High Risk PP Flashcards
what “traditionally” qualifies as hemorrhage?
greater than 500 ml
what are symptoms of PP hemorrhage?
- decreased BP
- increased pulse
- restlessness
- decreased urine output
when does early (primary) postpartum hemorrhage occur?
within 24 hours following delivery
what is early (primary) pp hemorrhage related to?
- poor uterine tone-atony
- lacerations
- episiotomy
- retained placental fragments
- hematoma
- uterine rupture
- problems with placental implantation
- coagulation disorders
what can cause uterine atony?
- over distention
- prolonged labor
- grandmultiparity (more than 5)
- meds (mag sulf)
- prolonged 3rd stage
- preeclampsia
- operative delivery
- retained placental fragments
what are some ways to manage atony related hemorrhage?
- massage
- IV access
- infusion of crystalloid
- blood products
- bimanual massage
- meds (pitocin, methergine)
- D&C
- arterial embolism
- uterine packing
- ligation of the uterine or iliac artery
- hysterectomy
what is associated with bright red bleeding with a firm uterus
lacerations
what are risks for laceration
- nulliparity
- epidural
- precipitous delivery
- macrosomia
- operative delivery
- pitocin
what results from partial separation of the placenta?
retained placental fragments
what is a possible cause of retained placental fragments?
massaging the fundus prior to separation
what should be done after retained placental fragments?
- placenta should be inspected
- uterine exploration
- possible D&C
what is injury to a blood vessel from birth trauma or bleeding of a repair site allows for colelction of blood
hematoma
what are risks for PP hematoma
- preeclampsia
- first full term delivery
- precipitous labor
- operative delivery
- vulvar varicosities
management of PP hematoma
- depends on size - may reabsorb or I&D (incision and drainage)
- ice/heat
- antibiotics
what are risks for uterine rupture?
- prior surgery or c/s
- fetal malpresentation
- grandmultiparity
- operative vaginal delivery
- pitocin induction
what is the management of uterine rupture?
surgery, fluids, blood replacement
when does late (secondary) postpartum hemorrhage occur?
between 24 hours and 6 weeks post partum
what is late (secondary) pp hemorrhage related to?
retained placenta
subinvolution (not returning to pre-preg state)
what would the PP assessment for a patient with subinvolution look like?
- high fundal height
- rubra > 2 weeks
- scant brown lochia
- back ache
what is used for management of late post partum hemorrhage due to subinvolution?
- methergine (contract&constrict)
- antibiotics (forminfection)
- possible D&C (retained placenta)
what is infection of the reproductive tract occuring within 6 weeks following delivery?
puerperal infection
what classifies puerperal morbidity?
a temp of 38 celsius or higher for any 2 of the first 10 days postpartum, exclusive of the first 24 hours
what kind of delivery is at greater risk for puerperal infection?
c/s delivery (incision)
what are some risks for reproductive tract infections
- c/s delivery
- diabetes
- pprom
- chorioamnionitis
- multiple vag deliveries
- lapses in aseptic technique
- compromised health
- internal monitoring
- trauma
- retained placenta/manual removal
what is inflammation of endometrial lining?
endometritis
what are s/sx of endometritis
- bloody vag discharge
- foul smelling discharge
- uterine tenderness
- fever
- tachycardia
what are causative agents of repro tract infections
- GBS, chlamydia, e. coli
what is management of repro tract infections
broad spectrum antibiotics
what is a repro tract infection that can spread to the entire peritoneal cavity?
peritonitis
what might you see in an assessment of a patient with an incision infection?
- redness
- foul drainage
- warmth
- approximation
what can urinary tract infections be related to?
- PP diuresis
- increased bladder capacity
- decreased bladder sensitivity
- catheterization
- bacteria
what is the inability to empty the bladder due to trauma (first birth, laceration, episiotomy)
over distention
what is the management of over distention
- catheterize
- encourage them to empty bladder
what can retention of urine, bacteria, and trauma cause?
UTI
what is a lower urinary tract infection called? (bladder)
cystitis
what is an upper UTI (kidney) called?
pyelonephritis
management of UTI?
- urine C&s
- antibiotics
- pyridium
what is inflammation of lobular connective tissue in the breast?
mastitis
what are some characteristics of mastitis
- unilateral
- more frequent in nursing mothers
- may progress to abscess
- red, painful, swollen
what are causes of mastitis?
- milk stasis (buildup)
- bacterial invasion
- trauma (lactation)
- obstruction of ducts
- failure to empty breast
treatment of mastitis
- frequent breastfeeding
- supportive bra
- ice packs
- meds: antibiotics or analgesics
what is the formation of a blood clot called?
venous thrombosis
what is inflammation leading to the formation of the clot?
thrombophlebitis
what are causes of thromboembolic conditions?
- hypercoagulablity (inc. in pregnancy)
- venous stasis
- vessel injury
what are additional blood factors during PP period?
- increased clotting factor
- thrombocytosis
- release of thromboplastin
- increased fibrinolysis inhibitors
what are some risk factors of thromboembolic disease?
- c/s
- immobility
- smoking
- prior thrombus
- varicose veins
- diabetes mellitus
- AMA
- multiparity
- anemia
- inherited disorders
what are s/sx of superficial thrombophlebitis
- tenderness
- localized warmth/redness
- normal temp/low grade fever
- feel bump
management of superficial thrombophlebitis
- heat
- elevation
- analgesics
- bed rest
- elastic compression stocking
what are s/sx of DVT
- edema
- tenderness
- pale limb color
- low grade fever, followed by spike
- chills
management of DVT
- often require heparin therapy (in addition to superficial thrombophlebitis)
what is post partum depression also known as?
post partum major mood disorder
what are symptoms of PPD/PPMMD
- sadness/crying
- sleep disturbances
- changes in appetite
- difficulty concentrating/decisions
- feelings of worthlessness/inadequacy
- lacks interest in pleasurable activity
- lack interest in appearance
risk factors of PPD/PPMMD
- primiparity
- ambivalence about pregnancy
- PP blues
- hx of PPD
- lack of support
- complications
- loss of newborn
- domestic violence
what is priority management of PPD/PPMMD
- antidepressants
- psychotherapy
- educate patients about PPD prior to discharge
what are symptoms of PP psychosis?
- irrational thinking
- delusions
- hallucinations
- confusion
- agitation
- hyperactivity
- insomnia
what are risk factors of PP psychosis?
- previous PP psychosis
- hx of bipolar diorder
- obsessive personality
- social factors
management of PP psychosis?
- safety priority
- often hospitalized
- meds
- psychotherapy/cognitive behavioral therapy
- assistance with newborn
