Challenges PP and mental health Flashcards
PPH stats?
Occurs in 5% of all births and is leading cause of maternal death worldwide
Primary vs secondary PPH?
P- early PPH, occurs from birth to 24 hrs
S- late PPH, occurs 24 hrs to 6 weeks
Definition of PPH?
> 500 mL blood loss vaginal delivery and >1000 mL from C-section (this is hard to count but can estimate with pads). Also any blood loss which results in hemodynamics instability (shock).
CVS changes in pregnancy?
Increased blood volume/stroke volume, increased CO and pulse. S
Some S+S of hemorrhagic shock?
Decrease in BP, dizzy, tachycardia, weak, sweating, palpitations, pallor, and oliguria
What can we do for PPH?
Early identification of risk factors, prevention, prompt recognition and intervention
Risk factors for PPH?
Long labour, uterine over distension, placenta previa/abruptio, labour induction/augmentation, use of vacuum/forceps, C-section, prolonged 3rd stage of labour, and multiparity
How to prevent PPH in 3rd stage?
Give oxytocin with delivery of anterior shoulder with vag delivery. C-section given carbetocin or oxytocin. Palpate the fundus and maintain tension on the cord
Signs of PPH?
Rise in level of fundus (above umbilicus), boggy uterus (doesn’t respond to massage), abnormal clots (>loonie), persistent moderate lochia rubra, bright red bleeding, increase pulse/decreased BP, bleeding when uterus is contracted, decreased LOC, pelvic discomfort and backache
Nursing assessment to recognize PPH?
Look at uterine tone, placenta (is it intact, all parts out), perineum (tears or lacerations), and any hematoma
4 Ts of what might cause a PPH?
Tone- uterine atrophy (most)
Trauma- laceration, tears
Tissue- retained products- membranes, clots, placenta parts
Thrombin- pre existing condition interferes with bodies ability to clot like DIC, HELLP (least)
What is uterine atony? and some causes
Most common cause of PPH when uterus doesn’t want to contract and there is a lack of uterine muscle tone. Causes- overdistended uterus (multiple gestation, LGA, polyhydraminos), exhausted (high parity, long labour), infection (prolonged ROM, fever in labour), abnormalities (uterine)
What is trauma under PPH? and 3 causes
Cervical/vaginal/perineal lacerations suspected when bright red bleeding occurs in presence of contracted uterus. Causes- hematoma (extreme pain in perineal area and swollen), uterine inversion (uterus inverts and turns inside out, causes blood to leak into peritoneal cavity), and uterine rupture
Tissue under PPH?
Retained products could include blood clots, retained placental lobes or membranes. This is a common cause of late PPH. Need to inspect placenta thoroughly after delivery to prevent this
What is retained placenta?
Retention of placenta 30min after birth. If not expelled it can be manually removed with gloved hand to separate placenta from uterine wall.
Treatment for PPH?
Fundal massage to check for clots/tissue/contract uterus, empty bladder (b/c full one impairs involution), administer oxytocin/cytotec/carbetocin (uterine stimulants), and administer antifibrinolytics as ordered to maintain clot stability (tranexamic acid).
What to do if bleeding persists?
Call for help, notify MRP. Anticipate these orders: large bore IV access (18G), IV bolus, oxytocin, meds: cytotec, ergometrine, hemabate, carbetocin (uterotonic), tranexamic acid (antifibrinolytic). CBC, transfusion, foley, O2, NPO, massage, pack uterus/bakri balloon, hysterectomy (worst case)
What are PPH meds used to control bleeding/uterus?
Oxytocin IV, Misoprostal/cytotec 400-800 ug SL/PO/PR, carboprost/hemabate 250 ug IM, and ergotrate 0.25 mg
Clients at risk for thrombosis formation?
Venous stasis, hypercoagulation, not very mobile
How to prevent thrombosis and interventions?
Prevent- avoid smoking, sitting/standing in one position for long period, oral contraceptives, encourage early activity/leg exercises
I- compression devices, anticoagulants
4 different PPH infections?
- Metritis (uterine infection)- causes Abdominal pain, fever, foul lochia, nausea/anorexia, fatigue, lethargy, WBC
- Wound infection (surgical, laceration, episiotomy)- REEDA, pain/tenderness at site, fever, WBC
- Urinary Tract Infection- drink lots, void frequently
- Mastitis- lump in breast that’s persistent, area is warm/red/painful/swollen/hard
Some PPH danger signs?
Fever >38, foul odour to lochia/unexpected change to colour or amount, large blood clots/saturating 1pad/hr, sever headaches/visual changes, calf pain, swell/red at incision, dysuria, SOB, depression
Risk factors for PPH mental health disorders?
Hx of depression (discontinue anti-depressants), low income, single, age (very young or old), lack of support, interpersonal violence, substance abuse, stress, unplanned pregnancy, difficult pregnancy/delivery, and INDG/new immigrants
What does PPH depression cause?
Depressed mood most of day, anhedonia (decreased pleasure in activities), weight change, insomnia, decreased energy, feel guilt/worthless, decreased concentration, thoughts of death, and restless/agitated
What is PPH pinks?
Elation of mood hrs to days after birth. It’s normal to be excited/happy but need to monitor extremes in mood.
What is PP blues?
Normal emotional response and 85% of women recover by 2 weeks. If depressed for 2-3 days it increases risk of PPH
What is PP psychosis and symptoms?
Very rare and has increased risk of recurrence with subsequent births. Causes insomnia, agitation, hallucinations, self harm, homicide, infanticide, bipolar, and mood swings. Usually occurs in 1st few weeks PP
What is PP anxiety?
Inability to relax, fearfulness, over concern with baby, have high parenting expectations of themselves. Can experience panic attacks (tension, sweat, palpitation). Usually goes together with depression
What is OCD?
Have instructive repetitive thoughts (like harming the baby) which causes guilt/worry. Then they complete a behaviour to avoid harm/the thoughts
Effects of women with stress/worry on different stages of pregnancy?
Pregnancy- could be preterm, HTN, less prenatal care, placenta abruption
Birth- more likely epidural, operative birth
Newborn- low APGAR score, fussier, <BF, sleep issues
PP- psychosis, suicide
