Module 09: High-Risk Postpartum Complications Flashcards
What are the risks of postpartum complications for a woman?
(A) Risk to her own health.
(B) Risk to her future childbearing potential.
(C) Risk to her ability to bond with her newborn.
TRUE OR FALSE. Most postpartum complications are preventable, and if they do occur, the majority can be treated effectively.
TRUE
This pertains to the loss of more than 500 mL of blood at the time of delivery or immediately after.
POSTPARTUM HEMORRHAGE
Postpartum hemorrhage is one of the causes of what?
MATERNAL MORTALITY
What are the two types of postpartum hemorrhage?
(A) Early postpartum hemorrhage – Occurs within 24 hours after childbirth.
(B) Late postpartum hemorrhage – Occurs anytime after the first 24 hours up to 6 weeks postpartum.
What conditions may lead to postpartum hemorrhage? (CCAUB)
(A) Conditions that excessively stretch the uterus.
(B) Cervical or uterine lacerations.
(C) Abnormal placental attachment.
(D) Uterus failing to contract properly.
(E) Blood coagulation disorders.
What are the main causes of early postpartum hemorrhage? (ULPD)
(A) Uterine atony
(B) Lacerations
(C) Perineal hematomas
(D) Disseminated Intravascular Coagulation (DIC)
What are the main causes of late postpartum hemorrhage?
(A) Retained placental fragments
(B) Subinvolution
Why is it important to manage postpartum hemorrhage quickly
It is a leading cause of maternal mortality and poses a serious risk to the mother’s health after childbirth.
What is uterine atony?
Relaxation of the uterus due to the loss of muscle tone.
Why is uterine atony a serious concern?
It is the most common cause of postpartum hemorrhage.
What are the predisposing factors for postpartum hemorrhage? (MLPIP)
(A) Multiple gestation
(B) Large baby (>9 lbs.)
(C) Polyhydramnios
(D) Inhalation of anesthesia
(E) Prolonged labor with maternal exhaustion
What are the key nursing assessments for postpartum hemorrhage?
(A) Monitor for signs of shock and blood loss (vital signs).
(B) Estimate the patient’s blood loss.
(C) Palpate the fundus at frequent intervals.
How does a contracted uterus feel upon palpation?
Firm and easily recognizable.
What is the purpose of fundal massage?
It stimulates uterine contraction, promotes uterine tone, and reduces the risk of hemorrhage.
How is oxytocin administered to manage postpartum hemorrhage?
(A) IV infusion: 10-40 units added to an existing IV line (Lactated Ringer’s solution).
(B) Never administer oxytocin via IV push.
What are the primary medications for postpartum hemorrhage?
(A) Methergine (Methylergonovine)
(B) Prostaglandins
What are key considerations when administering Methergine (Methylergonovine) or prostaglandins?
(A) Always check the woman’s baseline blood pressure before administration.
(B) Do not give Methergine if BP is 140/90 mmHg or greater.
When is a blood transfusion needed in postpartum hemorrhage?
(A) If significant blood loss occurs.
(B) Ensure proper blood typing and cross-matching before transfusion.
What are last-resort interventions for uncontrolled postpartum hemorrhage?
(A) Suturing or balloon compression to stop bleeding.
(B) Pelvic and uterine vessel embolization using an angiographic technique.
What is a laceration of the birth canal?
A tear in the cervical, vaginal, or perineal area during childbirth.
How do small and large lacerations differ?
(A) Small lacerations are common.
(B) Large lacerations are considered complications.
What are the key signs of a birth canal laceration?
(A) Firm uterus (unlike uterine atony).
(B) Steady trickle of bright red blood (arterial in origin).
What is a first-degree perineal laceration?
A tear involving the vaginal mucous membrane, perineal skin, and fourchette.
What structures are affected in a second-degree perineal laceration?
(A) Vagina
(B) Perineal skin
(C) Fascia
(D) Levator ani muscle
(E) Perineal body
What makes a third-degree perineal laceration more severe?
It involves the entire perineum, extending to the external sphincter of the rectum.
What is a fourth-degree perineal laceration?
A tear that extends through the entire perineum, rectal sphincter, and part of the rectal mucous membrane.
What are the predisposing factors for perineal lacerations? (PDBUOR)
(A) Primigravida status
(B) Difficult or precipitate births
(C) Birth of a large infant
(D) Use of lithotomy position
(E) Operative birth (forceps/vacuum-assisted)
(F) Rapid birth
Why are cervical lacerations difficult to repair?
Due to intense bleeding, which obstructs visualization.
What is an important intervention before repairing a cervical laceration?
Administer regional anesthesia to relax the uterus and prevent pain. And try to maintain an air of calm and reassure the mother about the baby’s condition
Why are vaginal lacerations difficult to repair?
