Postpartum Care/Complications Flashcards
What is the size of the fundus right after birth
Large grapefruit
Where is the fundus located right after birth
Midline midway between symphysis pubis and umbilicus
Where is the fundus located 6-12 hours after birth
Level of the umbilicus
How much does the fundus decrease in size
1 cm a day
When does the fundus descend into the pelvis
10th day
At 6-8 weeks how much does the fundus weigh
60 g
What is lochia rubra
dark red blood with some clotting less than the size of a nickel
When does lochia rubra occur
1st 2-3 days after birth
What is lochia serosa
pinkish discharge
When does lochia serosa occur
days 3-10
What is lochia alba
white/yellow-white discharge
What does breastfeeding reduce in the mom
- Breast/ovarian cancer
- HTN
- Type 2 diabetes
What does breastfeeding reduce in the baby (8)
- Asthma
- Obesity
- Type 1 diabetes
- Severe lower respiratory disease
- otitis media
- SIDS
- GI infections
- NEC in preterm babies
What are the postpartum warning signs (7)
- Bright red bleeding, increased bleeding, soaking more than 1 pad an hour, large clots
- Temperature >100.4, chills
- Increased/excessive pain
- Foul smelling lochia
- Urinary burning, frequency, unable to void
- Calf pain, redness, tenderness, increased edema
- Chest pain, SOB
How much blood is considered hemorrhaging after a vaginal birth
> 500 ml
How much blood is considered hemorrhaging after a c-section
> 1,000 ml
What change in Hg, Hct is considered hemorrhaging
10%
What is primary/early postpartum hemorrhage
bleeding during the 1st 24 hours after birth
What is secondary/late postpartum hemorrhage
bleeding 24 hours-14 days after birth
What are the interventions for postpartum hemorrhage
- Initiate emergency response based on hospital policy
- Massage uterus until firm
- Start large bore IV to replace volume with normal saline or lactated ringers
- Supplemental oxygen
- Vital signs every 15 minutes including I&O
- Foley catheter to empty bladder
- Blood for CBC, crossmatching
- Continuous ECG, pain management, support
What are the causes/risk factors for postpartum hemorrhage
- Prolonged/rapid labor
- Retained placenta/placenta products
- Oxytocin, augmentation, induction
- Preeclampsia
- History of postpartum hemorrhage
- Trauma to cervix, vagina, perineal muscles
- Multiple gestation
- Coagulation disorders - thrombocytopenia
- Placental abruption, placenta prevue
- Too frequent/too many pregnancies
What are the medications used to treat postpartum hemorrhage
- Oxytocin
- Misoprostol
- Carboprost
- Methergine
What is the dose for oxytocin during postpartum hemorrhage
IV 10-40 U/1,000 ml solution
What is the dose of Misoprostol during postpartum hemorrhage
800-1000 mcg rectally
