Ch. 21 postpartum complication Flashcards
Define postpartum hemorrhage
Loss of 500ml or more of blood for vaginal birth
Loss of 1000ml or more of blood for cesarean birth
Define uterine Antony
Marked hypotonia (relaxation) of the uterus
What is the leading cause of early postpartum hemorrhage
Uterine atony
What happens if the uterus is flaccid after detachment of all parts of the placenta
Brisk venous bleeding occurs and normal coagulation of the open casulature is impaired and continues until the uterine muscle is contracted
What are some of the common associations of uterine atony
High parity, polyhydramnios, fetal macrosomia, multifetal gestation
Uterus is overstretched and contracts poorly
When is the placenta said to be retained
If it has not been expelled within 30min after birth
Define pelvic hematomas
Collection of blood in the connective tissue
Vaginal hematomas are commonly associated with
Forceps-assisted birth
episiotomy
primigravidity
Retroperitoneal hematomas are commonly associated with
Laceration of the vessels, rupture of cesarean scar
How are hematomas corrected
Surgically evacuated, pain relief, monitor bleeding, replace fluids, review labs
Define uterine inversion
Turning inside out
What are some of the contributing factors to uterine inversion
Fungal implantation of placenta, vigorous fungal pressure, excessive traction applied to cord, fetal macrosomia, short umbilical cord, tocolysis, prolonged labor, uterine atony
What are the presenting signs of uterine inversion
Sudden hemorrhage, shock, pain, uterus is not palpable abdominally
Why are tocolytics given before attempting to replacing uterus when inversion is suspected
To relax the uterus
What medications are given after uterine involution has been corrected
Oxytocin, and antibiotics
Define subinvolution
Delayed return of the enlarged uterus to normal size and function
What are the common causes of subinvolution
Retained placenta fragments and pelvic infection
What are the signs and symptoms of subinvolution
Prolonged lochia discharge, irregular or excessive bleeding, hemorrhage
How do we treat subinvolution
ergotrate or methergine
These drugs will contract the uterus
What is the initial management for excessive postpartum bleeding due to uterine atony
Fungal message
T/F ergonovine and methergine are contraindicated in the presence of hypertension or cardiovascular disease
true
Define hypovolemic shock
It is a physiological compensatory mechanisms that are activated in response to hemorrhage.
What is the circular pattern of hypovolemic shock
Decreased profusion, increased tissue anoxic, acidosis, edema formation, pooling of blood further decreasing perfusion. Cellular death
What are the characteristics of hypovolemic shock
Rapid shallow respiration Rapid weak and irregular pulse Decreasing BP Cool, pale, clammy skin Decreased urinary output Lethargy, anxiety ---> coma Decreased central nervous pressure
What interventions need to be initiated when hypovolemic shock is suspected
Call for assistance
Start IV
Ensure patent airway give oxygen 10-12L
Monitor vitals
What is idiopathic immune thrombocytopenic purpura
Autoimmune disorder in which antiplatelet, antibodies decrease the life span of the platelets
What are the common diagnostics findings of ITP
Thrombocytopenia, capillary fragility, increased bleeding time
How do we treat ITP
Corticosteroids, IV immune globulin, platelet transfusion
What is disseminated intravascular coagulation
An imbalance between the body’s clotting and fribrinolytic systems
DIC can occur as a result
Hemorrhage, abruption placentae, amniotic fluid embolism, dead fetus syndrome, preeclampsia, sepsis, saline abortion, acute fatty liver
Diagnosis of DIC is made by which presenting clinical findings
Excessive bleeding, spontaneous bleeding, tachycardia, diaphoretic
How do we manage DIC
Correcting cause, volume replacement, optimizing oxygenation and perfusion
Because renal failure is one consequence of DIC, unitary output is
Closely monitored and must be maintained at more than 30ml/hr
Describe what a venous thromboembolism
Formation of a blood clot inside a blood vessel and is caused by inflammation or partial obstruction of the vessel
What is the medical management for DVT
Initial IV therapy w/ heparin
bedrest
Legs elevated
Oral warfarin for 3months
Are pregnant women allowed to take Coumadin (warfarin)
No, it is contraindicated
Lactating women can
What is endometritis
Infection of the lining of the uterus
What is a genital fistulas
Abnormal passageways b/w genital tract organs
What are the common signs and symptoms of vaginal fistulas
Presence of urine, flatus, feces in the vagina, odors, irritation
T/F Women with a history of asthma should not receive Methylprostaglandin (Carboprost (hemabate) because it causes bronchoconstriction
True