Vaginal tissue is friable, making suturing challenging.
How are vaginal lacerations managed?
(A) Suturing to stop bleeding.
(B) Vaginal packing for 24-48 hours to maintain pressure on the suture line.
(C) Indwelling urinary catheter to prevent urinary retention.
Vaginal packing left in place would lead to what?
(A) Packing that is left in place too long leads to stasis and infection similar to toxic shock syndrome.
(B) Packing causes pressure on the urethra and can interfere with voiding.
What are key nursing interventions for perineal lacerations?
(A) Increase fluid intake (if not contraindicated) to prevent constipation.
(B) Prescribe high-fiber diet and stool softeners for the first week.
(C) Assess and document the degree of the laceration.
PERINEAL LACERATIONS ARE EASILY TREATED.
What are perineal hematomas?
Localized collections of the blood in loose connective tissue beneath the skin that covers
(A) The external genitalia
(B) Beneath the vaginal mucosa
(C) The broad ligaments
What is unique about perineal hematomas compared to lacerations?
They usually occur without lacerations of the overlying tissue.
Perineal hematomas are usually found where?
Perineal and vaginal area.
What are the predisposing factors for perineal hematomas? (TIDD)
(A) Trauma during birth (spontaneous or forceps-assisted).
(B) Inadequate suturing of an episiotomy.
(C) Delayed homeostasis (failure to control bleeding).
(D) Difficult or prolonged second stage of labor.
What are the clinical manifestations of perineal hematomas?
(A) Excruciating pain and pressure in the perineal area.
(B) Tight, discolored skin that feels full and painful to touch.
(C) Decreased or absent lochia flow due to vaginal obstruction.
How are small (<3 cm) and large (>3 cm) perineal hematomas managed?
(A) Small hematomas: Resolve on their own with ice pack application.
(B) Large hematomas: Require evacuation and ligation of bleeding vessels
What are additional nursing interventions for perineal hematomas?
(A) Mild analgesics for pain relief.
(B) Broad-spectrum antibiotics to prevent infection.
(C) Iron-rich foods to aid recovery.
(D) Sitz bath after 24 hours for perineal comfort.
(E) Monitor VS for signs of shock.
(F) Assist with voiding (bed pad, running water technique).
What is the main cause of late postpartum hemorrhage?
Incomplete expulsion of the placenta.(retained placental fragments)
What are the risk factors for retained placental fragments?
(A) Succenturiate placenta (placenta with an accessory lobe).
(B) Placenta accreta (placenta abnormally attached to myometrium).
What are the clinical manifestations of retained placental fragments? (SPUAL)
(A) Slow, reddish oozing (6th–10th postpartum day).
(B) Positive hCG blood serum sample.
(C) Uterus not fully contracted.
(D) Abdominal pain and tenderness.
(E) Low, persistent backache.
What are the nursing interventions for retained placental fragments?
(A) Dilatation and curettage (D&C) to remove fragments.
(B) Methotrexate to destroy retained tissue.
(C) Careful inspection of the placenta after birth to ensure completeness.
This is known as the failure of the uterus to gradually reduce in size and return to its normal placement.
SUBINVOLUTION
What are the causes of subinvolution?
(A) Infection.
(B) Uterine tumors.
(C) Mild endometritis.
What are the clinical manifestations of subinvolution?
(A) Enlarged uterus that remains higher than expected in the abdomen.
(B) Lochia does not progress from rubra to serosa to alba.
(C) Leukorrhea and backache if caused by infection.
What medications are used to manage subinvolution?
(A) Methergine (0.2 mg PO QID): Improves uterine tone and involution.
(B) Oral antibiotics: Treat endometritis.
(C) Oxytocin: Enhances uterine contractions.
What important teaching should be provided about postpartum bleeding?
(A) Educate the client on normal blood loss (300–500 mL).
(B) Monitor for abnormal bleeding patterns.
This pertains to any infection of the reproductive tract occuring within 10 days of birth.
POSTPARTUM INFECTION (second leading cause of maternal morbidity)
What is the most common cause of postpartum infection?
Polymicrobial ascent
What is the main pathway of postpartum infection?
BROAD LIGAMENT
What are the predisposing factors for postpartum infection? (PCBPR)
(A) Prolonged rupture of membranes.
(B) Cesarean birth.
(C) Birth trauma.
(D) Poor perineal hygiene.
(E) Retained placental fragments.
This is known as the infection of the endometrium (uterine lining) due to bacterial access through the vagina, occurring at birth or postpartum.
ENDOMETRITIS
What are the risk factors for endometritis?
Any type of birth (but more common in cesarean birth and chorioamnionitis).
What are the clinical manifestations of endometritis?
