Postpartum Complications Flashcards
New criteria for EBL in PPH?
EBL increased to 1000 mL for any type of delivery due to how hard it is to see the actual blood loss
What criteria can help you put together that there’s been a PPH?
EBL of 1000 ml
Signs of shock
H&H levels
BUT it depends on when you are hemorrhaging (early vs late)
What H&H levels are indicative of PPH?
Decrease of 10% from admission H&H
Hematocrit - below 33%
Hemoglobin - below 11
What if then H&H does show there’s been a hemorrhage?
H&H will determine the IV fluids, blood products, ,iron, etc
Two types of Post Partum Hemorrhage?
Early (primary)
Late (secondary)
What is early PPH?
What is the criteria?
When PPH is occurring within first 24 hours after giving birth
- most happen right at birth tho
EBL of more than 1000 mL & can confirm with H&H check showing a change of more than 10%.
What is late PPH?
How does the patho work?
PPH that happens after 24 hrs up to 6 weeks post partum.
- usually happens 2-3 weeks out
PPH late patho is that there is sloughing of the placenta and breakthrough bleeding occurs.
The major complication of any type of PPH?
Hemorrhagic shock rt hypovolemia or when you can’t perfuse your organs anymore
Number one cause of early PPH
Uterine atony
What is uterine atony?
Time phrase this usually occurs in?
Flaccid uterus with no tone and clamping which leads to bleeding
1 hr after giving birth
List possible causes of uterine atony
Over-distention of uterus Labor dystocia Too much Oxytocin Grandmultiparity Agents that cause uterus to relax Prolonged 3rd stage of labor Operative births Retained placenta Asian, Hispanics, Gingers Preeclampsia Precipitous labor NO risks
Explain how over-distention of the uterus can cause uterine atony
A big fetus or multiples/twins can lead to over distention and stretch making it harder for the uterus to clamp shut
Explain labor dystocia causing uterine atony
Labor dystocia or being prolonged can stretch out the uterus and cause atony issues
How can oxytocin use cause uterine atony?
Too much oxytocin to induce can cause aggressive contractions that can lead to trauma and therefore uterine atony
How is that grandmultiparity is a cause of uterine atony?
A high amount of births can make your uterus stretch and atony can occur.
Why do relaxation of uterus agents cause uterine atony?
Because if the uterus is relaxed by these then it can’t clamp
Why is a mom who has had a prolonged 3rd stage of labor be more likely to have uterine atony?
Prolonged 3rd stage means the placental separation takes a long time. This can create a larger time frame for the placenta to bleed since the uterus can’t clamp down if it is still attached
What are operative births and how can they cause uterine atony?
Operative births are episiotomies, vacuum, forceps, or C-sections.
And they can cause uterine atony bc it can cause more trauma to uterus.
What is the reason why a piece of the placenta being left behind can cause uterine atony?
A retained placenta means that the uterus can’t clamp and so the atony and bleeding occurs.
Which populations are at higher risk of uterine atony?
Asians, hispanics, and red heads
- natural red heads have higher risk of bleeding
How is it that preeclampsia can cause uterine atony?
The pre-clampsia occurs and a hypovolemic state happens since the fluid moves into the vascular in order to try to compensate for high blood pressure (not a good comp tho)
Precipitous labor can cause uterine atony how?
Precipitous labor means a really fast labor and so with fast labors, there can be trauma which leads to uterine atony.
What should you as a nurse be doing if you patient doesn’t have any risk factors of PPH?
You still need to do all your assessments and checks. It can happen to anyone!
PPH assessment findings from Uterine Atony
Late signs of PPH?
1) boggy uterus
2) Lochia saturated pad with large clots
3) Pale, clammy skin
4) anxiety bc she knows something is wrong
Late sign) Tachycardia + Hypotension + Decrease UO
What should anticipate if someone is going to be high PPH risk patient?
What else do you need to?
Putting blood on hold for them
Establish and large bore IV site . 18 g usually or 16.
can’t hurt to have 2 ready to go either
When you feel the fundus and it feels high or shifted, what do you need to check?
What is the initial action you do if you learn the bladder is empty?
