Postpartum Complications

Question 1

what are afterpains? etiology?

Answer 1

cramping after birth
can be quite severe
etiology: rhythmic contractions PP in an attempt to involute the uterus

Question 2

RFs for afterpains? (4)

Answer 2

prolonged labor
poor muscle tone
overdistension of uterus
multiparity (grandmultips, st find these pains greater than labor)

Question 3

how to manage afterpains?

Answer 3

any pn after 3 days is considered abn

advise mom to keep uterus firm (empty bladder, massage uterus, nurse regularly)

Question 4

ssxs of afterpains?

Answer 4

mild to severe cramping usu beginning in 4th stage
may last hrs to several days
comes and goes
often accompanied with latching and nursing

Question 5

botanicals to prevent afterpains?

Answer 5

medicago
rubus
urtica
caulophyllum
cimicifuga
senecio

Question 6

pains dt debility, fullness and wt in pelvis, pains in legs

30 gtt q hr then PRN

Answer 6

caulophyllum

Question 7

tense, aching pains

30 gtt 1hr then PRN

Answer 7

cimicifuga

Question 8

do not give immediately PP
pains dt nervous exhaustion
10-20 gtt q 2 hrs PRN

Answer 8

gelsemium

Question 9

gentle anti-spasmodic, uterine tonic, laxative

30 gtt q hr PRN

Answer 9

leonurus

Question 10

severe, spasmodic pains

20 gtt q 15 min then PRN, up to 120 gtt x 4 d

Answer 10

viburnum op

Question 11

achy, bruised pain w/shocky, dazed sensorium, does not want to be touched
200c, 3 pellets q 1 hr x 3 hrs

Answer 11

arnica

Question 12

intense soreness, bruised feeling dt trauma, worse with cold drinks and cold drafts
200 c

Answer 12

bellis perennis

Question 13

cramping, spasmodic pains, intense, can be sharp

30c, 200 c

Answer 13

mag phos

Question 14

mineral great for relieving after pains?

Answer 14

cal/mag- 1000 mg q hr until resolved for 1-3 hrs

Question 15

etiology of hemorrhoids?

Answer 15

increased venous stasis from progesterone
physical P of baby’s wt
valsalva P during 2nd stage

Question 16

RFs for hemorrhoids?

Answer 16

existing hemorrhoids
prolonged 2nd stage
poor nutrition
obesity

Question 17

ssxs of hemorrhoids?

Answer 17

pain
protruding, bulging veins
bleeding- blood on outside of stool, not mixed in

Question 18

one way to prevent hemorrhoid formation during labor? management of hemorrhoids?

Answer 18

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

Question 19

etiology and predisposing factors of a hematoma?

Answer 19

etiology: rupture of BV causing extravasation of blood into tissue
predisposing factors:
varicosities
prolonged 2nd stage
excessive use of perineal stretching
instrumentation
macrosomia

Question 20

hematoma ssxs?

Answer 20

swelling, bruising
pain
displacement of uterus (if internal, broad lig hematoma)
signs of shock: increased pulse, decreased BP)

Question 21

management of external hematoma?

Answer 21

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

Question 22

etiology of urinary incontinence? RFs? ssxs?

Answer 22

etiology: weakened pelvic structures
RFs: prolonged 2nd stage, poor nutrition, intrapartum or PP urinary retention, multiparity
ssxs: incontinence overt or dt stress, cystocele

Question 23

management of PP urinary incontinence?

Answer 23

pelvic floor exercises- kegels should be started immediately and increased if incontinence persists
can add pelvic wts after lochia stops

Question 24

incontinence dt bruising and trauma

5 gtt tid

Answer 24

arnica

Question 25

incontinence dt tissue laxity astringent 30 gtt qid

Answer 25

achillea

Question 26

weakness of bladder caution- TOXIC BOTANICAL 10 gtt tid

Answer 26

claviceps

Question 27

incontinence dt prolapse tones pelvic tissue 30-60 gtt tid

Answer 27

helonias

Question 28

tones urinary apparatus caution- SEDATIVE EFFECT ON NURSING NEWBORN 20 gtt tid

Answer 28

piper

Question 29

weak bladder sphincter, dribbling with cough | 20 gtt qid

Answer 29

thuja

Question 30

stress incontinence dt prolapse, weak feeling in pelvis

Answer 30

helonias

Question 31

involuntary when walking, coughing | good after disappointing birth

Answer 31

nat mur

Question 32

involuntary urination worse with coughing and passing gas | worse at night

Answer 32

pulsatilla

Question 33

involuntary urination, esp during 1st sleep, pelvic weakness and uterine prolapse, slow sluggish urination

Answer 33

sepia

Question 34

incontinence dt cystocele, feeling a P on bladder

Answer 34

staphysagria

Question 35

whom is 5x more likely to experience a thrombosis? complication?

Answer 35

PG/PP women | complication is pulmonary embolism

Question 36

predisposing factors to a thrombus? (8)

Answer 36

``` C-section over 35 yo high parity obesity suppression of lactation smoking immobility trauma to legs ```

Question 37

ssxs of superficial thrombphlebitis? DVT?

Answer 37

superficial thrombophlebitis: tenderness, vein hard, red and warm DVT: pain, (+) Homan's sign, swelling in affected leg

Question 38

how to manage/tx a thrombosis?

Answer 38

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

Question 39

ssxs of PE?

Answer 39

``` severe chest pn dyspnea shock slight hemoptysis mb no sx if clot lg enough, death may occur w/o warning collapse cyanosis hypotension ```

Question 40

amniotic fluid embolism accounts for what %age of maternal deaths?

Answer 40

4-10%

Question 41

definition of amniotic fluid emobolism

Answer 41

amniotic fluid entering maternal circulation, may cause obstruction of pulmonary vessel but seems to more often cause anaphylaxis

Question 42

predisposing factors to amniotic fluid embolism?

Answer 42

precipitous labor multiparity excessive use of oxytocic drugs or prostaglandins uterine trauma- version, catheter, ruptured uterus, C-section

Question 43

ssxs of amniotic fluid embolism?

Answer 43

``` 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 ```

Question 44

mortality associate with amniotic fluid embolism?

Answer 44

mortality is ~85% 25% of deaths occur in 1st hr death dt: hypoxia, hypovolemic shock, cardiogenic shock, DIC

Question 45

how to manage an amniotic fluid embolism?

Answer 45

maintain airway oxygen CPR TRANSPORT!!