Postpartum Complications

Question 1

What do we do/what is management directed at if a PPH occurs and the uterus is hypotonic?

Answer 1

Hypotonic:
Increasing contractility and minimize blood loss
Massage, empty the bladder, IV oxytocin

If that doesn’t work: misoprostol (synthetic prostaglandin) is used, blood products, oxygen, bimanual compression

If the uterus is hypotonic, management is directed toward increasing contractility, primarily with active uterine massage and uterotonic medication to minimize blood loss

Question 2

Who are at a greater risk of developing a postpartum infections? What factors contribute to this?

Answer 2

Postpartum infections are more common in patients with obesity, who have concurrent medical or immunosuppressive conditions, or who had a Caesarean or other operative birth. Intrapartal factors such as prolonged rupture of membranes, prolonged labour, and internal fetal monitoring also increase the risk of infection

Question 3

What are some tissue and thrombin realted risk factors for a PPH?

Answer 3

Tissue:
Retained placental fragments
Placenta accrete, increta, perceta (abnormal attachment to the uterine wall)
Placental abruption
Placenta previa

Thrombin:
Coagulation disorders

Question 4

How does Mastitis progress?

Answer 4

Inflammatory edema and engorgement of the breast obstruct the flow of milk in a lobe; regional, then generalized, mastitis follows.

Question 5

What are some nursing interventions for a PPH?

Answer 5

Monitor for symptoms of PPH and hypovolemic shock

Encourage the mother to empty her bladder

Measure blood loss

Stay calm and be transparent

Discharge teaching should emphasize the signs of normal involution, potential complications, and the importance of prompt assessment by a health care provider in the event of PPH

Question 6

What are some symptoms of a post partum mood disorder?

Answer 6

Symptoms:
Fatigue
Frustration, anger
Irritability
Indecisiveness
Withdrawal from social situations

Question 7

How do we prevent mastitis?

Answer 7

Prevent by promoting a good latch and good hygiene

Question 8

What is Endometritis? What are some S+S of it?

Answer 8

-Infection of the lining of the uterus

-Usually begins at the placenta site, but can spread

-Higher risk with caesarean birth

S+S:
Fever
Increased pulse
Chills
Anorexia
Nausea
Fatigue and lethargy
Pelvic pain
Uterine tenderness
Foul smelling profuse lochia

Question 9

When can perinatal modd disorders (PMD) occur?

Answer 9

Can happen during pregnancy or within the first 12 months after birth

Question 10

If a PPH occurs and the uterus is firm, what must we do?

Answer 10

If the uterus is firm then the source of bleeding must be identified!!

1.) Visual, or manual inspection

2.) Laboratory findings

Question 11

What kind of emotions can patients expect to experience within 3 - 5 day postpartum?

Answer 11

Within 3 to 5 days postpartum up to 75% of patients will experience episodes of tearfulness, agitation, mood swings, anxiety, sleep and appetite disturbances, and feelings of being overwhelmed (RNAO, 2018a)

Question 12

What are signs of the baby blues? When should they go away?

Answer 12

-these should go away in a few days or 1 week):

1.) Sad, anxious, or overwhelmed feelings

2.) Crying spells

3.) Loss of appetie

4.) Difficulty sleeping

Question 13

What are examples of perinatal mood disorders (PMD)?

Answer 13

PMDs include anxiety, depression, and psychosis

Question 14

How do we treat a PPH?

Answer 14

Early identification and treatment is very important

Active management with oxytocin to prevent PPH, gentle cord traction, and immediate fundal massage after complete birth

Question 15

S+S of Mastitis?

Answer 15

Chills
Fever
Malaise
Tenderness/pain
Redness
Axillary adenopathy (swollen lymph nodes)

Question 16

What is the difference between the baby blues and a mood disorder?

Answer 16

The distinguishing factor between this and a mood disorder is that it resolves within 2 weeks and does not disrupt the postpartum patient’s ability to care for themselves and their baby.