Check to see if the bladder is full by using the catheter
- if it was already a complicated delivery they Cather may even be already left in so you don’t even have to check
Initial action is to massage the uterus to express clots and maybe initiate contraction
What will the physician and ONLY the physician do if uterine atony is suspected?
Bimanual massage by physician which is when they have one outside uterus to massage and one inside to clean out clots.
What uterotonic drugs and what do they do?
Oxytocin (first line), Hemabate, Cytotec, Methergine
They improve tone/clamp of the uterus for uterine atony care
Oxytocin side effects and route
water intoxication on day 3 or so, N/V
IV route in labor but IM too after
Misoprostol side effects and route
(Cytotec ) headache, n/v, hypertension IM Can give rectally too to control bleeding Sublingual
Methergine side effects?
What route do we give it in?
Who would this med be a good option for?
Hypertension, N/V, headache
IM route
Good for grandmultiparity moms
Hemabate side effects and route
Prostaglandin SE’s of n/v, diarrhea, fever
Avoid is asthma
Cervidil side effects and route
Prosaglanding SE’S of n/v, diarrhea, fever
Avoid in asthma
Usually for induction of labor but can also be given for PPH
What is Transexamic Acid?
What can it be given for? Route? Other delivery?
TXA is an Antifibrinolytic and so it keeps clots together for longer to keep blood loss down
Post partum hemorrhage/atony!
Heavy Menstruation
Hemophiliacs
Dental surgery (or any other surgery)
Route IV or PO whole.
Works best around 3 hrs and can be given in c section too
What will you as the nurse have to administer in atony hemorrhage?
What do you need to monitor on labs?
Oxygen via facemask
IV fluids
Level of anemia so H&H
What can be activated in a hemorrhage from atony?
Massive blood transfusion protocol includes fibrinogen, coagulation factors, packed rbcs, etc
“I want everything you got”
What leg positioning can be helpful during atony pph?
Elevating the legs to increase circulation
How can we put pressure against placenta in order to delay bleeding?
BAKRI or uterine balloon tamponade can be filled with around 300 ml of fluid to go inside uterus to put pressure on placenta
- its like the same things is bimanual massage but with object
Surgical intervention needed for uterine atony pph if nothing else works?
What needs to be done for this to happen?
Hysterectomy to save mom’s life
Get verbal consent from spouse or whoever they can talk to
What are lacerations? And where?
Tear upon birth canal that occurs in the pathway of least resistance so anywhere
(perineum, cervix , vagina, labia, urethra for example)
Laceration causes
Precipitous birth Anesthesia epidural Macrosomic infants Forceps/Vacuum Too much Oxytocin VBAC Pelvic varicosities Previous scarring
Which of these can cause Lacerations of the Birth canal….. ? part 1
Precipitous birth Preterm labor SGA baby Macrosomic baby Forceps/Vacuum Too much Oxytocin
Laceration caused are…
Precipitous birth due to the birth going too fast and trauma
Macrosomic baby bc too large and trauma
Forceps/Vacuums bc of trauma
Too much oxytocin bc if too powerful of contractions, can lead to trauma
Which of these can lead to Laceration of the Birth canal ? part 2
VBAC Pre-eclampsia Chromosome abnormalities Pelvic varicosities Previous scarring Epidural anesthesia
Laceration causes are..
VBAC (vaginal birth after section)
Pelvic varicosities or veins in the genital area which rupture ( is common in high gravidas)
Scarring due to the fibrous tissue not being able to stretch
Epidural anesthesia due to mom not feeling her push
What are classic findings of a laceration?
When there’s bleeding but the fundus is firm and midline like it should be
How to diagnose laceration?
What comes next?
Physician will go bottom to up to find the bleed.
Identify first then suture and manage will come next
What is there to manage after a suturing of a laceration?
What is there to prevent after laceration suture? And how?
Pain with meds
Infections with antibiotics
Constipation prevention with Colace, fiber, and WARM fluids.
- pain meds can contribute to the constipation
What is the meaning of Retained Placental fragments? And how long?
When the placental tissue is left behind for at least 3o min after delivery
What is a Retained Placental caused by?
An abnormally adherent placenta (there are categories of this)
Rare times when they had to manually remove placenta and some got left behind there too
What diagnostic test can be used to dx retained placenta?
