Postpartum Complications

Question 1

Postpartum Hemorrhage

Answer 1

Bleeding
1 pad per hour
> 500 ml vaginal delivery
> 1,000 ml c-section

Most common in multips, increased maternal age, operative procedures

VS will be SLOW to change

Question 2

Hemorrhage Treatment

Answer 2

Pitocin
Mizoprazole
Active bleeding = different treatment plan

Question 3

Uterine Atony

Answer 3

EARLY post partum hemorrhage 
Uterus is not toned,  relaxed
Large & Boggy uterus
From stretching- big baby, multiple gestation
From anesthesia, MGSO4

Question 4

Uterine Atony Treatment

Answer 4

Fundal massage

Pitocin

Question 5

Lacerations

Answer 5

Large babies, forceps
1st, 2nd, 3rd, 4th degree
Good assessment, teaching, peri care, stool softeners, sitz baths!
Uterus is firm

Question 6

Hematomas

Answer 6

Bleeding within the tissue
PAINFUL! Some possible bruising
1-2 Days PP
Unligated lacerations, episiotomy

Question 7

Hematoma Treatment

Answer 7

Small hematoma- will reabsorb on its own

Large- incision and drainage

Question 8

Retained Placental Fragments

Answer 8

LATE postpartum hemorrhage
Pulling on the cord, ripping or tearing of the cord
EXAMINE THE PLACENTA!
D&C left over fragments

Question 9

Uterine Inversion

Answer 9

Uterus is turned inside out
EMERGENCY! 
Causes: cord pulling is most common
Uterus is in the vagina
Can go into shock---- death
PUSH IT BACK IN NOW!

Question 10

Sub-involution of Uterus

Answer 10

Later in postpartum
Lochia remains heavy after 24 hours
Large uterus days after birth, higher than appropriate level
Causes: retained placental fragments, abnormal placental attachment
Medication to help contract uterus
Antibiotics
Correction of blood loss

Question 11

Nursing Care for PP Hemorrhage

Answer 11

Early and ongoing assessments
Stay on top of fundal checks
LOOK at the pad to try and asses amount of bleeding

Question 12

Hypovolemic Shock

Answer 12

Position: head down, legs a little up – get blood from legs back to the heart and organs

Question 13

DIC

Answer 13

From placental abruption
Decreased fibrinogen
Decreased platelets
Petechaie

Question 14

Superficial Blood Clot

Answer 14

Tender, red and warm

Question 15

Deep Blood Clot

Answer 15

One swollen leg

Question 16

Blood Clot Risks

Answer 16

Prolonged stirrup position
Pushing for a long time
Worried about moving to the heart, lungs and brain
SHARP CHEST PAIN = Possible PE

Question 17

Infection PP

Answer 17

Increased temperature, WBC and pain

Question 18

Endometritis

Answer 18

C-section
Prolonged labor and rupture of membranes
1-2 days PP
Increased temp, WBC, abdominal pain
Foul smelling lochia or NO lochia

Question 19

UTI PP

Answer 19

Frequent scant voiding, dysuria 
Any burning? Pain?
Sensory changes are normal, harder to start the fow
Some burning is normal from lacerations 
Catheters = higher risk for UTI

Question 20

Mastitis

Answer 20

Infection of the breast
Hard area of the breast- no plugged duct
Pain, redness, fever 
Massage and heat- may go away!
Antibiotics if non-pharmacological measures fail

Question 21

PP Psychological Complications

Answer 21

Interferes with family functioning

Question 22

Baby Blues

Answer 22

Transient
NORMAL!
Should go away after 2 weeks, if continues concerned about PPD

Question 23

PPD without Psychotic Features

Answer 23

Therapy

Medications

Question 24

PPD with Psychotic Features

Answer 24

Hospitalization 
Counseling, Social Worker, Help groups
Get child to a safer place 
Anti-depressants 
"Have you ever felt like you want to hurt your baby, yourself, or others?"

Question 25

Predictors for PPD

Answer 25

Prior psych history
Low self-esteem
Single
Low social economic status 
Baby blues