Complicated Postpartum

Question 1

What is Postpartum Hemorrhage after a vaginal birth?

Answer 1

PPH: >500ml blood loss
Severe PPH: >1000ml blood los
Defined as 10% decline in hemoglobin concentration

Question 2

What are the Risk Factors for Postpartum Hemorrhage?

Answer 2

• Abnormal uterine contractions
• Retained placenta or tissue
• Genital tract trauma
• Coagulation abnormalities

Question 3

What are the levels of Postpartum hemorrhage?

Answer 3

1. [Compensated] 500-1000ml (10-15%): minimal
2. [Mild] 1000-1500ml (215-25%): anxiety, diaphoresis, cool arteries, delayed cap refill
3. [Moderate] 1500-2000ml (25-35%): high HR, high RR, postural hypotension, oliguria
4. [Severe] 2000-3000ml (35-45%): hypotension, agitation/confusion, hemodynamic, instability

Question 4

What is Tone and treatment?

Answer 4

• Lack of uterine tone
• Overdistended
• Grand multipara
  -preeclampsia
• infection
• bladder distension
• uterine anomaly

Treatment: fundal expression, fundal height, manual removal, uterine stiimulants

Question 5

What is Trauma

Answer 5

• Inversion
• Laceration
• Extension
• Uterine Rupture

Question 6

What is Tissue and treatment?

Answer 6

• Retained placenta fragments,
• retained clots,
• retained placental lobes,
• previous uterine surgery,
• abnormal placenta insertion

Treatment: inspect placenta. manual examination, manual extraction

Question 7

What is Thrombin and management?

Answer 7

• Pre-existing bleeding disorder
• thrombocytopenia
• disseminated intravascular coag (DIC)
• GHTN

Management: Bloodwork, monitoring

Question 8

How is Postpartum Infection Detected?

Answer 8

• Temp => 38 on any 2 of the first 10 days after birth, after the first 24hours
• Temp >= 38 in the first 24 hours is a parameter for early infection = pre-existing infection
• Infections r/t incision, clots, or breast will develop 4 days after birth

Question 9

What are the types of Postpartum Infections?

Answer 9

• Wound Infection
• Endometritis
• Mastitis

Question 10

What is hematoma?

Answer 10

• Localized collection of blood
• Bleeding into the CT beneath the vaginal mucosa or vulvar skin (like a bruise)
• Can develop fast without external bleeding
• Tense fluctuant ecchymotic outline

Question 11

What are the ways to prevent and manage Hematomas?

Answer 11

Preventions:
- Ice to perineum post birth

Management:
- Visualization of perineum during postpartum assessment