CH 22 Flashcards
Common Postpartum Disorders - 4
- hemorrhage
- infection
- thromboembolic disease
- postpartum affective disorder
Postpartum hemorrhage Blood Loss
> 500mL following a vaginal birth
> 1,000mL following a c-section
-any amount of bleeding that places the mother in hemodynamic jeopardy
-some of the liquid can be amniotic fluid
Causes of Postpartum Hemorrhage
- most common = uterine atony - need uterine to contract
- lacerations of the genital tract - didn’t see lacerations and didn’t sew it up
- episiotomy - some can bleed and not be sewn up
- retained placental fragments - whole placenta needs to come out
- uterine inversion - doctor too quick to pull out the placenta and the uterus comes out with it
- coagulation disorders
- hematomas of the vulva, vagina, or subperitoneal areas - can do a lot of bleeding. Keep an eye on this.
4 T’s of Postpartum Hemorrhage
TONE: uterine atony, distended bladder (right side)
TISSUE: retained placenta and clots
TRAUMA: vaginal, cervical, or uterine injury (lacerations)
THROMBIN: coagulopathy (pre-existing or acquired)
Postpartum Hemorrhage: therapeutic management
-focus on underlying cause - gonna keep bleeding, need to fix problem
-uterine massage
-removal of retained placental fragments - Dr will stick hand up to get anything out
-antibiotics for infection - uterus may not want to contract so tx infection
-repair of lacerations
Postpartum Hemorrhage: RN Management
- fundal massage - 1st line of defense, get uterus to contract
- pad count - can weigh them
- admin of uterotonic meds — oxytocin, misoprostol (Cytotec) given rectally, Methylergonovine (Methergine) inject into uterus or IM shot can cause high BP, Carboprost (Hemabate) works well, very $$$ so last resort.
- fluid administration
- monitor for s/s of shock : cool, clammy, hypotension, tachycardia
- emergency measures of DIC (disseminated intravascular coagulation) occurs
Subinvolution
-Incomplete involution of uterus after birth. Uterus is not contracting after birth. Can hemorrhage to death.
-causes: retained placental fragments, distended bladder, uterine myoma, infection
Complications: hemorrhage, pelvic peritonitis, salpingitis, abscess formation
Thromboembolic Conditions
Inflammation of blood vessel lining
-causes blood clots
-venous stasis - sitting too long, pregnant
-injury to innermost layer of blood vessel
-hypercoagulation
3 Most Common Types of Thromboembolic Conditions
- superficial thrombosis
- deep vein thrombosis
- pulmonary embolism
Risk Factors of Thromboembolic Conditions
-smoking
-oral contraceptives
-prolonged standing
-hx of thrombosis
-varicose veins
S/S of Thromboembolic Conditions
pain
redness
warmth
Thromboembolic RN Management
-prevention
-adequate circulation : NSAIDs, bed rest, antiembolism stockings, anticoagulant therapy (heparin)
-education
Postpartum Infections
- fever >38C or 100.4F after first 24hrs
- organisms usually those of normal vaginal flora (aerobic and anaerobic)
- METRITIS: infection of endometrium, decidua, and adjacent myometrium
- wound infections
- UTIs
- MASTITIS: inflammation of the breast
Postpartum Infections Therapeutic Management
-broad spectrum antibiotics for METRITIS
-wound care for wounds
-fluids & antibiotics for UTIs
-breast emptying & antibiotics for MASTITIS
-infection prevention - aseptic technique, hand washing, perineal hygiene
REEDA method for assessing Perineum Healing
R: redness
E: edema
E: ecchymosis
D: discharge
A: approximation of skin edges