What other assessment?
Sonogram/ultrasound can be used to check. The placenta will show up as a thicker segment of the uterus on the sonogram.
Physician needs to look at the intact placenta to make sure
Main 3 types of abnormally adherent placenta categories?
Accreta
Increta
Percreta
Accreta
slight penetration of the placenta into the myometrium
Increta
Deep latching of the placenta into the myometrium
Percreta
When the placenta is penetrating the myometrium and other organs causing perforations
What type of delivery will mom do if she is accreta, increta, or percreta?
What surgery may have to happen if they can’t get the placenta to separate?
Planned C-section
Hysterectomy
What if the physician walks over and see’s the placenta isn’t all there?
Physician will do a manual exploration to remove the clots and tissue
- bimanual massage I think?
What invasive like treatment will they do to remove clots/tissue in retained placenta situations?
Risk?
Can do Curettage by using a serrated blade to go up and remove the fragments
Infection risk so use antibiotics
- really a risk for anytime they go up the vaginal canal
What are Hematomas?
An injury to blood vessel from labor which causes bleeding into the tissue
- on avg around 250-500 mL
Common areas of hematomas?
Vulva, vagina, pelvis
Risk factors for Hematomas that rt trauma
Episiotomy Forceps/Vacuum Macrosomia Prolonged second stage due to pushing and friction Precipitous birth going to fast
Vulva Hematoma symptoms
Vulva swelling, pain, and blue discoloration
Vaginal Wall Hematoma symptoms
Vaginal wall pain, pressure, and needing to urinate or stool but not being able to
What is pain like with Hematomas?
Very severe. You can give them pain meds but the pain comes right back.
What is an occult hematoma?
A lot of them can be seen but some are occult or hidden hematomas that you can’t see which are usually up high.
Retroperitoneal Hematoma symptoms?
Less pain due to less pressure but blood can pool more.
Tachycardia, hypotension can occur without other symptoms.
So if you see these trends and there’s no bleeding anywhere, talk to physician.
Late sign of Hematomas?
What if pt just doesn’t look right?
Fever due to blood being a foreign object in tissue
Make the resident come look. Ask physician if resident isn’t there.
Small Hematoma treatment
If less than 3 cm ice and apply pressure
Large Hematoma treatment
If greater than 3 cm, need to make incision, drain the blood, and suture.
- can put drain to and pack in but up to doctor
Why might a physician use a drain and pack for hematoma treatment?
Why use an indwelling Cather?
Leaving the drain in can help you know if the initial drain worked.
Packing can help absorb/collect more blood.
Doc will want indwelling catheter to make sure she can void after hematoma drain treatment.
What meds do you expect patient to be on after drainage of hematoma?
Antibiotics due to the pooling of blood being a good place for bacteria to breed
Analgesics for pain
Antipyretics for fever
Comfort intervention for hematoma treatment?
Warm sitz bath
- can also help clots absorption
In regarding hematoma, what should nurse do first before one even occurs?
Review chart for risk factors of hematoma in mom
Monitor mom frequently
What should nurse do with a hematoma?
Apply ice for up to 24 hrs.
Use pain scale and locate pain
Monitor vitals and pay attention to tachycardia
- bc mom’s hr should never go up after birth
What things to do with hematoma regarding physician?
Avoiding lawsuits nursing actions
Communicate
Know lab trends and report them to him
AND document well! avoid lawsuits
What is Uterine Inversion?
A prolapse of the uterine fundus through the cervix to the point it hangs out of the vagina
When doing a fundus check, what will a Uterine inversion feel like?
Is this a post or pre delivery problem?
The fundus will be unpalpable.
It comes post delivery or after the delivery of the fetus.
What can happen if you place too much traction on the umbilical cord?
Other reason due to placenta?
It can cause the uterine inversion or the flipping out of the vagina by pulling too hard during placenta separation with forceps
This may also be due to a placenta that is abnormally adhered to the uterus.
How can drugs cause uterine inversion? And which drugs?
Drugs can relax the uterus too much to where it inverts
Mag sulfate is one drug and Terbutaline (or even a long labor)
Main causes of Uterine inversion summary?
