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Maternity > Chapter 22: Postpartum Complications > Flashcards

Chapter 22: Postpartum Complications Flashcards

1
Q

early postpartum hem vs. late postpartum hem

A

early: w/n 24 hrs of birth
late: 24 hrs - 6 weeks

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2
Q

Causes of postpartum hem (7)

A 
uterine atony (most common)
lacerations of genital tract
Episiotomy
Retained placental fragments
Uterine inversion
Coagulation disorders
hematomas of vulva vagina or sub-peritoneal areas
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3
Q

5 T’s of postpartum hemorrhage

A 
Tone: uterine atony, distended bladder
Tissue: retained placenta
Trauma:
Thrombin: coagulopathy
Traction: causing uterine inversion
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4
Q

Why is retained tissue bad

A

Uterus can’t contract fully, cant clamp down on blood vessels

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5
Q

Uterine inversion

A

prolapse of uterine fundus to or through cervix so that uterus is turned inside out after birth

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6
Q

disorder of increased platelet destruction caused by autoantibodies

whats the risk?

A

Idiopathic thrombocytopenia purpura (ITP)

-increased hem risk!

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7
Q

Congenital bleeding disorder inherited as autosomal dom trait

A

Von willebrand

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8
Q

Life-threatening acquired coagulopathy in which clotting system is abnormally activated - widespread clot formation in small vessels

A

Disseminated Intravascular Coagulation

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9
Q

What primary diagnoses lead to DIC? (6)

A 
Abruptio placentae
amniotic fluid emobolism
Intrauterine fetal death with prolonged retention of fetus
Severe preeclampsia
HELLP syndrome
Septicemia and hemorrhage
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10
Q

Mgmt of uterine inversion

A

gentle pushing of usterus back into position

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11
Q

Uterine atony mgmt

A

Massage
Meds
Removal of retained placental fragments
Repair of lacerations

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12
Q

ITP tx

A

glucocorticoids and IV immunoglobulin

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13
Q

Postpartum hem assessment (3)

A

Risk factors
uterine tone
vaginal bleeding

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14
Q

Nursing mgmt postpartum hem

A 
fundal massage
pad count
adminstration of uterotonic
fluid administration
Check bladder
bimanual compression (MD or CNM)
monitoring for s/s shock
Emergency measures for DIC
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15
Q

Uterotonic drugs (4)

A
  • oxytocin (pitocin)
  • misoprostol (cyotec) or dinoprostone (prostin E2)
  • methylegronovine maleate (Methergine)
  • carboprost (Hemabate)
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16
Q

pitocin contraindications

A

never give undiluted as bolus injection

17
Q

misoprostol/cyotec contraindications

A

allergy, active CVD, pulmonary or hepatic disease

18
Q

Dinoprostin (prostin E2) contraindications

A

Active cardiac, pulmonary, renal or hepatic disease

19
Q

Methylergonovine maleate/methergine contraindcations

A

Hypertension!

20
Q

Carboprost/Hemobate contraindcations

A

Asthma!

21
Q

Carboprost/hemobate SE

A

diarrhea

22
Q

Hematoma risk factors (8)

A
  1. preeclampsia
  2. pudendal anesthesia
  3. nulliparity
  4. precipitous labor
  5. prolonged second stage
  6. macrosomia
  7. forceps/vacuum assisted birth
  8. history of vulvar varicosities
23
Q

hematoma s/s (3)

A

pain out of proportion
rectal pelvic pressure
signs of shock

24
Q

Tx of hematoma:

<5 cm vs. >5 cm

A

<5: ice, observation, pain meds, sitz bath

>5: incision and drainage

25
Q

3 most common thromboembolic conditions occuring during postpartum period

A

superficial venous thrombosis

Deep venous thrombosis

Pulmonary embolism

26
Q

Risk factors for thromboembolic conditions

A 
obesity
>35 yo
smoking
imobility
grand multip
severe anemia
varicose veins
hx thrombosis, thrombophlebitis, endometritis
27
Q

S/s thromboembolic conditions

A 
edema
pain
warmth
redness
heat
changes in skin color
decreased peripheral pulse
28
Q

s/s pulmonary embolism

A 
sudden onset of SOB
severe chest pain
apprehensive and diaphoretic
tachypnea
tachycardia
hypotension
syncope
JVD
decreased oxygen saturation
cardiac arrhythmia
hemoptysis
suden change of mental status
29
Q

PE prevention

A
  • NSAIDs for analgesia
  • Bed rest
  • Anti-embolism stockings
  • Heparin, warfarin, aspirn
  • Edu about risk factors, symptoms, and prevention
  • Activity
  • elevating legs above heart
  • stopping smoking
  • apply compression stockings
  • passive ROM in bed
  • deep-breath exercises
  • NO pillows under knees, no crossing legs for long time
  • Bed cradle to keep blankets off extremities
  • increase fluid intake
  • NO oral contraceptives
  • warm compresses to affected area
30
Q

s/s postpartum infection

A

fever >38.5 or 100.4 after 1st 24 hours

31
Q

c/s and risk of metritis

A

increases it dramatically! 10-20% of c/s

32
Q

Endometritis risk factors (11)

A
  1. prolonged labor
  2. PROM
  3. multiple cervical exams
  4. internal monitoring
  5. meconium
  6. operative delivery (c/s)
  7. GBS
  8. HIV
  9. preterm/postterm
  10. GDM
  11. Severe anemia
33
Q

S/s endometritis (5)

A 
temp
foul smelling lochia
chills
malaise
tachycardia
34
Q

Dx of endometritis

A

-temp >38.0 on 2 successive days between 1-10 days postpartum (orally, at least 4 hours apart)

35
Q

mastitis timing

A

w/n first 2 weeks

36
Q

Engorgment timing

A

day 3-5

37
Q

Most common cause of mastitis

A

S. aureus

38
Q

Mastitis s/s

A

fever > 38.3
myalgia, chills, malaise, flu-like
localized breast tenderness
red, warm, hard area

39
Q

Cystitis/pylonephritis

A 
Frequency and urgency
dysuria
Nocturia
Hematuria
Suprapubic pain
Elevated temp
CVA tenderness

Maternity (8 decks)

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