Complications of the Postpartum Period: 13

Question 1

Postpartum Hemorrhage

4 T’s

Answer 1

Tone: Atonic uterus

Trauma: Lacerations, Hematoma, inversion rupture

Tissue: Retained tissue, invasive placenta

Thrombin: Coagulopathies

Question 2

PPH

Stage 1?
Stage 2?
Stage 3?
Stage 4?

Answer 2

Stage 1: blood loss >1000ml with normal vital signs and lab values

Stage 2: Continued bleeding with up to
1500ml lost or already received >2 uterotonics and normal vital signs

Stage 3: Continued bleeding with >1500ml loss or >2 RBC given or possible occult bleeding/coagulopathy, or abnormal VS

Stage 4: Cardiovascular collapse

Question 3

PPH Medium Risk factors?

Prior?
Multiple?
_births?
Prior?
Large?
EFW?
bmi?

Answer 3

Prior c section

Multiple gestation

> 4 prior births

Prior PPH

Large Myoma

EFW >4000

BMI >40

Question 4

PPH nursing management

Answer 4

Frequent uterine assessment (fundal location, firmness) and vital signs

Fundal massage

Empty bladder

IV access, preferably 18g

Administer uterotonics

Question 5

Tranexamic Acid (TXA) for PPH

given when?
Can’t give to?

Answer 5

Stage 2 medication given after 1st meds dont work

Cant give to people with history of coagulopathy or active intravascular clotting (HELLP syndrome)

Question 6

PPH High Risk Factors

Placenta?
Platlet count?
Active?
Known?

Answer 6

Placenta previa, accreta, percreta

Platlet count <70,000

Active bleeding

Known coagulopathy

Question 7

Oxytocin (Pitocin)
Misoprostol (Cytotec)

Contraindication?

Answer 7

Hypersensitivity to drug

Question 8

Carboprost (Hemabate)

Used for?
Contraindication?
Use with caution in?

Answer 8

Used to treat severe bleeding

Hypersensitivity to drug

People with asthma and Hypertension

Question 9

Methylergonovine (Methergine)

Used for?
Contraindicated in?

Answer 9

Used to treat severe bleeding

Preeclampsia and Hypertension

Question 10

Preeclampsia

What is it?
Symptoms?

HEVBS

Answer 10

If blood pressure gets worse in PP

Symptoms:
* Headache not relieved by Tylenol (2/3 present with this)
* Epigastric or RUQ pain
* Visual disturbances
* Blood pressure—often reduction in 1st 48hrs; then increases
* Seizure activity

Question 11

Postpartum infections

consider?
4?

Answer 11

Consider dehydration

Breast engorgement

Urinary tract infection

Endometritis – infection of the endometrium

Postoperative wound/laceration infection

Question 12

Signs and Symptoms of postpartum infections

FUFIL CHPC

Answer 12

Tachycardia can be early sign of worsening infection
-Chills/fever

Fever (101.6 in the first 24 hours , 100.4 in first 10 days PP)

Uterine tenderness

Foul-smelling lochia

Increased pulse rate

Lower abdominal/pelvic pain

Chills
Headache
Painful urination
Costovertebral angle tenderness

Question 13

Cardiomyopathy

Symptoms?

NON CC FS PP

Answer 13

Symptoms:

Nocturnal cough
orthopnea
nocturnal dyspnea

Chest discomfort
cold extremities

fatigue
sinus tachycardia

peripheral edema
palpitations

Question 14

Cardiomyopathy Risk factors?

HODAMP

Answer 14

Hypertension
Obesity

Diabetes
Advanced maternal age
Multiple gestation.
Preeclampsia

Question 15

Nursing care for venous thromboembolism (VTE)

Answer 15

Prevention is key!

Mechanical compression devices
(SCDs) for pts on prolonged bed rest or c section

Early ambulation (within 12 hours of C section)

• Bedrest (don’t want to dislodge clot)
• Elevate affected extremity
• Anti-thombolytic stockings
• Anticoagulants

Question 16

Signs of DVT
2

Answer 16

Unilateral leg pain and edema
May be warm and tender