Postpartum Complications Flashcards
What are the postpartum complications?
Hemorrhage
Infections
-endometritis
-UTI
-mastitis
Thromboembolic disease (blood clots)
Psychiatric problems
-Postpartum blues
-postpartum depression
-postpartum psychosis
Define postpartum hemorrhage
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
When does early or primary postpartum hemorrhage occur?
In the first 24 hours after childbirth and is the most common
What is late or secondary postpartum hemorrhage?
24 hours after delivery to 12 weeks after birth
What is the primary cause of postpartum hemorrhage?
Uterine atony
What are the clinical signs of postpartum hemorrhage?
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
What is uterine atony?
Relaxation of the uterus
What are the risk factors for postpartum hemorrhage?
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
What are preventative treatments for postpartum hemorrhage?
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
What are the second line medication’s for PPH?
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)
When should we suspect lacerations?
If the uterus is firm and bright red bleeding persists
Risk factors for hematoma
Episiotomy / Lacerations
Primiparity
Prolonged 2nd stage
Macrosomia
Preeclampsia
Clotting disorders
Vulvar varicosities
How do you treat hematomas
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
Why do hematomas usually occur?
Injury to a blood vessel from birth trauma or inadequate hemostasis at the side of repair of an incision or laceration
What causes late postpartum hemorrhage?
Subinvolution (failure to return to normal size)
Retained placental fragments
Signs of subinvolution
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
Nursing interventions for PPH
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)
Define postpartum endometritis
Infection of the uterine lining
Risk factors for postpartum endometritis
Cesarean birth
PPROM
Manual removal of placenta
Chorioamnionitis
Compromised health status
Diabetes
How to asses for postpartum endometritis
Uterine tenderness on palpation
Foul smelling lochia
Tachycardia
Chills
Fever
How to treat postpartum endometritis
IV antibiotics
If fever persists after 48 hours, additional testing needed
Define postpartum mastitis
Infection of the interlobular connective tissue of lactating women
Onset typically between 2 to 8 weeks after delivery
Signs and symptoms of postpartum mastitis
Warm, reddened, painful area on the breast
Fever, chills, headache, flu like aches and malaise (tiredness,discomfort)
How do you prevent postpartum mastitis?
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
How do you treat postpartum mastitis
Keep breastfeeding!
Antibiotics!
Rest
Increased fluid intake
Warm or ice packs
Pain medication such as ibuprofen
What are risk factors for thromboembolic disease?
Cesarean birth
Prolonged immobility
Obesity
Smoking
Varicose veins
Symptoms of a DVT
Leg or calf pain/tenderness
Unilateral swelling, warmth, or redness
Symptoms of a PE
Apprehension/anxiety/panic
Chest pain
Dyspnea
Tachypnea/tachycardia
Cough and possibly hemoptysis
Hypotension/cyanosis/syncope
How do you treat a DVT or PE?
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
What is the taking in period?
First 2-3 days
Preoccupied with own needs, passive, dependent
Touches and explores infant
Needs to discuss her L&D experience
What is the taking hold period?
Lasts 3 to 10 days
Obsessed with body functions, initiates self-care
Rapid mood swings
Responds to instruction about infant care and self-care
What is the letting go period?
Lasts 10 days to six weeks
Mothering functions have been established
Sees infant as a unique person
What is postpartum blues?
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
What is postpartum depression?
Also known as peripartum major mood episodes
Typically begins about 4th week after delivery, but can occur anytime in the first year
What is postpartum psychosis?
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
What are common symptoms of postpartum blues?
Mood swings, difficulty sleeping, anorexia, feeling of let down
Risk factors for postpartum blues
Changing hormone levels, pain, fatigue, an unsupportive environment or insecurity
Symptoms of postpartum depression
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
Risk factors for postpartum depression
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
Treatment for postpartum depression
Individual or group therapy plus antidepressants
-selective serotonin re-uptake inhibitor (SSRI)
-tricyclic antidepressants
Symptoms of postpartum psychosis
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
Risk factors for postpartum psychosis
History of previous postpartum psychosis
History of bipolar
Family history of either condition above
Treatment for postpartum psychosis
Keep mom and baby safe
Inpatient psychiatric care
Anti-psychotic medications
Psychotherapy
Social support
What are some nursing intervention to assess mom’s mental status?
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
