high risk postpartum Flashcards
s/sx of hemorrhage
- decreased BP
- increased pulse
- restlessness, decrease LOC
- decreased UOP
early (primary) postpartum hemorrhage
occurs within 24 hrs following delivery
what is primary PP hemorrhage r/t?
- poor uterine tone (atony)
- lacerations
- episiotomy
- retained placental fragments
- hematoma
- uterine rupture
- problems w/ placental implantation
- coag disorders
uterine atony can be r/t?
- over distention (polyhydramnios, LGA, multiples)
- prolonged labor (dystocia)
- mag
- > 30 min to deliver placenta
- preeclampsia
- forceps or vacuum use
- retained placental fragments
management of atony r/t hemorrhage
- massage
- blood products
- pitocin, methergine
- D&C
- hysterectomy if all fails
indications of risk for lacerations
- nulliparity
- epidural
- precipitous delivery
- macrosomia
- operative delivery
- pitocin
risks for a hematoma
- preeclampsia
- first full term delivery
- precipitous labor
- operative delivery
- vulvar varicosities
management of hematomas
- < 3 cm = ice packs and analgesia
- > 3 cm = may consider I&D
- antibiotics
risks for uterine rupture
- prior c/s (scar makes muscle thinner)
- fetal malpresentation
- grandmultiparity
what would a patient report if she’s experiencing a uterine rupture?
intense abdominal pain, minimal/diffused bleeding
management of a uterine rupture
surgery, fluids, blood replacement
late (secondary) postpartum hemorrhage
occurs between 24 hours and 6 weeks PP
- less common
what is secondary postpartum hemorrhage r/t?
- retained placenta
- subinvolution
what would the PP OB assessment for a patient with subinvolution likely reveal?
- fundal height would be greater than expected
- rubra lochia may persist for longer than 2 weeks
- brown lochia or heavy bleeding
- backache
management of secondary postpartum hemorrhage
- methergine
- antibiotics
- possible D&C
puerperal infection
infection of the reproductive tract occurring w/in 6 weeks following delivery
puerperal morbidity
38C or > for any 2 of the first 10 days PP, exclusive of the first 24 hrs
endometritis
inflammation of the endometrial lining
how would a patient present with endometritis?
- bloody vaginal discharge
- foul smelling vaginal discharge
- uterine tenderness
- fever
- tachy
what are the causative agents of endometritis?
GBS, chlamydia, e.coli
how do we treat endometritis?
broad spectrum antibiotics
peritonitis
reproductive tract infection can spread to the entire peritoneal cavity; can be serious and life threatening
peritonitis can get into…
blood, lymph, and spread
cystitis
lower UTI (bladder)
- urgency, frequency, burning
pylenephritis
upper UTI (kidney)
- flank pain
how do we treat UTIs?
- urine C&S
- antibiotics
- pyridium –> analgesic
venous thrombosis
formation of a blood clot
thrombophlebitis
inflammation, leading to formation of clot
perinatal loss
death of fetus or infant from conception through 28 days following birth
stillbirth/fetal demise
- occurs after 20 weeks
- not breathing or heart beating
intrauterine fetal death (IUFD)
occurs while in utero
neonatal death
- when baby’s born, well or not well but dies prior to 28 days of life
bereavement
to suffer loss
grief
reaction to loss
mourning
process of incorporating the loss
dual process model
- need to address loss
- regain balance
