Maternal Midterm 2nd sem Flashcards
6-week period after birth
Puerperium
Involution of the uterus and vagina
Retrogressive maternal changes
Production of milk
Restoration of the menstrual cycle
Progressive maternal changes
the leading cause of mortality and
maternal morbidity.
Postpartum hemorrhage (PPH)
occurs within 24 hours of birth hemmorhage
Early(acute or primary)
occurs more than 24 hours but less
than 6 weeks postpartum hemmorhage
Late (secondary)
Most Common Causes of PPH
Uterine Atony
Lacerations/hematomas
Retained placental fragments
Disseminated Intravascular Coagulations
deep attachment of the placenta
Placenta accreta
What does it suggest if…
it Spurts of blood with clots?
It may indicate partial placental
separation.
What does it suggest if…
Failure of blood to clot or remain
clotted?
It indicates coagulopathy
Marked hypotonia of the uterus
Uterine Atony
Causes of Uterine Atony
High parity
Hydramnios
Macrosomic fetus
Multifetal
gestation
Traumatic birth
Causes of Uterine Atony
Rapid or prolonged
labor
Chorioamnionitis
Use of halogenated
anesthesia
Use of oxytocin for
labor induction and
augmentation
What does it suggest if…
Dark blood
venous origin
varices
or
superficial lacerations of the birth canal.
What does it suggest if…
Bright blood
arterial
indicates deep lacerations of
the cervix
Risk factors/Causes of Lacerations
Primigravidas
Large infant (>9lbs)
Use of lithotomy position and instruments
Lacerations of the perineum (the most common)
Classification
vaginal mucous membrane and skin of
the perineum to the fourchette laceration
First degree
vagina, perineal skin, fascia, levator
ani muscle, perineal body laceration
Second degree
entire perineum, external sphincter of
the rectum laceration
Third degree
entire perineum, rectal sphincter,
mucous membrane of the rectum laceration
Fourth degree
ligation of bleeding vessels
Episiorrhapy
Stool softeners examples
Dulcolax
Colase
Docusate
Retained Placenta
Why bleed?
The retained parts keep the
uterus from contracting
fully.!
Uterine fundus is not firm.
Can be detected through
UTZ and serum HCG levels.
In Retained Placenta
interventions
?
Manual separation and
removal
Administration of
anesthesia
Blood transfusion
Hysterectomy (may be
indicated)
Coagulopathies
assessed when laboratory results:
o Increased prothrombin time & partial
thromboplastin time
o Decreased platelet
o Decreased fibrinogen
o Prolonged bleeding time
Coagulopathies
Causes
o Idiopathic or Immune Thrombocytopenic
purpura (ITP)
o autoimmune disorder, in which platelet
antibodies decrease the lifespan of platelets.
o Tx: Corticosteroids, IV immunoglobulins,
Platelet transfusion
formation of a blood clot or
clots inside a blood vessel
Thrombosis
Type of Thrombosis
o Arterial thrombosis
o Venous thrombosis
o blood clots form in an artery
o arteries carry blood from your
heart to the rest of your body.
o the most common cause of heart
attacks and strokes.
o Arterial thrombosis
o blood clots form in a vein
o veins carry blood back to your
heart from your body
o the most common cause of a
pulmonary embolism (blood clot
in your lung).
o Venous thrombosis
Complications of Thrombosis
Lungs:
Pulmonary embolism
complications of Thrombosis brain
Transient ischemic attack
(TIA) or stroke
complications of Thrombosis
heart
(coronary artery): Myocardial
Infarction (MI)
complications of Thrombosis
neck
(coronary artery): TIA or
stroke.
complications of Thrombosis belly
(superior mesenteric artery or
one of its branches): Mesenteric
ischemia
Antiplatelet & anticoagulant (blood-thinners). EXAMPLES
Aspirin, Warfarin, Heparin, & Enoxaparin
o uses medications to dissolve blood clots
.
o serve as an emergency treatment for MI, strokes, and other
thrombosis complications.
o e.g., Tissue plasminogen activator (tPA), Streptokinase
Thrombolytic therapy
the most direct way to remove a clot is for a surgeon to access it &
remove it.
