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Peds/OB > Postpartum Complications > Flashcards

Postpartum Complications Flashcards

1
Q

Everybody has this risk
Just giving birth puts you at risk for bleeding; gives birth at risk for bleeding - need blood transfusion potentially
Definition and incidence
Etiology and risk factors
Inversion of uterus
Subinvolution of uterus

A

Postpartum hemorrhage

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2
Q

Leading cause of maternal death worldwide
PPH traditionally defined as loss of more than:
500 ml+ of blood after vaginal birth
1000 ml+ after cesarean birth - cut open and make bleed
Can happen slowly or at once
Early indication of hypovolemia - HR increase
Need proactive care third and fourth stage
Weigh things to quantify blood loss
Life-threatening with little warning
Often unrecognized until profound symptoms
First sign of hypovolemia - low HR

A

Definition and incidence

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3
Q

Four T’s
Uterine atony (Tone)
Lacerations of genital tract (Trauma)
Hematomas (Thrombin)
Retained placenta (Tissue)

A

Etiology and risk factors

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4
Q

No tone
Low tone of uterus after uterus delivered - fire hoses of arteries and uterus usually contracts - no tone - bleeds
Marked hypotonia of uterus

A

Uterine atony (Tone)

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5
Q

Shoulder distocia - tore up to get out baby

A

Lacerations of genital tract (Trauma)

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6
Q

Assessing after give birth - super personal
No losing blood outside but losing blood into muscle

A

Hematomas (Thrombin)

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7
Q

Not fully contract because part placenta adhered - sometimes a lot and adhered - have DNC - too much bleeding - no more than saturating one pad in a day

A

Retained placenta (Tissue)

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8
Q

Turning inside out of uterus - fundus in vaginal vault
Caused by lack support uterine muscle, pelvic floor issues, placenta not want to let go, docs tug on uterus to remove
Potentially life threatening
1 in 3000 births

A

Inversion of uterus

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9
Q

Getting smaller
Late postpartum bleeding - causing this
Retained placental fragment and potential pelvic infection
Uterus at umbilicus - 1 day after; 2 days - 1 finger width below; 3 days - 2 finger width below; if going above belly button - need investiage

A

Subinvolution of uterus

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10
Q

Medical management
Acting hypovolemic
Hypotonic uterus
Bleeding with a contracted uterus
Uterine inversion
Subinvolution
Nursing interventions

A

Care management

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11
Q

Early recognition is critical - lot assessments; q15 first hour, q30 second hour
First step is evaluation of contractility of uterus - assess same place
BP cuff not going to stay on likely
Firm massage of fundus - contracted; boggy - more bleeding
Management is directed toward increasing contractility and minimizing blood loss in immediate postpartum - eval lochia - qualify lochia - end measure for quantify blood loss - interum scant, small, moderate

A

Medical management

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12
Q

Pale
Greenish hue potentially
Dizzy
Nauseous
Ears ringing
Assess for bleeding - lay back and pull back covers to assess bleeding; assess uterus for contractility
Losing volume - assess for contractility and assess fundus - fundus firm - find out why look like
Some output - may be lacerations - call doc
Placenta retained - provider come get

A

Acting hypovolemic

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13
Q

Hemorrhage - what can do
Call provider for order of meds
Massage fundus
Call provider!!!! - tell gave meds
Orders - do them - call provider

A

Bleeding with a contracted uterus

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14
Q

Potentially PPH

A

Uterine inversion

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15
Q

Infection - really hurts - uterus should not hurt after
Subinvolution and hurting and spiking fever - abx

A

Subinvolution

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16
Q

Massage fundus
Call provider

A

Nursing interventions

17
Q

Puerperal sepsis: any infection of genital tract within 28 days after miscarriage, induced abortion, or birth
Most common infecting agents are numerous streptococcal and anaerobic organisms/bacteria
Endometritis
Wound infections
Urinary tract infections
Mastitis
Management during labor - consider what cause later - everytime go down there at risk for infection

A

Postpartum infections

18
Q

Puerperal - intrapartum to postpartum

A

Puerperal sepsis: any infection of genital tract within 28 days after miscarriage, induced abortion, or birth