(A) Fever (on the 3rd–4th postpartum day).
(B) Oral temperature >38°C for two consecutive 24-hour periods.
(C) Chills.
(D) Dark brown, foul-smelling lochia.
(E) Loss of appetite, malaise.
(F) Uterus is not well contracted and painful to touch.
What is the antibiotic therapy used for endometritis?
Clindamycin, based on vaginal culture results.
Why is Methergine administered for endometritis?
It encourages uterine contraction to help expel infected secretions.
What are two nursing interventions to help prevent pooling of infected secretions in endometritis?
(A) Increase oral fluid intake to combat fever.
(B) Encourage Fowler’s position or walking to promote lochia drainage by gravity.
Why is a woman with perineal sutures at higher risk of infection?
The suture line can trap bacteria, leading to localized infection.
What are the clinical manifestations of perineal infection? (PFIF)
(A) Pain and warmth at the infected area.
(B) Feeling of pressure.
(C) Inflammation and purulent drainage.
(D) Fever (may or may not be present, depending on the spread of infection).
What is the primary intervention for a suture line infection?
Remove the perineal sutures to allow drainage.
How is the infected perineal area managed?
(A) Packing with iodoform gauze to keep the area open for drainage.
(B) Administer systemic or topical antibiotics.
(C) Give analgesics for pain relief.
(D) Use sitz baths or warm compress to cleanse the area.
What health teachings should be given to prevent perineal infection?
(A) Change perineal pads frequently.
(B) Wipe front to back after a bowel movement.
(C) Do not place the baby on the bottom bed sheet of the mother’s bed.
What are the three common causes of UTI in postpartum women?
(A) Coliform bacteria.
(B) Bladder trauma during delivery.
(C) Break in technique during catheterization → Introduces bacteria into the bladder.
What are the clinical manifestations of UTI? (SFBIP)
(A) Suprapubic or costovertebral angle pain
(B) Fever
(C) Burning, urgency, frequency of urination
(D) Increased WBC count & hematuria
(E) Positive urine culture for causative organism
What is the purpose of a urine culture in UTI?
To identify the causative organism and determine the appropriate antibiotic.
What are the nursing interventions for UTI?
(A) Administer antibiotics as ordered for 7 days.
(B) Give analgesics for pain relief.
(C) Catheterize if necessary, using a sterile technique.
(D) Encourage fluid intake (minimum of 3L/day) to help flush out the infection.
(E) Monitor bladder status frequently.
This is known as the infection of the breast.
MASTITIS
What is the causative organism of mastitis?
Hemolytic Staphylococcus aureus.
What is the most common cause of mastitis?
Cracked and fissured nipples due to improper latching.
What are the clinical manifestations of mastitis? (RCES)
(A) Redness, tenderness, or a hardened area in the breast (unilateral)
(B) Chills and malaise
(C) Elevated temperature and heart rate
(D) Scant breast milk production
What are the nursing interventions for mastitis?
(A) Administer antibiotics as ordered.
(B) Apply ice or heat:
Cold → decreases tissue metabolism & milk production.
Heat → may increase milk production and worsen symptoms.
(C) Encourage wearing a well-fitting bra for support.
(D) Assist in regular milk expression to prevent engorgement.
This is known as the inflammation of the lining of a blood vessel with clot formation.
THROMBOPHLEBITIS
What are the three types of thrombophlebitis that can occur postpartum?
(A) Femoral Thrombophlebitis
(B) Pelvic Thrombophlebitis
(C) Pulmonary Embolism
What are the predisposing factors for thrombophlebitis?
(A) Obesity or overweight
(B) History of varicose veins or thrombophlebitis
(C) Age ≥30 with increased parity
(D) Positive family history of thrombophlebitis
What are the clinical manifestations of thrombophlebitis?
(A) Pain or discomfort at the thrombus site (legs, pelvis, chest)
(B) Leg pain, edema, and redness (if in leg veins)
(C) Elevated temperature and chills
(D) Decreased peripheral pulses
(E) Positive Homan’s sign (pain in the calf on dorsiflexion of the foot)
(F) Cool and pale leg (if deep vein is affected)
It measures the ratio of systolic ankle pressure (SAP) to systolic brachial pressure (SBP) to assess peripheral artery disease (PAD).
Ankle-Brachial Index (ABI)
How is ABI calculated?
ABI = Systolic Ankle Pressure / Systolic Brachial Pressure
Example: If SAP = 100 mmHg and SBP = 120 mmHg, then ABI = 120/100 = 1.2
What are the ABI interpretation values?
(A) 1.0 - 1.4 → Normal
(B) 0.9 - 1.0 → Borderline
How do you elicit a positive Homan’s sign?
(A) Support the patient’s thigh with one hand and hold the foot with the other.