Excessive traction on the umbilical cord
Abnormal adherence to placenta
Fundal pressure applied to the relaxed uterus
Drugs relaxing a uterus too much
How can too much fundal pressure on a uterus cause uterine inversion?
If you apply pressure to a relaxed uterus you can just push it out
What does uterine inversion look like?
A. beefy red mass hanging out
How do you know not to push forceps to hard on the cord to avoid uterine inversion?
If you get resistance - need to stop.
First step in uterine inversion treatment?
Immediate recognition
When dealing with uterine inversion, what do the physician have to do?
Is this painful?
Physician will have to reposition the uterus
Very painful so may need tocolytic or general anesthesia
After the physician repositions the uterus in a uterine inversion, what needs to be done?
Mom needs to be on Oxytocin to promote uterine clamp and tone
What surgical treatment may be needed for a uterine inversion?
A hysterectomy if no other option
- in order to avoid large blood loss
What risk goes up with uterine inversion?
Infection risk due to the uterus literally being turned inside out
- so give antibiotics
What needs to be replaced for uterine inversion?
Blood product replacement and IV fluids
After uterine inversion treatment and repositioning, should you do fundal checks?
What should you do?
No because it can push the fundus out again
Keep mom flat and assess lochia and vitals
3 R’s with uterine inversion
Recognition
Replacement
Restitution
What is a uterine rupture?
Just a uterine wall tear
Biggest risk factor of a uterine rupture?
A previous uterine scar that ruptures
- so this risk only occurs in a TOLAC or trial of labor after c section
How can over distention cause a uterine rupture?
The over distention causes thinning of the uterus and so the uterus just breaks
How can grand multiparity hx cause a uterine rupture?
Having lots of babies can thing uterus too and so it just ruptures
What types of operative births can cause uterine rupture?
Vacuum
Forcep
How can too much Oxytocin induction cause uterine rupture?
It’s only if the oxytocin is given too aggressively but the induction causes too much pushing for the body to handle and so there’s a rupture
What happens to FHR if uterine rupture occurs?
FHR changes very abruptly
What will mom feel if there is a uterine rupture?
She will feel sudden onset of pain that feels like a tearing sensation
During a uterine rupture what symptoms can arise from blood loss?
Shock like symptoms due to excessive bleeding
How serious is a uterine rupture?
What do you need to make sure of?
An obstetric emergency. You will be racing to the OR to save mom’s life immediately .
- so make sure you have a plan
How many IV sites do you need incase of uterine rupture ?
Two IV sites
- so definitely make sure to have a 2nd IV site before going into birth if you think she might bleed or rupture
What do you need to provide for family during uterine rupture of mom?
Provide support for family and keep them informed
What directions can a uterine rupture occur?
Literally anywhere and any direction
Types of Coagulation Disorders that can cause blood loss?
HELLP Syndrome
DIC
What is HELLP syndrome again?
What is HELLP syndrome associated with?
Lab diagnosis of Hemolysis , Elevated Liver, Low platelets
Pre-eclampsia but you don’t actually have to be hypertensive
What is DIC?
Disseminated Intravascular Coagulation syndrome that coagulation pathways are hyper activated and you use up factors way too quickly and thus you eventually bleed out orifices (DIC)
- too many mini clots that use up the factors and plug organs too
What causes DIC usually?
It is secondary to another cause therefore it has a trigger
- abruptio placenta is very common
What other things can cause the DIC or hyper- clotting?
Retention of the demised fetus due to thromboplastin release
Septicemia
Severe Preeclampsia or HELLP
Amniotic Fluid emboli
Septic abortion
Maternal liver disease
Any major trauma
- icu is common to see DIC
Essentially some trauma causes it.
Other names for DIC?
Consumption Coagulapathy
Defibrination Syndrome
How can DIC affect organs?
Mini clots get pilled up and can cause organs from getting blood and have organ failure
Fibrinogen levels of DIC
Fibrinogen levels drop
D-dimer levels of DIC
Elevated D-dimer
- should be single digits
In DIC they have present of FSP or FDP. What does this mean?
In DIC, there will be Fibrin Split Products or Fibrin Deprivation Products
- same thing just means fibrin is breaking down means no coagulation/clotting
What will H&H levels in DIC be?
Platelets of DIC?
