Maternal Flashcards
Postpartum endometritis
Risk factors
Cesarean birth Intraamniotic infection Group B Streptococcus colonization Prolonged rupture of membranes Operative vaginal delivery
Postpartum endometritis
Clinical
features
Fever >24 hr postpartum
Uterine fundal tenderness
Purulent lochia
Postpartum endometritis
Etiology
Polymicrobial infection
Postpartum endometritis
Priority Treatment
Clindamycin & gentamicin
Endometritis is characterized by
uterine tenderness and subinvolution, foul-smelling or purulent lochia
fever
tachycardia
chills.
Postpartum endometritis
comfort measures
repositioning, oral hydration, pain medication) can be
provided after antibiotic therapy is initiated.
Postpartum endometritis is
an infection of the endometrium (uterine lining) and is characterized
proper breastfeeding and latch technique include:
Breastfeed every 2-3 hours on average (8-12 times/day)
• Breastfeed “on demand” whenever the newborn exhibits hunger cues (eg, sucking, rooting reflex)
• Position the newborn “tummy to tummy” with mouth in front of nipple and head in alignment with body
• Ensure a proper latch (ie, grasps both nipple and part of areola)
• Feed for at least 15-20 minutes per breast or until the newborn appears satisfied
• Insert a clean finger beside the newborn’s gums to break suction before unlatching (Option 3)
• Alternate which breast is offered first at each feeding
Lactational mastitis
(infection and inflammation of breast tissue) result from inadequate milk duct drainage or poor breastfeeding technique.
Lactational mastitis
Manifestations
fever, muscle aches, and breast pain and
inflammation (eg, warmth, redness, edema)
lactational mastitis
Treatment
antibiotic therapy, continued breastfeeding, breastfeeding support (eg, proper latch technique), warm compresses, massage, adequate
nutrition and hydration, and appropriate analgesics (eg, ibuprofen, acetaminophen).
Postpartum vaginal bleeding
saturates a perineal pad in <1 hour is considered excessive.
Bladder distension
fundus is also elevated above
the umbilicus and deviated to the right
Bladder distention
Treatment
assisted to void then perform fundal massage
Oxytocin infusion should
be initiated
is a uterotonic
if initial attempts to control postpartum bleeding (relief of bladder distention and
fundal massage) have failed.
Pregnancy is a hypercoagulable state
increases risk for deep venous thrombosis and pulmonary embolism (PE).
pulmonary embolism (PE) Sign
anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, and hemoptysis
deep venous thrombosis (DVT)
Who at risk
cesarean section
obesity
smoking
genetic predisposition.
DVT may progress to
pulmonary embolism (PE)
deep venous thrombosis (DVT) /PE
nurse’s priority is rapidly step
- assessing respiratory status
- administering supplemental oxygen
- before administering requested pain medication
- notifying the health care provider (HCP)
Postpartum depression (PPD)
Symptoms
crying irritability difficulty sleeping (or sleeping more than usual) anxiety feelings of guilt.
Postpartum depression (PPD)
Symptoms typically arise
4 weeks of delivery
feelings of inadequacy or guilt as they experience challenges in caring for their infant (eg, breastfeeding difficulties, infant colic).
Postpartum depression (PPD) Questions to ask
specific questions about depression hopelessness to assess for PPD
thoughts of self-harm or harm to the
newborn.
Postpartum hemorrhage (PPH)
uterine atony may require uterotonic drug administration to reverse excessive bleeding (may cause overdistension of the uterus)
Methylergonovine causes
vasoconstriction and is contraindicated for clients with hypertension due to the risk of seizure or stroke
(eg, preeclampsia, preexisting hypertension)
Postpartum hemorrhage (PPH)
interventions
If excessive bleeding persists after initial interventions
(eg, firm fundal massage, oxytocin bolus)
second-line uterotonic drugs (eg, carboprost, methylergonovine, misoprostol) may be
given.
Misoprostol
> combats uterine atony by contracting the uterine muscle
> given per rectum for PPH to increase absorption
Eclampsia
(severe preeclampsia + seizures)
Clinical features
Hypertension Proteinuria Severe headaches Visual disturbances Right upper quadrant or epigastric pain 3-4 minutes of tonic-clonic seizure, usually self-limited
postpartum preeclampsia
with signs and symptoms of preeclampsia
edema persistent headache vision changes elevated blood pressure should be evaluated and treated immediately.
Postpartum blues
Symptoms
Emotional lability,
mild sadness,
irritability
insomnia
Postpartum blues
Onset and duration
40%-80%
2-3 days postpartum; resolves within 2weeks
Postpartum blues
(“baby blues”)
Treatment
Supportive care,
client & family education,
ongoing assessment for
worsening symptoms
Postpartum depression
8%-15%
4-6 weeks postpartum; up to 12 months postpartum; gradual improvement
over first 6 months postpartum
Postpartum depression
Symptoms
Extreme sadness,
irritability, emotional
outbursts, severe mood
swings; can present with postpartum anxiety
Postpartum depression
Treatment
Supportive care plus
pharmacologic intervention &/or
psychotherapy
Postpartum psychosis
0.1%-0.2%
2 weeks postpartum;
severity & duration can vary
Postpartum psychosis
Symptoms
Hallucinations, delusions,
impulsivity, hyperactivity,
confusion, delirium; often
associated with bipolar disorder
Postpartum psychosis
Emergency psychiatric
hospitalization,
pharmacologic
intervention
Perinatal mood disorders may occur
sudden drop in estrogen and progesterone levels after birth
endometrial infection
elevated temperature, chills, malaise, excessive pain, and foul-smelling lochia
foul odor of lochia
During the first 24 hours postpartum
temperature and WBC count
are normally elevated
