombocytopenia Purpura

It is an autoimmune disorder where antiplatelet antibodies decrease the lifespan of plate;ets — result in longer bleeding time

53
Q

What to do with ITP?

A

Platelet transfusion!

54
Q

It can cause HTN.
Factor 8 deficiency and platelet dysfunction which leads to prolonged bleeding time.

It will increase risk for PPH.

A

Von Willebrand Disease

55
Q

What to give w pt’s with von willebrand disease

A

DDAVP - Desmopression

Acetate

(IV 30 mins before birth of newborn)

56
Q

What happens with DIC?

A

When there is an imbalance between the body’s clotting and fibrinolytic system.
It is an acquired clotting disorder where low fibrin level
Initiall lots at the sire of bleed then tehre will be deficit in the remainder of body

57
Q

What are signs that there might be DIC

A

Bloodwork reveals — decreased PLT, fibrinogen, prothrombin

Diaphoresis

TACHY

HYPOtension

Peteciae around where BP was placed

Spontaneous bleeding from gums, nose, IV site, IM site. subcut injection. Etc

58
Q

What are the risk factors that may cause DIC

A

Acute APH

Acute PPH

Placental abruption

Aminotic fluid embolism

Fetal demise that remains in utero for extended periods

Severe preeclampsia

Sepsis

+ still birth

59
Q

When suspecting DIC, that to do???

A

Rule out other clotting disorders first!

60
Q

Therapy for DIC — disseminated intravascular coagulation

A

FLUID REPLACEMENT as ordered

BLOOD COMPONENT REPLACEMENT as ordered

Optimization of oxygenation and perfusion

Labs as ordered

Consider placement of FOLEY with urometer

Emplain and support

61
Q

What can happen w DIC.

A

Renal failure.
Urinaty output should be more than 30 ml / hour

62
Q

What is given to support blood clotting

A

TRANEXAMIC ACID - an antifibrinolytics drug

63
Q

What are these a sign of…

Rapid & shallow resps

Rapid, irregular, weak pulse

Decreased BP (late sign)

Pale, cool, clammy skin

Decreased urinary output

Increasing anxiety and disorientation

Lethargic

A

HEMORRHAGIC SHOCK

64
Q

What to do — HENORRHAGIC SHOCK

A
  1. IV AV+CCES LARGE BORE IV (18G) — ,ah require two lines
  2. FLUID REESUS
  3. Blood component administratiom
  4. Lab studies as ordered
  5. O2 administration
  6. Uirnary output — indwelling i]urinary catheter
65
Q

What to assess for PP bleeding?

A

CBC

IV
Tocolytics

Uterotonics

Gender And Reproductive Health Finals (6 decks)

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