19
Q

Subinvolution and tender uterus
Endometrium uterus infected

A

Endometritis

20
Q

Laceration
Episiometies
C-sections

A

Wound infections

21
Q

Everyone at risk - indwelling catheters
Lot things down south and urethra next to it - periurethral tears wear tear up there

A

Urinary tract infections

22
Q

Inflammation of breasts
Can become septic - can have breasts removed due to level infection
NEEDS abx - not on own
Pump and nurse on side - not hurt baby but hurts her - engorgement hurts

A

Mastitis

23
Q

Mental health disorders in postpartum period have implications for mother, newborn, and entire family
Perinatal Mood and Anxiety Disorders (PMADs) represent a broad group of mental health problems that occur during and after pregnancy. These include the following six diagnosable and treatable disorders:
Mood disorders
Postpartum depression with psychotic features

A

Perinatal mood and anxiety disorders

24
Q

Interfere with attachment to newborn and family integration
May threaten safety and well-being of mother, newborn, and other children

A

Mental health disorders in postpartum period have implications for mother, newborn, and entire family

25
Q

Lot people affected with pregnancy; now everyone screened routinely
Depressive Disorders
Obsessive Compulsive Disorders
Anxiety Disorders (including Panic) - variety
Psychosis
Post-traumatic Stress Disorder - from birth affect in postpartum; how go pregnant - preggo whole mess
Bipolar Mood Disorders (I and II)

A

Perinatal Mood and Anxiety Disorders (PMADs) represent a broad group of mental health problems that occur during and after pregnancy. These include the following six diagnosable and treatable disorders:

26
Q

Baby Blues=80% of women - not depression; many women have labile womens after birth; due to placenta - lot estrogen and progesterone - better after couple weeks; not issue - issue is crying all time, not eat, not do things like do, not allow people - not dismiss - esp if month after delivered
Perinatal depression=10% to 15% of women
Paternal postpartum depression=10% of male partners
Anxiety=25% of women - OCD, PTSD, phobias
Psychosis=0.01% of women - psychotic breaks, homicide, suicide - baby cannot stay with her if admitted to hospital
Biggest risk - massive drop in hormones

A

Mood disorders

27
Q

Postpartum psychosis: syndrome characterized by depression, delusions, and thoughts of harming either infant or herself
People see this: ED
Psychiatric emergency; may require psychiatric hospitalization - hearing voices, delusional; killing baby - believe supposed do - not rational
Associated with bipolar (or manic-depressive) disorder
This disorder has a 5% suicide rate and a 4% infanticide rate
Challenge: noncompliance - amt people with mental health disorders increased
Look for it and ask questions

A

Postpartum depression with psychotic features

28
Q

Generalized anxiety disorder (GAD)
Obsessive-compulsive disorder (OCD)
Panic disorder and panic attacks
Specific phobias
Social anxiety disorder
Posttraumatic stress disorder (PTSD)
Come up r/t pregnancy
Intrusive thoughts - come towards you non-stop and need be aware of them

A

Postpartum anxiety disorders

29
Q

Screening for postpartum depression - EPDS - screened before go home; screen again at 6-weeks; score it and based on score - now follow-up - talk about some questions asked - may need come back in 2 days and not 2 weeks - hook up with therapist - may need Zoloft; convo before d/c; asked her how feel
Depressed - flat affect, not put together; severely depressed - no makeup, sade faced, extremely flat
High funxing anxiety - at risk; assess person - give scale and answer honestly
Nursing care on the postpartum unit
Nursing care in the home and community
Referrals
Providing safety
Psychiatric hospitalization
Psychotropic medications
Postpartum depression and anxiety - affects life; affects business; affects gross natural product
Decrease chance of PMAD
Other treatments for postpartum depression

A

Care management

30
Q

Assess and report it
Check pt on how interacting with pt - postpartum - pain and breastfeeding

A

Nursing care on the postpartum unit

31
Q

Not being separated from child help
Breastfeeding

A

Decrease chance of PMAD

Peds/OB (68 decks)

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