Postpartum Complications Flashcards
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
Postpartum hemorrhage
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
Definition and incidence
Four T’s
Uterine atony (Tone)
Lacerations of genital tract (Trauma)
Hematomas (Thrombin)
Retained placenta (Tissue)
Etiology and risk factors
No tone
Low tone of uterus after uterus delivered - fire hoses of arteries and uterus usually contracts - no tone - bleeds
Marked hypotonia of uterus
Uterine atony (Tone)
Shoulder distocia - tore up to get out baby
Lacerations of genital tract (Trauma)
Assessing after give birth - super personal
No losing blood outside but losing blood into muscle
Hematomas (Thrombin)
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
Retained placenta (Tissue)
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
Inversion of uterus
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
Subinvolution of uterus
Medical management
Acting hypovolemic
Hypotonic uterus
Bleeding with a contracted uterus
Uterine inversion
Subinvolution
Nursing interventions
Care management
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
Medical management
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
Acting hypovolemic
Hemorrhage - what can do
Call provider for order of meds
Massage fundus
Call provider!!!! - tell gave meds
Orders - do them - call provider
Bleeding with a contracted uterus
Potentially PPH
Uterine inversion
Infection - really hurts - uterus should not hurt after
Subinvolution and hurting and spiking fever - abx
Subinvolution
Massage fundus
Call provider
Nursing interventions
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
Postpartum infections
Puerperal - intrapartum to postpartum
Puerperal sepsis: any infection of genital tract within 28 days after miscarriage, induced abortion, or birth
Subinvolution and tender uterus
Endometrium uterus infected
Endometritis
Laceration
Episiometies
C-sections
Wound infections
Everyone at risk - indwelling catheters
Lot things down south and urethra next to it - periurethral tears wear tear up there
Urinary tract infections
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
Mastitis
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
Perinatal mood and anxiety disorders
Interfere with attachment to newborn and family integration
May threaten safety and well-being of mother, newborn, and other children
Mental health disorders in postpartum period have implications for mother, newborn, and entire family
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)
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:
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
Mood disorders
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
Postpartum depression with psychotic features
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
Postpartum anxiety disorders
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
Care management
Assess and report it
Check pt on how interacting with pt - postpartum - pain and breastfeeding
Nursing care on the postpartum unit
Not being separated from child help
Breastfeeding
Decrease chance of PMAD