Thrombectomy
vein inflammation: pain
and swelling occur when a
blood clot forms in one of
your veins.
Thrombophlebitis
Predisposing factors Thrombophlebitis
o Cesarean birth
o History of venous
thrombosis or
varicosities
o Obesity
o Maternal age over 35
o Multiparity
o Smoking
Thrombophlebitis
o Precipitating factors
o Increased fibrinogen
level
o Dilation of lower
extremity pressure of
the fetal head
o Inactivity/ prolonged
delivery- pooling and
stasis
Types of Thrombophlebitis
Deep Vein Thrombosis (DVT)
Pelvic
o blood clots happen in major veins,
usually in one of the legs.
o swelling, pain, redness, warmth,
shiny, red, or white (phlegmasia
alba dolens)
o Homans’ sign (+), unilateral
discomfort on dorsiflexion
o Deep Vein Thrombosis (DVT)
Management of Thrombophlebitis
Diagnostics
o Physical
examination
o Blood tests
o Venography
(X-ray of the veins
o Imaging test (USS)
Management of Thrombophlebitis interventions
o Early ambulation
o Side-lying or back-lying
o Not to squat
o Not to use constrictive
clothing
o Use anti-embolic
stockings
o Never massage
o Rest the affected leg,
elevation
Management of Thrombophlebitis
o Pain Medications, e.g., Paracetamol or NSAID
o Anticoagulants (blood thinners), e.g., Heparin &
Warfarin
o Thrombolytic agents (clot-busting drugs), e.g.,
Streptokinase
o Antibiotics
one of the leading causes of morbidity and
mortality throughout the world.
Puerperal infection
o Common Postpartum Infections
o Endometritis
o Wound infections
o Mastitis
o Urinary tract infections
o Respiratory tract infections
An infection of the lining of the
uterus
Endometritis
Endometritis
o What are the Typical laboratory
findings?
o Leukocytosis (>20,000 mm³)
o Anemia
o Blood cultures or intracervical or intrauterine
bacterial cultures reveal the offending pathogens
within 36 to 48 hours.
Treatment of Endometritis
IV Broad spectrum antibiotic therapy
(Cephalosporins, Penicillins, or Lincosamides and
Macrolides).
When it already spreads through the
peritoneal cavity through fallopian
tubes
Peritonitis
Mastitis (Breast Infection)
o First-time mothers
Staphylococcus aureus (oral/nasal
cavity of infant)
Predisposing Factors mastitis
o Inadequate emptying of the breast
o Sudden decrease in the # of feedings, abrupt
weaning
o Wearing underwire bras
o Sore, cracked nipples
(provides a portal of entry)
o Stress and fatigue
o Ill family members
o Breast trauma
o Poor maternal nutrition
Management mastitis
o Proper way of breastfeeding
o Hand hygiene o Expose to air-dry
o Vit E (to soften nipples daily)
o Broad-spectrum antibiotic
o Breastfeeding continued
o Breast emptying(2-3h interval)
o Cold compresses/ warm
o Firm-fit bra
o Hydration and a balanced diet
STRESS brought about by
Giving birth
o Unmet expectations
o Low support
o Fetal death/ anomalies
some immediate feelings (1 to 10 days
postpartum) of sadness almost every woman
notices after childbirth.
Postpartal Blues
occurs as a response to the anticlimactic
feeling after birth and is probably related to
hormonal shifts
Postpartal Blues
– body’s coordinator for stress response
corticotropin-releasing hormone (CRH)
A feeling of extreme sadness
Postpartum Depression
Postpartal Depression
Risk factors
o History of depression
o A troubled childhood
o Stress in the home or at work
o Lack of self-esteem or lack of effective support
people
An actual separation from reality
Woman appeals exceptionally sad.
A severe mental illness that requires referral to a professional psychiatric counselor and
antipsychotic medication.
Postpartal Psychosis
Onset post partum blues
1 to 10 days after
birth
onset Postpartal
Depression
1 to 12 months after
birth
onset Postpartal Psychosis
within the first month after
birth
Signs &
Symptoms post partum blues
sadness, tears
Postpartal
Depression s/s
anxiety, feelings of
loss, & sadness