RBC of DIC?
Decreased H&H
Decreased platelet
Decreased RBC
Prothrombin/INR time of DIC?
Prolonged prothrombin/INR time
What will you see on CBC morphology smear in DIC?
Torn or fragmented RBC - - known as Schistocytes
What peripheral signs will you see with DIC around the mouth? What are some you can’t see right away?
What about their neurologic symptoms?
Peripheral signs of the thrombosis such cyanosis around the mouth.
Organ failure or impairment that you may not pick up on.
Confusion, drowsiness, and then slip into coma
What will bleeding be like in DIC?
Prolonged uncontrolled bleeding and can occur at 3 or more sites really anywhere
Attitude of DIC patient?
Anxious
Body marks of DIC?
Bruising and Petechia
- especially from Blood pressure cuff
From bleeding, DIC can cause what shock symptoms?
Pale, clammy skin
Tachycardia
Tachypnea
Hypotension
First step of DIC management
Treat the cause or trigger:
Abruptio Placenta
Retention of the demised fetus due to thromboplastin release
Septicemia
Severe Preeclampsia or HELLP
Amniotic Fluid emboli
Septic abortion
Maternal liver disease
Any major trauma
- icu is common to see DIC
Essentially some trauma causes it.
What do we give to mom with DIC?
Oxygen
IV
Blood transfusions
- monitor for reaction here
What to monitor for DIC care?
Monitor reactions to blood transfusions
Monitor blood loss
Monitor I&O
Monitor lab trends
Why is it so important to monitor I&O with DIC?
They’re at a renal failure risk
So monitor for blood and color in urine, SG, I&O hourly with catheter
Why do DIC patients go to ICU?
They can be monitored there better
After DIC, what is a patient considered
Anemic
- so put on blood products and iron
How long is DIC hospital stay?
Prolonged
What is ITP or Idiopathic thrombocytopenia?
Antibodies kill of platelets causing decreased count of platelets and more bleeding due to fragile capillaries
Risks of Idiopathic thrombocytopenia or ITP?
What about risks to newborn with ITP?
Bleeding in vaginal or C-section birth
Newborn being born with thrombocytopenia
What meds can help with Idiopathic thrombocytopenia or ITP to stabilize platelets?
Prednisone but only until close to delivery so corticosteroids
IV immunoglobulin
What more invasive methods can help manage ITP or idiopathic thrombocytopenia?
Platelet transfusion
Splenectomy if medical management needs it
Main lab to check for ITP or Idiopathic thrombocytopenia?
CBC or platelet
What are blood dyscarshias?
Blood issues that cause bleeding with no other obvious cause
What is a von Willebrand Disease?
Main risk? And how long?
Type of hemophilia lacking vW factor.
They can bleed out in labor and can be at risk for up to 4 weeks
Symptoms of von Willebrand Disease?
Nosebleeds and bruises Prolonged bleeding Factor 8 deficiency Lochia progression (or regression?)
Treatment of von Willebrand Disease?
Desmopressin and with a little bit of factor 8
Transfusion w plasma
Antihemophiliac factor
Diagnosis of von Willebrand Disease sometimes if someone doesn’t know they have it?
Blood clotting factor panel is ordered for those who are showing signs but have no hx of Willebrand disease.
How to be 1. Ready for OB hemorrhage of any kind (safety bundle)?
Hemorrhage cart and meds
Team on stand by
Massive blood transfusion protocols
Unit education drills
How to 2. Recognize and Prevent hemorrhage?
Assess risk factors for hemorrhage and inform others like anesthesia and aid
Do Active Blood Loss measurement - but don’t estimate
Active management of 3rd stage (placenta stage)
How to 3. Respond to hemorrhage?
Emergency plan with checklist
Pt and family support
How to 4. Report and System learn?
Debrief post incident
Multidisciplinary review to improve (what could be done better)
Monitor outcomes and process (was there good communication, call back of meds)
Major 4 steps of safety bundle for OB Hemorrhage
1) Readiness
2) Recognize and Prevention
3) Response
4) Report and System Learn
What is Late Hemorrhage due to?
Sub-involution of uterus due to retained placenta and infection caused by it
- sub involution is just the uterus not going back to normal
Signs of Late Hemorrhage (3 groups)?