Question 17

What is a PPH (post partum hemorrhage?

Answer 17

PPH= any blood loss that has the potential to cause hemodynamic instability (no defined volume)

PPH may be defined as a 10% decline in hemoglobin concentration and the need for a transfusion (Francois & Foley, 2017).

Question 18

What can cause secondary postpartum bleeding?

Answer 18

Secondary postpartum bleeding may occur as a result of subinvolution of the uterus (delayed return of the enlarged uterus to normal size and function). Recognized causes of subinvolution include retained placental fragments, in the and pelvic infection

Question 19

What are common postpartum infections that occur?

Answer 19

Common infections:
Endometritis

Wound infections

Mastitis

Urinary track infections

And respiratory track infections

Question 20

When should a HCP be called in regards to postpartum blues, depression, and psychosis?

Answer 20

The baby blues continue for more than 2 weeks

Symptoms of depression get worse

Difficulty performing tasks at home or at work

Inabilitly to care for yourself or your baby

Thoughts of harming yourself or your baby

Question 21

What is the treatment for Mastitis? What can happen if it is not promptly treated?

Answer 21

Treatment: antibiotics, comfort (heat/cold, supportive bra)

If treatment is not prompt, mastitis may progress to a breast abscess.

Question 22

What are some trauma related risk factors for a PPH?

Answer 22

Trauma
Lacerations of the birth canal
Trauma during labour and birth (e.g forceps)
Ruptured uterus
Manual removal of a retained placenta

Question 23

What are the signs of post partum depression? When can they begin?

Answer 23

-Can begin anytime in the first year

Same signs as baby blues, but they last longer and are more severe
*Thoughts of harming yourself or the baby
*Not having nay interest in the baby

Question 24

What should discharge emphasize about PPH include?

Answer 24

Discharge teaching should emphasize the signs of normal involution, potential complications, and the importance of prompt assessment by a health care provider in the event of PPH

Question 25

How are Postpartum infection or puerperal infection defined?

Answer 25

Postpartum infection or puerperal infection is any clinical infection that occurs within 42 days after miscarriage, induced abortion, or birth (WHO, 2015).

Question 26

What is Mastitis? What comes before this develops? How does it occur (unilateral or bilateral)?

Answer 26

Breast infection: Mastitis, or breast infection, affects 2 to 10% of patients after childbirth.

Inflammatory edema and engorgement usually happen before the infection!

Usually unilateral

Question 27

Who are at a greater risk of developing perinatal mood disorders?

Answer 27

Women with a history of anxiety or depression have the greatest risk for developing PMD

Question 28

What are symptoms of postpartum psychosis?

Answer 28

Auditory or visual hallucinations
Paranoid or grandiose delusions
Delirium
Disorientation
Extreme deficits in judgement
Impulsive
Fatigue
Insomnia
Restlessness
Emotionality labile

Question 29

What is a late post partum hemorrhage (PPH)?These occur due to?

Answer 29

Late: more than 24 hours but less than 12 weeks postpartum due to retained products, infection, or both

Question 31

What is defined as a primary (early) post partum hemorrhage (PPH)?

Answer 31

Primary (early): within 24 hours after birth-Uterine atony is the leading cause of early PPH. It is associated with high parity, polyhydramnios, fetal macrosomia, and multiple gestation. In such conditions, the uterus is “overstretched” and contracts poorly after birth

Question 32

What are some tone specific risk factors for a PPH?

Answer 32

Tone*** (leading cause for PPH)
Overdistended uterus
Anesthesia and analgesia
Previous history of uterine atony
High parity
Prolonged labour
Magnesium sulfate (treats eclampsia) administration during labour or postpartum
Chorioamnionitis
Uterine subinvolution

Question 33

What are signs of postpartum psychosis?

Answer 33

-Seeing or hearing things that are not htere
-Feelings of confusion
-Rapid mood swings
-Trying to hurt yourslef or your baby