Postpartum Complications Flashcards
What do we do/what is management directed at if a PPH occurs and the uterus is hypotonic?
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
Who are at a greater risk of developing a postpartum infections? What factors contribute to this?
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
What are some tissue and thrombin realted risk factors for a PPH?
Tissue:
Retained placental fragments
Placenta accrete, increta, perceta (abnormal attachment to the uterine wall)
Placental abruption
Placenta previa
Thrombin:
Coagulation disorders
How does Mastitis progress?
Inflammatory edema and engorgement of the breast obstruct the flow of milk in a lobe; regional, then generalized, mastitis follows.
What are some nursing interventions for a PPH?
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
What are some symptoms of a post partum mood disorder?
Symptoms:
Fatigue
Frustration, anger
Irritability
Indecisiveness
Withdrawal from social situations
How do we prevent mastitis?
Prevent by promoting a good latch and good hygiene
What is Endometritis? What are some S+S of it?
-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
When can perinatal modd disorders (PMD) occur?
Can happen during pregnancy or within the first 12 months after birth
If a PPH occurs and the uterus is firm, what must we do?
If the uterus is firm then the source of bleeding must be identified!!
1.) Visual, or manual inspection
2.) Laboratory findings
What kind of emotions can patients expect to experience within 3 - 5 day postpartum?
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)
What are signs of the baby blues? When should they go away?
-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
What are examples of perinatal mood disorders (PMD)?
PMDs include anxiety, depression, and psychosis
How do we treat a PPH?
Early identification and treatment is very important
Active management with oxytocin to prevent PPH, gentle cord traction, and immediate fundal massage after complete birth
S+S of Mastitis?
Chills
Fever
Malaise
Tenderness/pain
Redness
Axillary adenopathy (swollen lymph nodes)
What is the difference between the baby blues and a mood disorder?
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.
What is a PPH (post partum hemorrhage?
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).
What can cause secondary postpartum bleeding?
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
What are common postpartum infections that occur?
Common infections:
Endometritis
Wound infections
Mastitis
Urinary track infections
And respiratory track infections
When should a HCP be called in regards to postpartum blues, depression, and psychosis?
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
What is the treatment for Mastitis? What can happen if it is not promptly treated?
Treatment: antibiotics, comfort (heat/cold, supportive bra)
If treatment is not prompt, mastitis may progress to a breast abscess.
What are some trauma related risk factors for a PPH?
Trauma
Lacerations of the birth canal
Trauma during labour and birth (e.g forceps)
Ruptured uterus
Manual removal of a retained placenta
What are the signs of post partum depression? When can they begin?
-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
What should discharge emphasize about PPH include?
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