Fundus does not firm and it is high
Unexpected Lochia that is heavy or is regressing (should be rubra, serosa, alba so if its backwards its a problem)
Symptoms of Endometritis
- foul odor, fever, uterine tenderness, bachache
Endometritis signs (rt to late hemorrhage)
Symptoms of Endometritis
- foul odor, fever, uterine tenderness, bachache
She acts like a C-section
Vaginals don’t feel super painful with fundal checks
How is diagnoses of Late hemorrhage done?
Ultrasounds to see if there’s still fragments and signs
Procedure for Late Hemorrhage?
What is given after?
D&C to remove placental fragments left behind
Oxytocin and Antibiotics
- start on IV but only in hospital for 24 hours so then oral
What position is required for Late Hemorrhage post procedure of D&C?
Semi Fowlers
Discharge instructions for moms with Late hemorrhage?
Diet?
Limit activity and tell mom need will assistance
Increase iron, protein, and fluids
How can a late hemorrhage affect breastfeeding?
Delayed lactogenesis leading insufficient milk production from anterior pituitary necrosis rt cushings
What doe late hemorrhage increase risk of mental health wise?
Post partum depression risk increased with late hemorrhage
What is the defintion of Postpartum infections?
Any infection of the genital tract within 28 days after birth (miscarriage and abortion count too)
Types of Post partum infections?
Endometritis or Metritis
Pelvic Cellulitis/Perimetriritis
Wound Infections
What is Endometritis or Metritis?
What has reduced this?
Symptoms?
Involved endometrial lining
Prophylactic antibiotics before c-section or invasive procedures
Symptoms of Endometritis
- foul odor, fever, uterine tenderness, bachache, tachycardia, chills
What is Pelvic Cellulitis/ Perimetritis?
A spreading of the original endometritis to the pelvic area from the cervix or lymphatic system
Symptoms of Pelvic Cellulitis/ Perimetritis?
Go to ICU
High fever, rebound pain, sub involution of uterus, tachycardia, Abscess!!!
Why are wound infections from C-Sections so low?
Due to prophylactic antibiotics but they still happen.
Lexus ring
Closure technique
Irrigation
Assessment for C-sections to avoid the Post partum infection?
REEDA assessment
Why are crash emergency C-sections more likely to have post partum infection?
Due to them being done quick and being unexpected so asepsis is altered
How do they diagnose the post partum infection?
Culture the exudate - especially if wound is open.
Treatment for wound after section (to avoid post partum infection?)
NS irrigation w frequent dressing changes
Wound vac
- But sometimes people go home with open wounds so they could go home with this too
Puerperal Morbidity?
Why are the first days not included?
Temp greater than 100.4 on days 2-10 days after delivery
Due to dehydration and fatigue
If it is high later on, its an infection.
- uti/cystitis
- pyelonephritis
-
Why is UTI a risk postpartum 2-10 days ?
Due to her using a urinary catheter
Anesthesia stopping mom from peeing
Frequent pelvic exams
Postpartum urinary retention
Symptoms of UTI and cystitis?
Dysuria, frequency increase, urgency, hematuria, pyuria (puss in urine_
DX of UTI and cystitis?
Clean catch of the urine
UA micra
Culture and sensitivity
- just typical UTI treatment
Pyelonephritis?
Kidney infection that is an ascending infection from elsewhere
- usually happens in right kidney
Pyelonephritis signs and symptoms?
Cystitis symptoms, high fever, flank pain, n’v, CVA tenderness, acute illness
Pyelonephritis diagnosis?
Urine culture to dx organism for antibiotics
Pyelonephritis treatment?
Antibiotics
Fluids
Acidify urine with cranberry, plum, apricot , prune juice and vitamin C (bc less friendly to organisms)
Void frequently
Repeat urine culture and sensitivity after treatment to make sure
What is Mastitis?
Can be 10 days - 2 weeks out from delivery
One breast that is warm to touch and painful with maybe even a fever
- can be from plugged duct
Contributing factors to Mastitis?
Milk stasis - so empty breasts and empty one before next
Alternate starts
Hygiene
Assessment of the breast for mastitis?
What if it yeast?
