Postpartum Complications Flashcards
what are afterpains? etiology?
cramping after birth
can be quite severe
etiology: rhythmic contractions PP in an attempt to involute the uterus
RFs for afterpains? (4)
prolonged labor
poor muscle tone
overdistension of uterus
multiparity (grandmultips, st find these pains greater than labor)
how to manage afterpains?
any pn after 3 days is considered abn
advise mom to keep uterus firm (empty bladder, massage uterus, nurse regularly)
ssxs of afterpains?
mild to severe cramping usu beginning in 4th stage
may last hrs to several days
comes and goes
often accompanied with latching and nursing
botanicals to prevent afterpains?
medicago rubus urtica caulophyllum cimicifuga senecio
pains dt debility, fullness and wt in pelvis, pains in legs
30 gtt q hr then PRN
caulophyllum
tense, aching pains
30 gtt 1hr then PRN
cimicifuga
do not give immediately PP
pains dt nervous exhaustion
10-20 gtt q 2 hrs PRN
gelsemium
gentle anti-spasmodic, uterine tonic, laxative
30 gtt q hr PRN
leonurus
severe, spasmodic pains
20 gtt q 15 min then PRN, up to 120 gtt x 4 d
viburnum op
achy, bruised pain w/shocky, dazed sensorium, does not want to be touched
200c, 3 pellets q 1 hr x 3 hrs
arnica
intense soreness, bruised feeling dt trauma, worse with cold drinks and cold drafts
200 c
bellis perennis
cramping, spasmodic pains, intense, can be sharp
30c, 200 c
mag phos
mineral great for relieving after pains?
cal/mag- 1000 mg q hr until resolved for 1-3 hrs
etiology of hemorrhoids?
increased venous stasis from progesterone
physical P of baby’s wt
valsalva P during 2nd stage
RFs for hemorrhoids?
existing hemorrhoids
prolonged 2nd stage
poor nutrition
obesity
ssxs of hemorrhoids?
pain
protruding, bulging veins
bleeding- blood on outside of stool, not mixed in
one way to prevent hemorrhoid formation during labor? management of hemorrhoids?
counterpressure during 2nd stage to prevent
afterwards: donut cushions, sitz baths, epsom salts, suppositories, keep stool soft, refer at 2 mos if still present for Kesey tx
etiology and predisposing factors of a hematoma?
etiology: rupture of BV causing extravasation of blood into tissue predisposing factors: varicosities prolonged 2nd stage excessive use of perineal stretching instrumentation macrosomia
hematoma ssxs?
swelling, bruising
pain
displacement of uterus (if internal, broad lig hematoma)
signs of shock: increased pulse, decreased BP)
management of external hematoma?
apply pressure: ice pack, truss, wrung out sanitary pad
stop bleeding
prevent infxn via good hygiene, peri bottle, sitz baths, immune stimulating herbs
broad lig hematomas should be monitored and may require surgical drainage
etiology of urinary incontinence? RFs? ssxs?
etiology: weakened pelvic structures
RFs: prolonged 2nd stage, poor nutrition, intrapartum or PP urinary retention, multiparity
ssxs: incontinence overt or dt stress, cystocele
management of PP urinary incontinence?
pelvic floor exercises- kegels should be started immediately and increased if incontinence persists
can add pelvic wts after lochia stops
incontinence dt bruising and trauma
5 gtt tid
arnica
incontinence dt tissue laxity
astringent
30 gtt qid
achillea
weakness of bladder
caution- TOXIC BOTANICAL
10 gtt tid
claviceps
incontinence dt prolapse
tones pelvic tissue
30-60 gtt tid
helonias
tones urinary apparatus
caution- SEDATIVE EFFECT ON NURSING NEWBORN
20 gtt tid
piper
weak bladder sphincter, dribbling with cough
20 gtt qid
thuja
stress incontinence dt prolapse, weak feeling in pelvis
helonias
involuntary when walking, coughing
good after disappointing birth
nat mur
involuntary urination worse with coughing and passing gas
worse at night
pulsatilla
involuntary urination, esp during 1st sleep, pelvic weakness and uterine prolapse, slow sluggish urination
sepia
incontinence dt cystocele, feeling a P on bladder
staphysagria
whom is 5x more likely to experience a thrombosis? complication?
PG/PP women
complication is pulmonary embolism
predisposing factors to a thrombus? (8)
C-section over 35 yo high parity obesity suppression of lactation smoking immobility trauma to legs
ssxs of superficial thrombphlebitis? DVT?
superficial thrombophlebitis: tenderness, vein hard, red and warm
DVT: pain, (+) Homan’s sign, swelling in affected leg
how to manage/tx a thrombosis?
prophylactic tx is via preventing trauma and partaking in exercise
afterwards: supportive hose or bandages, elevate legs, Vit E 400-1200 IU, bioflavinoids, immune stim herbs, bromelain 1000 mg qid, heparin/warfarin
ssxs of PE?
severe chest pn dyspnea shock slight hemoptysis mb no sx if clot lg enough, death may occur w/o warning collapse cyanosis hypotension
amniotic fluid embolism accounts for what %age of maternal deaths?
4-10%
definition of amniotic fluid emobolism
amniotic fluid entering maternal circulation, may cause obstruction of pulmonary vessel but seems to more often cause anaphylaxis
predisposing factors to amniotic fluid embolism?
precipitous labor
multiparity
excessive use of oxytocic drugs or prostaglandins
uterine trauma- version, catheter, ruptured uterus, C-section
ssxs of amniotic fluid embolism?
sudden onset of dyspnea rapid, shallow resps pulmonary edema tachycardia hypotension out of proportion to blood loss convulsions/seizures hemorrhage dt DIC pt often states she is going to die
mortality associate with amniotic fluid embolism?
mortality is ~85%
25% of deaths occur in 1st hr
death dt: hypoxia, hypovolemic shock, cardiogenic shock, DIC
how to manage an amniotic fluid embolism?
maintain airway
oxygen
CPR
TRANSPORT!!
