CHAP 25 - POSTPARTUM COMP Flashcards
Assessing the Postpartum Patient with Complications
EFPTP
DRUAP
PLPP
Elevated temperature
Feeling of extreme sadness or unreality
Pallor
Thready, rapid, weak pulse
Pain and swelling
Decreased blood pressure
Relaxed uterus
Uterine hemorrhage
Abdominal pain
Pain of symphysis pubis on walking
Perineal pain
Lochia with foul odor
Pain and tenderness in calf of leg
Positive Homans sign
Expected outcomes for discharge include:
Lochia is free of foul odor.
Fundus remains firm and midline with progressive
descent.
Patient maintains a urinary output greater than 30 mL/h
Lochia discharge amount is 6 in or less on a perineal pad
1 hour.
Patient maintains vital signs and oxygen saturation
within defined normal limits.
Patient identifies signs and symptoms that should be
reported.
Patient demonstrates attachment behaviors with infant
despite separation or activity restriction.
HEMORRHAGE
one of the primary causes of mortality associated with childbearing,
is a major treat during
pregnancy, throughout labor, and continuing into the postpartum period.
4 Main Reasons for Postpartum Hemorrhage
1) Tone - uterine atony
2) Trauma - lacerations, hematomas, uterine inversion, or
uterine rupture
3) Tissue - retained placental fragments
4) Thrombin - development of disseminated intravascular
coagulation (DIC)
TONE
UTERINE ATONY
TRAUMA
lacerations, hematomas, uterine inversion, or
uterine rupture
TISSUE
retained placental fragments
THROMBIN
development of disseminated intravascular
coagulation (DIC)
or relaxation of the uterus, is the most
frequent cause of postpartum hemorrhage; it tends to occur
most often in Asian, Hispanic, and Black patients.
UTERINE ATONY
UTERINE ATONY
or relaxation of the uterus, is the most
frequent cause of postpartum hemorrhage; it tends to occur
most often in Asian, Hispanic, and Black patients.
S/sx of Uterine Atony
1) Abrupt gush of blood
2) Hypovolemic shock
3) Falling BP
4) Rapid, weak, o rthready pulse
5) Increased and shallow respirations
6) Clammy skin with hypopigmented mucocutaneous
surfaces
7) Increasing anxiety
Conditions that Distend the Uterus Beyond Average
Capacity
1) Multiple gestation
2) Polyhydramnios (excessive amount of amniotic fluid)
3) Large baby (greater than 9 lb)
4) Presence of uterine myomas (fibroid tumors)
Conditions that Could Have Caused Cervical or Uterine
Lacerations
1) Operative birth
2) Rapid birth
Conditions With Varied Placental Site or Attachment
1) Placenta previa
a) Low lying placenta
b) Marginal placenta
c) Partial previa
d) Complete previa
2) Placenta accreta
a) Accreta
b) Increta
c) Percreta
3) Premature separation of the placenta
4) Retained placental fragments
Conditions that Leave the Uterus Unable to Contract Readily
1) Deep anesthesia or analgesia
2) Labor initiated or assisted with an oxytocin agent
3) High parity or age over 35 years of age
4) Previous uterine surgery
5) Chorioamnionitis or endometritis
6) Secondary illness such as anemia
7) Prior history of postpartum hemorrhage
8) Prolonged use of magnesium sulfate or other tocolytic
therapy
Conditions that Lead to Inadequate Blood Coagulation
1) Fetal death
2) Disseminated intravascular coagulation
Additional Measures That Can Be Helpful To Combat
Uterine Atony Include:
Elevate the patient’s lower extremities to improve
circulation to essential organs.
Offer a bedpan or assist the pt to the bathroom at least
every 4 hours to be certain their bladder is emptying
because a fulll bladder predisposes a patient to uterine
atony.
Administer oxygen by face mask at a rate of about 10-12
L/min.
Obtain vital signs.
other therapeutic management of uterine atony
1) Bimanual Compression
2) Blood Replacement
3) Hysterectomy or Suturing
Therapeutic Management for Uterine Atony
1) Oxytocin bolus/infusion
2) Tranexamic acid for bleeding
3) Carbopost thomethamine
4) Misoprostol (cytotec)
5) Prostaglandin F2a derivative
6) Methylergonovine maleate (Methergin)
HOW MANY DEGREE OF SEPERATION
4 (0-3)
GRADE 2
VAGINAL BLEEDING, UTERINE CONTRACTIONS, NO SIGNS OF MATERNAL SHOCK, SIGNS OF FETAL DISTRESS PRESENT
PPC
Partial abruption concealed hemorrhage
Partial abruption apparent hemorrhage
Complete abruption, concealed hemorrhage
is a prolapse of the fundus of the uterus
through the cervix so that the uterus turns inside out.
UTERINE INVERSION
GRADE 0
ASYMPTOMATIC, SMALL RETROPLACENTA CLOT DETECTED
GRADE 1
VAGINAL BLEEDING, UTERINE IRRITABLITY, AND TEDNERNESS PRESENT; NO SIGN OF MATERNAL OR FETAL DISTRESS
GRADE 3
SEVERE BLEEDING PRESENT OR CONCEALED
UTERINE HYPERTONOUS
WOODEN HARD UTERUS
PERSISTENT ABDOMINAL PAIN
MATERNAL SHOCK
OFTEN COAGULOPATHY
FETAL DISTRESS OR DEATH
a placenta does not detach
in its entirely; fragments of it separate and are left still
attached to the uterus.
RETAINED PLACENTAL FRAGMENTS
a placenta that fuses with the
myometrium because of an abnormal decidua basalis
layer, may also be retained.
PLACENTA ACCRETA
LACERATION
They occur most often:
With difficult or precipitate births
In primigravidas
With the birth of a large infant (heavier than 9 lb)
With the use of a lithotomy position and instruments
(e.g., focep, vacuum extraction)
a placenta with an accessory
lobe, it can happen in any instance.
SUCCENTURIATA PLACENTA
3 KINDS OF LACERATION
CERVICAL
VAGINAL
PERINEAL
If a pt has a suture line on the perineum from an
episiotomy or a laceration repair, a ready portal of entry
exists for bacterial invasion.
INFECTION OF THE PERINEUM
4 CLASSIFICATION OF PERINEAL LACERATION
FIRST
SECOND
THIRD
FOURTH DEGREE
is inflammation with the formation of
blood clots.
THROMBOPHLEBITIS
is a
defficiency in clotting ability caused by vascular injury.
DIC
is the incomplete return of the uterus to its
pre-pregnant size and shape.
SUBINVOLUTION
or infection of the peritoneal cavity, usually
occur as an extension of endometritis.
PERITONITIS
is an infection of the endometrium, the lining
of the uterus.
ENDOMETRITIS
is a collection of blood below the
epidermis of the vulva.
VULVAR HEMATOMAS
PHLEBITIS
is inflammation of the lining of a blood vessel.