(B) Bend the leg slightly at the knee.
(C) Abruptly dorsiflex the ankle.
(D) If deep calf pain occurs, the test is positive.
What do positive and negative Homan’s sign indicate?
(A) Positive Homan’s sign → Deep vein thrombosis (DVT) may be present.
(B) Negative Homan’s sign → No pain, no resistance to dorsiflexion.
What should you ask the patient before performing Homan’s sign?
Ask if they already feel pain in the calf. If yes, do not perform the test (automatic positive).
Why is Pulmonary Embolism (PE) a medical emergency?
It can cause sudden cardiopulmonary arrest due to blockage of pulmonary arteries.
What are the signs and symptoms of PE?
(A) Sudden sharp chest pain
(B) Tachypnea (rapid breathing)
(C) Tachycardia (rapid heart rate)
(D) Orthopnea (difficulty breathing unless upright)
(E) Cyanosis
What is the priority nursing intervention for PE?
Refer to the physician immediately and administer oxygen.
What percentage of women experience postpartum mood disturbances?
85% experience mood changes; 10-15% develop depression or anxiety.
Women with a history of postpartum psychiatric illness have what risk of recurrence?
50% chance of recurrence.
What are the three types of postpartum psychiatric disorders?
(A) Postpartum Blues
(B) Postpartum Depression
9C) Postpartum Psychosis
What are the suspected causes of postpartum psychiatric disorders?
(A) Hormonal imbalances
(B) Life stresses
(C) Situational Risks (condition of life maybe related to loss of job/lack of finances)
What are the predisposing factors for postpartum psychiatric disorders?
(A) Previous depression, psychosis, or bipolar disorder
(B) Life stress and lack of social support
(C) Marital dissatisfaction
(D) History of sexual abuse
(E) Traumatic birth experience
(F) Unrealistic expectations of birth/parenting
(G) Unwanted pregnancy
(H) Baby’s physical problems
(I) Problems with healthcare providers
This is known as the temporary, unpleasant emotional state after childbirth that lasts up to 2 weeks and affects 50-85% of women.
POSTPARTUM BLUES
When does postpartum blues typically occur?
It starts 3-5 days after delivery and lasts up to 2 weeks.
What are the clinical manifestations of postpartum blues?
(A) Mood swings
(B) Sadness and irritability
(C) Crying spells
(D) Decreased concentration
(E) Trouble sleeping
What is the nursing management for postpartum blues?
(A) No specific treatment needed
(B) Encourage social interactions and support groups
(C) Promote rest and diversional activities
(D) Ask how the mother feels
This condition is more severe, long-lasting (up to a year), and affects the mother’s ability to care for the baby.
POSTPARTUM DEPRESSION
What percentage of new mothers experience postpartum depression?
10-20% of new mothers.
What are the clinical manifestations of postpartum depression?
(A) Lack of joy in life
(B) Feelings of shame, guilt, or inadequacy
(C) Severe mood swings
(D) Loss of appetite
(E) Difficulty bonding with the baby
(F) Insomnia
What are the commonly used antidepressants for postpartum depression (PPD)?
Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine.
What are two common side effects of antidepressants?
Weight gain and loss of libido.
How does estrogen replacement therapy help postpartum depression?
It helps counteract the rapid drop in estrogen after childbirth, which may ease PPD symptoms.
Why should a mother be careful not to blame the baby for her postpartum depression?
Older children may become angry at the baby and develop negative feelings toward them.
What are some ways to prevent postpartum depression?
(A) Maintain balanced nutrition, exercise, and sleep.
(B) Express feelings with a support person.
(C) Take personal time for hobbies or self-care.
(D) Avoid perfectionism—prioritize important tasks.
(E) Stay socially connected via the internet or phone.
This is the most severe and rarest form of postpartum depression, involving loss of contact with reality.
Postpartum psychosis
When does postpartum psychosis typically occur?
Within the first two weeks after childbirth.
What are the symptoms of postpartum psychosis?
(A) Confusion and disorientation
(B) Auditory hallucinations and delusions
(C) Paranoia
(D) Rapid mood shifts
(E) Illogical thoughts
(F) Suicidal or homicidal thoughts
Why is postpartum psychosis considered an emergency?
It has a 5% suicide rate and a 4% infanticide rate, requiring immediate medical intervention.
What should be done in case of postpartum psychosis?
(A) Call a doctor or go to the nearest hospital immediately.
(B) Provide family education and support.
(C) Avoid labeling the affected individual as a bad mother.
What are two commonly used antipsychotic medications for postpartum psychosis?
Risperidone and Olanzapine.
Why is early treatment important for postpartum psychosis?
Delayed treatment reduces medication effectiveness, increasing complications.
