Chapter 28: Postpartum Maternal Complications

Question 1

what are common causes of early postpartum hemorrhage?

Answer 1

• uterine atony
• trauma

Question 2

what are the common causes of late postpartum hemorrhage?

Answer 2

• subinvolution
• retained placental fragments

Question 3

risk factors for postpartum hemorrhage

Answer 3

• grand multiparity
• more than 4 deliveries
• LGA: 4000 g or 8 lb 13 oz–> >90th percentile
• multiple gestation/polyhydramnios
• placenta previa
• prolonged labor
• oxytocin induction
• prolonged ROM
• manual removal of placenta
• C/S and operative births

Question 4

Post Partum Hemorrhage Etiologies

Answer 4

• tone
• tissue
• trauma
• thrombin

Question 5

PPH: Tone Etiology

Answer 5

• uterine atony
• “boggy” uterus

Question 6

PPH: Tone–Nursing Implications

Answer 6

• massage uterus while supporting lower uterine segment
• assess level of uterine fundus
• administer meds:
  
  • methylergonovine
  • carboprost tromethamine
  • misoprostol
• Bakri placement (only by an MD)

Question 7

Methylergonovine

Answer 7

• used for PPH
• 0.2 mg IM or PO
• do not use if HTN

Question 8

carboprost tromethamine

Answer 8

• used with PPH
• 0.25 mg IM
• contraindicated in asthmatics
• refridgerate drug prior to use
• causes diarrhea

Question 9

misoprostol

Answer 9

• used for PPH
• 800 mcg rectally
• may cause diarrhea

Question 10

PPH: Trauma Etiology and Nursing Implications

Answer 10

• vaginal or cervical lacerations
  
  • would be evident with a continuous trickle of blood with a FIRM uterus
• hematoma
  
  • bulging vulva
  • severe pain and pressure
• nursing implications:
  
  • notify MD
    prepare for visualization

Question 11

PPH: Tissue Etiology and Nursing Implications

Answer 11

• D&C for retained placenta
• hysterectomy for placenta accreta

Question 12

PPH: Thrombin Etiology

Answer 12

• thrombocytopenia
• decreased fibrinogen
• increased PT/PTT

Question 13

hypovolemic shock: nursing care

Answer 13

• V/S Q3-5 min
• assess:
  
  • fundus, lochia amount
  • skin temp and color
  • cap refill
• administer O2
• fluid bolus
• monitor H&H and clotting studies
• type and cross match
• administer blood, PRBCs, FFP
• foley cath: monitor output

Question 14

DVT: assessment, diagnosis, and therapeutic management

Answer 14

• assess lower extremities for warmth, tenderness, redness, and pain
• diagnose by doppler or MRI
• therapeutic management: prevent thrombus formation by:
  
  • SCDs, compression stockings
  • fluids
  • ambulation
  • active ROM of lower extremities

Question 15

S/S of PE

Answer 15

• dyspnea, chest pain
• tachycardia
• tachypnea
• pulmonary rales, cough
• hemoptysis
• abdominal pain
• low grade fever

Question 16

PE: diagnosis and management

Answer 16

• diagnose with spiral CT scan
• management: thrombolytics

Question 17

factors that inc risk of thromboembolic disorders

Answer 17

• inactivity
• obesity
• C/S
• smoking
• hx of previous thrombosis
• varicose veins
• DM
• prolonged bed rest

Question 18

mastitis

Answer 18

• can occur anytime during breastfeeding
• usually unilateral
• S/S: flu like symptoms, fatigue, fever, aching muscles, enlarged lump, redness, heat inflammation
• results from nipple trauma and milk stasis
  
  • milk stasis can result from ineffective emptying, supplementation (not completely emptying breasts), tight bra

Question 19

mastitis: treatment

Answer 19

• pumping and nursing
  
  • only time to stop nursing is if discharge is yellow, green, purulent
• antibiotics
• massage: to express milk ducts
• increase fluids
• analgesics