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MIH Final review > MIH Chapter 33 > Flashcards

MIH Chapter 33 Flashcards

1
Q

What defines postpartum hemorrhage

A

Loss of 500 ml or more of blood after vaginal birth
Loss of 1000 ml or more after cesarean birth
A 10% change in Hct between labor and postpartum

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2
Q

what is the leading cause of maternal morbidity and mortality

A

Postpartum hemorrhage

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3
Q

what are the classifications of PPH

A

early or late

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4
Q

what is early PPH

A

occurs within 24 hrs of the birth

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5
Q

what is late or secondary PPH

A

occurs more than 24 hours but less than 6 weeks after the birth.

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6
Q

why does postpartum hemorrhage go unrecognized

A

because moms think bleeding is normal during labor

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7
Q

what are symptoms of postpartum hemorrhage

A

weakness
fatigue
tachycardia
hypotension
dizziness
pale
loss of consciousness
decreased urine output

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8
Q

what are the causes of postpartum hemorrhage

A

uterine atony
retained placental fragments
lacerations of genital tract
hematomas
subinvolution of uterus
inversion of uterus

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9
Q

what is uterine atony

A

marked hypotonia of uterus , boggy/flaccid uterus

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10
Q

what is the cause of uterine atony

A

high parity
hydramnios - too much fluid causes over distention
macrocosmic fetus
multifetal gestation
can have distention of uterus from clots

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11
Q

how does the uterus control bleeding

A

by contracting

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12
Q

how can uterine atony be treated

A

fundal rubs, oxytocin, breastfeeding

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13
Q

types of retained placental

A

non adherent and adherent

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14
Q

what is nonadherent retained placenta ?

A

its normal and able to remove manually or surgically

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15
Q

what are the types of adherent retained placenta

A

placenta accrete
placenta increta
placenta percreta

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16
Q

what is placenta accrete

A

where placenta is adhering to uterus , slight penetration of myometrium of uterus

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17
Q

what is placenta increta

A

deep penetration of myometrium

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18
Q

what is placenta percreta

A

perforation of myometrium and uterine serosa and can involve adjacent organs

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19
Q

what are the risks associated with retained placenta

A

won’t deliver in 30 min
won’t get it all
risk for bleeding
risk for having hysterectomy

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20
Q

what will you see with lacerations

A

slow steady trickle of blood

21
Q

what are the causes of lacerations

A

size
presentation
forceps
vacuum
uncontrolled labors (fast)
not stretching

22
Q

what is a hematoma

A

collection of blood in connective tissue will be painful and visible

23
Q

what is the most common type of hematoma

A

vulvar

24
Q

what is the most common hematoma

A

vulvar

25
Q

describe vaginal hematoma

A

wont be as visible, most often in first babies, deliveries using forceps, and in patients who have had episiotomy

26
Q

describe retroperitoneal hematoma

A

least common
can be life threatening
caused by laceration of vessel connected to hypogastric artery
pt may complain of perineal or rectal pain
may be asymptomatic
may not know of symptoms until go into shock

27
Q

what is inversion of the uterus

A

uterus turns inside out

28
Q

what is the treatment of inverse of uterus

A

give tocolytics to relax uterus and put back in, will make it contract once back inside

29
Q

what is an incomplete inversion

A

cannot be seen, but may palpate smooth mass through dilated cervix

30
Q

what is a complete inversion

A

lining of uterus comes through cervical opening and forms mass in vagina

31
Q

what is a prolapsed uterus

A

obvious large red mass protrudes outside of vagina

32
Q

what are the possible signs of inversion

A

all of a sudden bleeding, shock, pain

33
Q

what are important consideration with inversion of uterus

A

Provider needs to be careful of pulling on cord
support neck of uterus when doing fundal rubs

34
Q

what is subinvolution of uterus

A

Uterus delays the return to nonpregnant size and function

35
Q

what is a common cause of late PPH

A

subinvolution of uterus

36
Q

what are the causes of subinvolution of uterus

A

retained placental fragments, pelvic infections

37
Q

what are symptoms of subinvolution

A

prolonged lochial discharge, irregular, excessive bleeding, hemorrhage

38
Q

what is the treatment of subinvolution

A

medications to help uterus contract (uterotonic), D&C for retained placenta fragments

39
Q

what is the treatment of postpartum hemrrohage

A

The initial intervention is firm massage of the fundus.
Expression of any clots in the uterus
Elimination of bladder distention (straight Cath or foley)
Oxytocin infusion
Additional uterotonic medications
D&C
Bakri ballon

40
Q

How does a bakri balloon work

A

Similar to foley
Inserted vaginally into uterus, inflate balloon, applies constant pressure to uterus, helps with PPH
Do not do fundal rubs with this
Has a reservoir to measure lochia

41
Q

what is hemorrhagic (hypovolemic) shock

A

Results from hemorrhage
Emergency situation in which perfusion of organs may become severely compromised, death may occur

42
Q

what are the primary concerns for hemorrhagic shock

A

Restore circulating blood volume
Monitor pulse and blood pressure
Fluid or blood replacement therapy

43
Q

nursing interventions for hemorrhagic shock

A

Give meds
give blood
monitor VS
monitor UOP cuz decreased in shock , <30ml/hr is concerning

44
Q

what is Idiopathic thrombocytopenic purpura (ITP)

A

Autoimmune disorder in which antiplatelet antibodies decrease the life span of platelets

45
Q

what is von Willebrand disease (vWD)

A

A type of hemophilia
Deficiency or defect in blood clotting protein (vWD factor)

46
Q

Signs of ITP

A

thrombocytopenia
capillary fragility
increased bleeding

47
Q

what are risk associated with ITP

A

Increased risk for hemorrhage and hematomas, neonatal thrombocytopenia

48
Q

what is the treatment for ITP

A

may require platelets, if caugh early may treat with steroids and immunoglobulins

49
Q

what is the treatment for vWD disease

A

treatment of choice is iv desmospressin which promotes release of vWD factor or can administer concentrates of factor 8

MIH Final review (16 decks)

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