Chapter 33 Flashcards
This term is defined as - excessive bleeding after childbirth defined as a blood loss of _____ ml or more after a vaginal birth and ____ ml after a cesarean birth
Also defined as a 10% drop in ______
Postpartum Hemorrhage 500 1000 Hct Tip - : lochia accounts for 25% of total blood loss. Largest loss occurs during delivery and immediately after.
How do we remove retained placental fragments?
What is the test that confirms presence of retained products of conception?
Manual exploration done to remove fragments
Ultrasonography confirms retained products of conception
Will separation occur if there is abnormal adherence of placenta?
No, separation will not occur in these instances
What is the cause of abnormal adherence of placenta related to?
Related to implantation of zygote in area of defective endometrium
What are the types of placental attachments?
Placenta acreta – slight penetration of myometrium
Placenta increta – deep penetration of myometrium
Placenta percreta – perforation of uterus
Placenta Acreta is…
A Type of placental attachment -> Slight penetration of myometrium
Placenta Increta is…
A type of placental attachment -> Deep penetration of myometrium
Placenta Percreta is…
A type of placental attachment -> Perforation of Uterus
If your assessment revealed that the uterus is firm and well contracted but constant trickle is present or frank bleeding - What may be the cause? How To Manage?
Genital tract lacerations
Usually cervix, vagina, perineum (most common)
Sutures
Definition: Collection of blood in connective tissue of pelvis, vagina, vulva
Hematoma
Most common symptom of a hematoma?
Pain
Patient presents with hemorrhage, shock, pain, non-palpable uterus on assessment - What may be the cause
(Hint)
The Uterus is turned inside out
Uterine Inversion
Management of uterine inversion
Replace uterus by obstetrician, must be relaxed, treat shock
Fundal implantation of placenta (abnormal), vigorous fundal pressure, excessive traction to cord, short cord, and uterine relaxant (Mg SO4) are all causes of what disorder?
Uterine Inversion
Is Uterine Inversion considered an Emergency?
YES
Definition: Delayed return of enlarged uterus to normal size and function
Subinvolution of the uterus
Common causes of subinvolution of the uterus
retained placental fragments and infection
S/S of this disorder include prolonged lochial discharge, excessive bleeding, and pain
Subinvolution of the uterus
Management of subinvolution of the uterus?
- Treatment is based on cause. D&C may be needed,
- Methergine 0.2 mg q 3-4 hr x 24 hrs contraindication is HTN
- ABX therapy
Management of PPH?
- Identify cause of PPH
- Assess uterine fundus – palpate (first action)
if boggy, perform fundal massage
if firm but blood trickle present, inspect m
perineum, vagina uterus, cervix - Assess bladder
if distended straight catheterization may be
indicated - Continue infusion of oxytocin (20 units/1L RL, 30
units/500 ml LR) - Laboratory studies: hemoglobin & hematocrit (h/h)
- Adhere to PPH protocol of unit
If atony of uterus persists - even after a firm massage of fundus, emptied bladder, and continued IV oxytocin - then what do you do?
Administer other uterotonic medication:
Besides oxytocin, name other uterotonic meds
Misoprostol (Cytotec) a synthetic prostaglandin E1 given rectally, sublingually, or orally
Methylergonovine (Methergine) given IM or po to produce sustained uterine ctx
Hemabate IM
Prostaglandin E2 (Dinoprostone) given vaginally or rectally
Blood or blood products, LR or NS
Oxygen therapy and foley catheter placed if needed
If bleeding persists, bimanual compression is performed
Surgical management optons for hematoma and bleeding
- Hematoma - Incision and drainage
- Uterine Tamponade - uterine packing with thrombin or insertion of intrauterine balloon
- Bilateral Uterine Artery Ligation
- Ligation of utero-ovarian arteries and infundibulopelvic vessels
- Total Abdominal Hysterectomy (TAH)
Give the common weights in grams (ie if a person soaked a chux pad, estimate how much blood loss there would be) Chux Peri-pad Vaginal pack Bath towel Hospital gown Flat sheet
40 gm - Chux 15 gm - Peri pad 20 gm - Vaginal pack 200 gm - Bath Towel 370 gm - Hospital Gown 75 gm - Flat Sheet
Continuous bleeding with unidentifiable cause _____ can be suspected
Coagulapathy
Define: Idiopathic Thrombocytopenic Purpura (ITP)
Autoimmune disorder in which antiplatelet antibodies decrease the life span of platelets
Coagulation studies will include_________, ____________, and _________, to assess blood clotting function in patients
Order a ______ for platelet count
Prothrombin time(PT)
Activated partial thromboplastin time (aPTT)
Thrombin Time (TT)
CBC
Most common type of hemophilia; defect in blood clotting protein (vWf)
von Willebrand Disease
Symptoms and Treatment of von Williebrand Disease
Symptoms: bruising easily, nose bleed, bleeding after dental extraction
Tx administration of factor VIII (nasal, IV, PO)
Definition: Formation of a blood clot(s) within a blood vessel caused by inflammation (thrombophlebitis) or partial obstruction
VTE (Venous Thromboembolic Disorder
What are the two causes of VTE
Give three S/S of VTE
Causes: venous stasis (compression of blood vessels by gravid uterus), hypercoagulation (condition of pregnancy and early pp)
s/s: pain and tenderness to lower extremity, swelling
Name the three diagnosis of VTE and how do you treat?
superficial venous thrombosis- analgesia (non-steroidal anti-inflammatory agents), rest, compression stockings
deep venous thrombosis (DVT)- Anticoagulant Therapy (Heparin or Levenox)
pulmonary embolism (PE)- Emergent Situation
Definition: Any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion, or birth
Puerperal Infection
What is Endometritis
an infection of the endometrium that usually starts at the placental site and can spread to encompass the entire endometrium
What are the s/s of endometritis and how do you manage?
s/s: fever, chills, headache, elevated pulse rate, uterine tenderness, subinvolution
Nursing mx: treat symptoms, administer ABX, maintain IV fluids, encourage oral fluids
What are the predisposing factors of a UTI?
urinary catheterization
frequent pelvic exams
genital tract injury
h/o UTI
What are the S/S of a UTI and how do you manage?
s/s: pain/burning on micturition, fever, chills, malaise, frequency & urgency
Nursing mx: treat symptoms, administer ABX, IV and oral fluids
Give the three PP infections discussed
Endometritis UTI Wound Infection (occurs mostly with C-section)
