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Womens Health Exam 3 > Postpartum Complications > Flashcards

Postpartum Complications Flashcards

1
Q

What are the postpartum complications?

A

Hemorrhage

Infections
-endometritis
-UTI
-mastitis

Thromboembolic disease (blood clots)

Psychiatric problems
-Postpartum blues
-postpartum depression
-postpartum psychosis

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2
Q

Define postpartum hemorrhage

A

Greater than 500ml blood loss following a vaginal delivery

Greater than 1000ml blood loss following C-section

Or 10% drop in hematocrit (hct) from pre-delivery baseline

Or postpartum hemodynamic instability

Or postpartum blood transfusion needed

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3
Q

When does early or primary postpartum hemorrhage occur?

A

In the first 24 hours after childbirth and is the most common

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4
Q

What is late or secondary postpartum hemorrhage?

A

24 hours after delivery to 12 weeks after birth

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5
Q

What is the primary cause of postpartum hemorrhage?

A

Uterine atony

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6
Q

What are the clinical signs of postpartum hemorrhage?

A

Decreased blood pressure, increasing pulse, widening pulse pressure

Thirst

Restlessness

Decreasing urinary output

Boggy uterus or fungus that is higher than expected

Excessive or bright red bleeding

Multiple clots expressed during fundal Massage

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7
Q

What is uterine atony?

A

Relaxation of the uterus

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8
Q

What are the risk factors for postpartum hemorrhage?

A

Over distention of the uterus due to multiple gestation, hydramnios, or a large baby (macrosomia)

Exhaustion of uterus muscle caused by grand multiparity, prolonged or precipitous labour, oxytocin induction, or augmentation of labor

Use of medications which cause the uterus to relax

Placenta problems

Previous history of postpartum hemorrhage doubles, or triples the risk of a repeat occurrence

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9
Q

What are preventative treatments for postpartum hemorrhage?

A

Controlled traction on the umbilical cord if prolonged third stage (more than 30 minutes from delivery of baby to delivery of placenta)

Uterine massage after birth

Administration of oxytocin after delivery of placenta either IM or IV

Is estimated that these three interventions can prevent 50% of PPH

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10
Q

What are the second line medication’s for PPH?

A

Methylergonovine (methergine)
-contraindicated for women with hypertension, cardiac disease, Raynaud’s disease

Carboprost
-contraindicated for women with asthma, cardiovascular, renal, or liver disease

Misoprostol (cytotec)

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11
Q

When should we suspect lacerations?

A

If the uterus is firm and bright red bleeding persists

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12
Q

Risk factors for hematoma

A

Episiotomy / Lacerations

Primiparity

Prolonged 2nd stage

Macrosomia

Preeclampsia

Clotting disorders

Vulvar varicosities

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13
Q

How do you treat hematomas

A

Ice packs and analgesia

Small ones resolve on their own like less than 3 cm and not expanding

Large ones and ones that are expanding require surgical interventions

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14
Q

Why do hematomas usually occur?

A

Injury to a blood vessel from birth trauma or inadequate hemostasis at the side of repair of an incision or laceration

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15
Q

What causes late postpartum hemorrhage?

A

Subinvolution (failure to return to normal size)

Retained placental fragments

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16
Q

Signs of subinvolution

A

The postpartum fundal height is greater than expected

Lochia fails to progress normally from rubra to serosa to alba

Lochia rubra that persist longer than normal may be suggestive of subinvolution

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17
Q

Nursing interventions for PPH

A

Uterine massage

Empty the patient’s bladder

Oxytocin as ordered

Monitor VS, I&O, o2 stat, LOC

If not resolve quickly, contact HCP

Pad count (weigh)

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18
Q

Define postpartum endometritis

A

Infection of the uterine lining

19
Q

Risk factors for postpartum endometritis

A

Cesarean birth

PPROM

Manual removal of placenta

Chorioamnionitis

Compromised health status

Diabetes

20
Q

How to asses for postpartum endometritis

A

Uterine tenderness on palpation

Foul smelling lochia

Tachycardia

Chills

Fever

21
Q

How to treat postpartum endometritis

A

IV antibiotics

If fever persists after 48 hours, additional testing needed

22
Q

Define postpartum mastitis

A

Infection of the interlobular connective tissue of lactating women

Onset typically between 2 to 8 weeks after delivery

23
Q

Signs and symptoms of postpartum mastitis

A

Warm, reddened, painful area on the breast

Fever, chills, headache, flu like aches and malaise (tiredness,discomfort)

24
Q

How do you prevent postpartum mastitis?

