Ch 31 + 33 postpartum complications Flashcards
definition of early PPH
-cumulative blood loss >1000 mL
-blood loss w/ S+S of hypovolemia
-within 24 hrs after birth (includes blood loss during birth)
causes early PPH (4 Ts)
-tone: uterine atony
-trauma: lacerations
-tissue: retained placenta
-thrombin: clotting abnormalities
risk factors uterine atony
-high parity
-labor dystocia/trauma during L&D
-rapid/prolonged labor
-use of oxytocin during labor
-anesthesia and analgesia
-over-distended uterus
-previous history
-magnesium sulfate admin
-chorio
-placenta previa/abruption
what part of hand do you use to massage fundus during uterine atony
palm of hand
Tx uterine atony
-massage fundus
—-if doesn’t work——:
-bimanual exploration and massage
-uterine tonics
anticipatory prep nursing interventions for uterine atony
-IV access with large bore catheter
-blood in lab
-uterine tonics readily available
-keep bladder empty
nursing interventions uterine atony
-call for immediate help
-empty bladder if distended
-massage fundus
-IV fluids
-administer oxytocin, uterine tonics
-position and O2 (if hypovolemic)
-administer blood prn
1st drug of choice for PPH
oxytocin
adverse effects of oxytocin admin
-HTN
-severe uterine Cxs
adverse effects of misoprostol (cytotec) - causes uterine contractions
-headache
-N/V/D
-fever
-chills
meds for PPH (uterine stimulant meds)
-oxytocin/pitocin
-cytotec
-methergine
-hemabate/carboprost
adverse reaction to methergine
HTN
contraindications to methergine
-HTN
-preeclampsia
-cardiac disease
when would you not be able to admin methergine for PPH
if BP >140/90
side effects all uterine stimulant meds (prostaglandins)
-headache
-N/V/D
-fever
-chills
contraindications to admin of hemabate/carboprost
asthma
HTN
what VS to check with hemabate/carboprost
temp q1-2h
breath sounds
what pts should dinoprostone (prostin) be used with caution with
-asthma
-HTN/hypoTN
purpose of tranexamic acid (TXA)
interferes with break down of clots
what pts would use of tranexamic acid (TXA) be contraindicated with
-known thromboembolic event during pregnancy
-h/o coagulopathy
risk factors lacerations
-operative birth
-precipitate labor (fast)
-congenital abnormalities
-contracted pelvis/pelvic dystocias
-abnormal fetal characteristics
-previous scarring
-variscocities
S+S lacerations
-firm, contracted fundus
-continued bleeding
S+S pelvic hematomas
-pain/pressure unrelieved by analgesics
-pressure
-shock
PPH after 24 hrs of birth
late PPH
most common cause late PPH
uterine subinvolution
2 causes uterine subinvolution
-infection
-retained placental fragments
S+S late PPH
-vaginal bleeding (usually slow, oozing
-low, persistent backache
-abdominal pain/tenderness
-fatigue
Tx late PPH
-oral methergine
-oral Abx
-re-evaluate in 2 wks
-if frank hemorrhage without response to uterine tonics: D&C
risk factors PP (puerperal) infections
-ROM >24 hrs
-lacerations/incisions
-hemorrhage, hematomas
-anemia/poor physical health before birth
-intrauterine manipulation during labor/birth/pp
S+S puerperal infections
-fever (after 1st 24 hrs)
-site specific S+S
S+S perineal infection
-red, swollen, very tender
-purulent drainage
-wound dehiscence
infection of uterus PP
endometritis
S+S endometritis
-fever
-N/V
-malaise, anorexia
-foul smelling discharge
-abdominal distention
-uterine distention
-decreased bowel sounds
-lochia return from serosa to rubra
causes endometritis
-birth
-prolonged ROM
-vaginal exams
-poor hygiene
Tx endometritis
-IV Abx
-fowlers/semifowlers position
-palpate fundus q8h
prevention of mastitis
-frequent feeds
-good latch
-teach early S+S
-warm line (phone # for PP nurse/hospital)
-2 week PP visit
risk factors thromboembolic disease
-venous stasis
-immobility
-endothelial damage (stirrup use)
-increased clotting of pregnancy
-wound infection
-obesity
-previous history
-heart disease
-varicosities
S+S thromboembolic disease
-abrupt onset
-sever leg pain
-edema
Tx thromboembolic disease
-consultation
-anticoag therapy
S+S superficial thrombophlebitis
-day 3-4 PP
-tenderness
-heat
-redness
-low grade fever
-elevated pulse
Tx superficial thrombophlebitis
-heat
-elevate
-analgesia
-bedrest
-support hose
-anticoags
prevention of DVT
-good hydration
-early ambulation
-avoid long use stirrups
-minimize blood loss
-avoid estrogen until 2 weeks PP (or done breastfeeding)
S+S pulmonary embolism
-dyspnea, SOB
-cough, hemoptysis
-tachycardia
-chest pain
nursing interventions pulmonary embolism
-O2
-IV access
-raise hob
-notify hcp
S+S baby blues
-should go away in about 10 days
-sad, anxious, overwhelmed
-crying spells
-loss of appetite
-difficulty sleeping
S+S PP depression
-same as baby blues but last longer and more severe
-thoughts of harming self/baby
-uninterested in baby
screening tools for PP depression (3)
-EPDS: edinburgh postnatal depression screen (gold standard)
-PDSS: postpartum depression screening scale
-two item screen
red flags for PP depression (identified during antenatal period)
-lack of acceptance of pregnancy
-excessive mood swings
-withdrawal
-preoccupation with appearance
-excessive physical complaints
-failure to prepare for baby
red flags for PP depression (during PP period)
-excessive fatigue
-marked depression
-preoccupation with physical status
-low self esteem
