Postpartum Complications

Question 1

Primary causes of mortality associated with childbearing

Answer 1

Postpartum hemorrhage

Question 2

When hemorrhage might occur?

Answer 2

Early (within the first 24hrs after birth)
Late (from 24hrs to 6 weeks after birth)

Question 3

When is the time where this kind of hemorrhage is considered the “greatest danger”

Answer 3

Early hemorrhage (within the first 24hrs after birth)

Question 4

It is the relaxation of the uterus

Answer 4

Uterine atony

Question 5

it is the most frequent cause of postpartum hemorrhage

Answer 5

Uterine atony

Question 6

Therapeutic Management for Uterine Atony

Answer 6

1. Drain the bladder and attempt fundal massage
2. Remain with the patient after massaging the fundus
3. Elevate the patient’s lower extremities to promote blood flow to organs
4. Offer a bedpan or assist the patient to the bathroom at least every 4hrs
5. Administration of oxygen face mask 10-12L/min
6. Obtain VS frequently

Question 7

During uterine atony, if the uterus does not remain contracted, what would be the next course of action?

Answer 7

Contact the primary care giver so interventions to increase contractions are performed

Question 8

During uterine atony, what are the possible interventions to increase the contraction?

Answer 8

1. Administrating a bolus
2. Dilute IV infusion of oxytocin

Question 9

During uterine atony, if oxytocin is not effective as part of a management, what drugs can be administered next through IM?

Answer 9

1. Carboprost tromethamine (hemabate)
2. Methylergonovine maleate (methergine)
3. Misoprostol (cytotec)
4. Tranexamic acid (TXA)

Question 10

What drug should NOT be administered for second dose unless a minimum of 2hrs has elapsed

Answer 10

Misoprostol (cytotec)

Question 11

This drug can increase BP

Answer 11

Methergine

Question 12

Primary care provider inserts one hand into the vagina while pushing against the fundus through the abdominal wall with the other hand

Answer 12

Bimanual compression

Question 13

If bimanual compression is ineffective, what would be the next course of action?

Answer 13

The patient may be returned to the birthing room so that the uterine cavity can be explored manually

Question 14

It is to replace blood loss with postpartum hemorrhage

Answer 14

Blood replacement/Blood transfusion

Question 15

What kind of therapy should be administered to ensure good hemoglobin formation

Answer 15

Iron therapy

Question 16

Therapeutic Management for Blood replacement

Answer 16

1. Observe any patient who has experienced more than a normal loss of blood for changes such as scant or odorous lochia discharge
2. Monitor their temperature closely in the postpartum period

Question 17

If all other therapeutic management are not effective for uterine atony, what would be the last resort of therapeutic management to be performed?

Answer 17

1. Ligation of uterine arteries
2. Compression suturing of the uterus
3. Hysterectomy