How can bacteria cause the mastitis?
Breast consistency, skin color, surface temp
Nipple is pink, shiny, itchy and painful . Milk smells like yeast.
- treat w anti fungal like Diflucan
cracked nipple so keep the area clean
Mastitis prevention
Proper feeding Consult with lactation nurse Bra must be supportive Hygiene Check to see if breast is fully soft all the way around
Why does the breast need to be soft all the way around?
If it is hard, then it is blocked duct and can lead to mastitis.
How to empty the breast to keep from mastitis?
Start with unaffected breast, let down, switch to affected breast last
- but some will just quick
How to make breast feel better for mastitis?
Analgesics
Warm moist compress
Supportive bra
Bedrest
How to treat bacterial mastitis?
Dicloxacillin
Cephalosporins
What happens if you delay treatment fo mastitis?
Treatment?
Post - treatment needs?
Abscess formation
IV antibiotics
I&D to open, drain , pack and suture up the breast
Continue to empty breast with breast-feeding or pumping
What is a VTE or Venous Thromboembolism?
Blood clot in vein wall in response to inflammation
When is the VTE risk the highest?
During PG and into 6 weeks post partum. Blood is thicker and women is less active after delivery
What is VTE cause rt Virchow’s triad?
Venous stasis
Increased clotting factors and fibrinogen
Injury to epithelium of blood vessels
(The perfect storm for clot formation)
Birth that can cause VTE?
PG Conditions related to it?
Csection
Endometritis
Inherited clotting disorder (Leiden 5 factor )
High parity (so experienced moms) advanced maternal age (so old moms)
Lifestyle choices that cause VTE?
Limitations that cause VTE?
Obesity
Smoking
Anything that cause decreased mobility
Meds that cause VTE?
Fibronolysis inhibitors
What meds will you be on for Factor 5 Leiden?
Anticoagulants like Lovenox or heparin
Major concern with VTE?
Example?
What kind is worse?
Main concern is that the clot will become an emboli.
Example : deep leg vein clot traveling to pulmonary artery and causing an obstruction flow
Deep VT is way more serious
Should you use homans sign for VTE or DVT?
No probably not
Where will pain be in the VTE?
What else happens to leg?
Pain in leg, inguinal area, or lower abdomen
Edema in leg (2cm difference) that feels cool to touch
Perfusion assessment fr VTE?
Which leg is VTE in PG more common in?
Diminished pulses, change in limb coloring, circumference change of greater than 2 cm
Left leg
VTE/DVT diagnosis
What meds are you going to put them on if its just superficial?
What interventions?
What is the seriousness of a DVT?
Doppler ultrasound and physical findings
If positive superficial, not a big issue. Put on aspirin or heparin if you need to and give analgesics, stockings, heat and rest
If deep vein, this is a concern.
Treatment meds for DVT for the clots, infection , and pain?
Can mom breast feed?
Heparin,
Lovenox
Oral anticoagulants (newer ones like Xarelto or Eliquis can be used)
Coumadin later on.
Antibiotics if there’s an infection
Analgesics for pain
Probably no breast-feeding. Will have to pump and dump.
Watch prothrombin time.
Once mom is walking under a VTE risk, what do you do?
How will we position mom to avoid VTE?
Use support stockings
Leg elevated and bed rest
Dietary teaching to avoid VTE while on medicatons?
Avoid VIt K foods like leafy greens if you aren’t used to eating them
- kale
- canola oil, mayo
- mint
- peppers
- watercress
Family planning with VTE?
What other med to avoid?
Avoid estrogen products bc of increased clots
Avoid aspirin too bc it inhibits clotting
Ways to decrease risk of VTE for mom to know for Antepartum?
Stay active and hydrated (even in the car)
Quit smoking
Elevate legs when sitting
Don’t wear constrictive garments
Ways to decrease risk of VTE for mom to know for Intrapartum?
Walk if you can Leg exercises Avoid pillow under knees Pad the stirrups and correct positioning But limit stirrup time Anti-embolism stockings for high risk patients
Postpartum measures for VTE risk?
Early walking Turning and leg exercise while in bed Stay hydrated No smoking Antiembolism stockings Penumatic compression stockings Don't sit or cross legs Elevate legs
