Module 11 (Final) Flashcards
Rh Incompatibility
Rh - mother carrying a Rh + fetus
Mother’s body considers Rh+ blood an antigen and an antibody response is triggered.
When does Rh incompatibility take place?
Pregnancy: small amount of fetal blood may enter maternal circulation VIA microtears in placenta
Placental separation (greatest risk): Larger amounts of fetal blood enter maternal circulation
Fetal/Newborn Effect of Rh incompatibility
Antibodies from mother attack Rh+ blood cells. Hemolysis of fetal/newborn RBCs takes place.
Result: hemolytic anemia, pathological jaundice
How is Rh incompatibility prevented?
Rhogam
What does Rhogam do?
Suppresses mother’s normal immune response. The mother’s cells no longer recognize fetal cells as foreign and no antibody formation occurs.
How long does Rhogam last?
12 weeks
Coombs Test
Identifies antibodies to Rh+ blood. It is interpreted as positive or negative.
Direct Coombs
Done on baby. Identifies antibodies to Rh+ blood in the neonate’s serum.
Indirect Coombs
Done on momma. Identifies antibodies to Rh+ blood in maternal serum.
Negative: no antibodies. given rhogam.
Positive: antibodies. No rhogam (too late). The fetus is at risk for hemolytic anemia and pathological jaundice.
When is indirect coombs testing performed?
Indirect coombs testing is performed on all Rh- women at about 28 weeks’ gestation
When is direct coombs testing performed?
postpartum, on a neonate with a Rh + blood sample.
Negative: mother recieves Rhogam within 72 hours to prevent antibody formation to protect future pregnancies.
Positive: Infant has been exposed to maternal antibodies. Monitor infant for jaundice. Treat infant for hemolytic anemia (transfusion)
When does ABO incompatibility occur?
Type O mother, Type A, B or AB fetus
Mother may have naturally occurring antibodies to blood type A or B, so sensitation does not necessarily have to be from fetal/maternal blood crossing.
Antibodies hemolyze type A and/or type B RBCs. Typically mild.
Effects of ABO incompatibility on the newborn and fetus
Fetus: No effects
Newborn: Potential hemolytic anemia, potential jaundice
How would you manage ABO incompatibility postpartum?
If mother is blood type O: Determine newborn blood type and perform direct coombs to detect antibodies to both blood type and Rh.
Coombs Positive: Monitor infant for jaundice, anticipate treatment for possible pathologic jaundice and/or hemolytic anemia (HA is rare)
Negative: Infant not at risk. No interventions necessary.
PP Hemorrhage Vaginal Birth
greater that 500mL blood loss
PP Hemorrhage Cesarean Birth
greater that 1000mL blood loss
Other criterion for PP Hemorrhage
Decrease in HCT of 10% or more from admission
Early postpartum hemorrhage
Criteria are met within 24 hours after birth
Late postpartum hemorrhage
Criteria are met after the first 24 hours
Cause of early postpartum hemorrhage
Uterine atony associated with “boggy” fundus
Predisposing factors: uterine overdistention, multiparity, rapid labor, prolonged labor, macrosomia, rapid labor, assisted birth
Other causes: trauma, lacerations (perineum, vagina, cervix), hematoma (vagina, perineum)
Prevention and Treatment of early postpartum hemorrhage
Prevention: Identification of risk factors
Treatment: Fundal massage, IV fluid replacement, oxytocic medications, foley catheter (inserted for pressure from inside), treat underlying cause, monitor blood loss (weigh pads)
Causes of late postpartum hemorrhage
Uterine subinvolution
Other: retained placental fragments
Management of late postpartum hemorrhage
Outpatient: surgical removal of placental fragments
What is a puerperal infection?
Bacterial infection during the six weeks following birth
What are the most common puerperal infections?
- Endometritis
- Urinary Tract
- Mastitis
What is endometritis?
Infection of the endometrium
What are the risk factors for endometritis?
- Prolonged rupture of membranes
- Prolonged labor
- Multiple vaginal exams
- Trauma of the perineum, vagina, or cervix
- Catheterization
- Retained placental fragments
- Cesarean birth
- Concurrent problems (ie. diabetes)
What assessment data would you find consistent with endometritis?
- Uterine tenderness
- Chills and malaise
- Abdominal cramping
- Fever of 38 degrees or higher after the first 24 hours
- Foul smelling lochia
- Uterine subinvolution
- Elevated WBCs
What would you do for endometritis?
- Place the woman in fowler’s position
- Analgesics
- IV antibiotics
- Non-pharmacological comfort measures
- Assistance with infant care
What are the risk factors for urinary tract infection?
- Trauma (pressure on urethra from presenting part)
- Catheterization
- Stasis/reflux (regional anesthesia, pressure on bladder from presenting part)
What assessment data would you find for urinary tract infection?
- Dysuria
- Frequency
- Suprapubic pain
- Low grade temperature
- Signs of ascending infection
- Flank pain
- Elevated temperature
How would you manage a urinary tract infection?
- Antibiotics
- Analgesics
- Encourage frequent voiding
- Reinforce perineal hygiene
- Encourage increased fluid intake
- Discharge teaching
- Signs/symptoms of worsening urinary infection
What are the risk factors for mastitis?
- Poor hand washing
- Newborn oral contact (staph aureus)
- Milk stasis
- Infrequent breastfeeding
- Engorgement
- Clogged duct
What assessment data would you find with mastitis?
- Flu like symptoms
- Temperature of 38 degrees or greater
- Localized pain over effected breast area
- Warmth and erythema of affected breast
How would you manage mastitis?
- Frequent breast feeding
- Monitor breast feeding technique
- Antibiotics
- Analgesics
- Non pharmacologic comfort measures
- Assistance with newborn care
What are the risk factors from thromboembolitic disorders?
- Compression of large veins of lower extemities during pregnancy
- Venous stasis
- Postpartum hypercoagulation
What assessment data would you find with superficial thrombophlebitis?
- Localized tenderness
- Swelling
- Warmth
- Erythema
- Homan’s negative
How would you manage superficial thrombophlebitis?
- Ambulation as tolerated
- Analgesics
- Moist heat
- Elevation of limb
- Anticoagulation not indicated
What assessment data would you find with deep vein thrombosis?
- Positive Homan’s sign (pain)
- Extemity cool to palpation
- Edema of effected extremity
- Diminished peripheral pulses in affected area
How would you manage deep vein thrombosis?
- Doppler flow studies
- Bedrest
- Analgesics
- IV anticoagulation
- Monitor for pulmonary embolism
- Dyspnea
- Shortness of breath
- Decreased oxygen status
Define puerperal infection
Infection of the reproductive tract up to six weeks postpartum
Define subinvolution
Failure of a part to return to its normal size after functional enlargement
Define mastitis
Inflammation of the breast ocurring primarily in lactating women
Describe the rationale for weighing perineal pads postpartum
1 gram = one mL of blood loss