A

Handwashing before breast-feeding

Supportive but non-constricting bra

Frequent and complete emptying of breastmilk

Avoid trauma to nipples
-learn correct latch technique
-Keep nipples dry between feedings

25
Q

How do you treat postpartum mastitis

A

Keep breastfeeding!

Antibiotics!

Rest

Increased fluid intake

Warm or ice packs

Pain medication such as ibuprofen

26
Q

What are risk factors for thromboembolic disease?

A

Cesarean birth

Prolonged immobility

Obesity

Smoking

Varicose veins

27
Q

Symptoms of a DVT

A

Leg or calf pain/tenderness

Unilateral swelling, warmth, or redness

28
Q

Symptoms of a PE

A

Apprehension/anxiety/panic

Chest pain

Dyspnea

Tachypnea/tachycardia

Cough and possibly hemoptysis

Hypotension/cyanosis/syncope

29
Q

How do you treat a DVT or PE?

A

Immediate administration of anticoagulants
-Heparin or low molecular weight heparin

Maintenance with warfarin it started at 1 to 5 days

Strict bed rest and elevation of affected limb are required

Avoid massage of extremity

Once symptoms have subsided, encourage walking and have patient wear support hose

For PE, administer O2

30
Q

What is the taking in period?

A

First 2-3 days

Preoccupied with own needs, passive, dependent

Touches and explores infant

Needs to discuss her L&D experience

31
Q

What is the taking hold period?

A

Lasts 3 to 10 days

Obsessed with body functions, initiates self-care

Rapid mood swings

Responds to instruction about infant care and self-care

32
Q

What is the letting go period?

A

Lasts 10 days to six weeks

Mothering functions have been established

Sees infant as a unique person

33
Q

What is postpartum blues?

A

The mildest out of the three other postpartum psychiatric disorders

Also known as adjustment reaction with depressed mood

Typically begins 2 to 4 days after delivery and resolves within 10 to 14 days

34
Q

What is postpartum depression?

A

Also known as peripartum major mood episodes

Typically begins about 4th week after delivery, but can occur anytime in the first year

35
Q

What is postpartum psychosis?

A

Most serious of the three

Also known as postpartum mood episodes with psychotic features

Symptoms usually show up within a few days of delivery

Considered an emergency

36
Q

What are common symptoms of postpartum blues?

A

Mood swings, difficulty sleeping, anorexia, feeling of let down

37
Q

Risk factors for postpartum blues

A

Changing hormone levels, pain, fatigue, an unsupportive environment or insecurity

38
Q

Symptoms of postpartum depression

A

Similar to symptoms of postpartum blues, but also include:

Feelings of worthlessness

Lack of interest in usual activities

Lack of concern over personal appearance

Irritability or hostility towards baby

Thoughts of suicide

39
Q

Risk factors for postpartum depression

A

History of depression prior to pregnancy

History of bipolar

Stressful life events

Lack of social support or stable life partner

Loss of newborn

First pregnancy or young mother

40
Q

Treatment for postpartum depression

A

Individual or group therapy plus antidepressants
-selective serotonin re-uptake inhibitor (SSRI)
-tricyclic antidepressants

41
Q

Symptoms of postpartum psychosis

A

Sleep disturbances

Depersonalization (unaware of or distant from immediate environment or people within it)

Confused, irrational

Hallucinations, delusions

Psychomotor disturbances:
-stupor
-agitation
-rapid and incoherent speech

42
Q

Risk factors for postpartum psychosis

A

History of previous postpartum psychosis

History of bipolar

Family history of either condition above

43
Q

Treatment for postpartum psychosis

A

Keep mom and baby safe

Inpatient psychiatric care

Anti-psychotic medications

Psychotherapy

Social support

44
Q

What are some nursing intervention to assess mom’s mental status?

A

Observe patient with the baby, by herself, with her family and friends

Review history

Note adequacy of coping skills

Note degree of self-esteem

Recognize early signs of problems

Support positive parenting behaviors

Discuss patients plans for baby and self

Refer to social services if necessary

Womens Health Exam 3 (6 decks)

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