Postpartum Complications & Childbearing Family With Special Needs Flashcards
Typically postpartum complications (4)
Hemorrhage
Infection
Thromboembolic disease
Postpartum Affective Disorder
PPH
Vag delivery ____
CS delivery _____
Any amount that causes hemodynamic instability
Vag <500
CS <1000
4 Ts of Pathophysiology of PPH
Tone
Tissue
Trauma
Thrombin
Tone: Uterine tone most common cause 80%
Tissue: Retained placental fragments
Trauma: Lacerations, Episiotomy, Uterine Inversion
Thrombin: Coagulation Disorders
Grand multipara….
4 or more previous pregnancy and deliveries
Maternal Factors
(Macrosomia, Grand Multipara, Multiple fetal pregnancy, Over Distention)
Preexisting clotting disorder
Long labor
Tocolytics/ Uterotonics
Use of forceps
Cesarean
General Anesthesia
Manual removal of Uterus
All risk factors for….
PPH
Soft boggy uterus
2 most important interventions
Massage Fundus
&
Call for help
Hemorrhage
Increase IV fluids containing Oxytocin
False
Increase IV without Oxytocin
Hemorrhage
Methylergonovine (Methergine)
0.2 mg IM (may repeat)
Avoid with…
HTN
Carboprost (Hemabate)
250 micrograms IM
May repeat q15min Max 8 doses
Avoid with….
Asthma
Stage 1 PPH
Define
CS >1000 mL
Vag >500 mL
Stage 2 Hemorrhage
Define
- EBL up to 1500 mL
- Use to 2 Uterine tonics (Not effective)
Oxytocin 10 - 40 U
Methylergonovine 0.2 mg IM May repeat
Carboprost 250 micrograms May repeat q15m Max 8 doses
Misoprostol 800-1000 micrograms Per Rectum
- Vital signs Normal
Stage 2 Hemorrhage
Define
EBL up to 1500 mL
Use to 2 Uterine tonics (Not effective)
Oxytocin 10 - 40 U
Methylergonovine 0.2 mg IM May repeat
Carboprost 250 micrograms May repeat q15m Max 8 doses
Misoprostol 800-1000 micrograms Per Rectum
Vital signs Normal
During the Stage 2 PPH (EBL upto 1500ml or atleast 2 uterotonics used & normal VS)
Consider this medication….
Describe administration…
Tranexamic Acid (TXA)
1 G over 10 minutes
Add 1 G to 100mL NS IV & give over 10 minutes. Maybe repeated once after 30 minutes
Possible interventions for STAGE 2 PPH
4
Bakri balloon
Compression suture/B-Lynch suture
Uterine artery ligation
Hysterectomy
Stage 3 PPH
Define…
EBL >1500mL
Or
2 RBC givn
Or
At risk for Occult bleeding/Coagulopathy
Or
Any patient with abnormal VS/labs/ oliguria
Stage 4 PPH
Define…
Cardiovascular collapse (massive hemorrhage, profound Hypovolemic shock, amniotic fluid embolism)
1st line of intervention for Stage 2 PPH
Bakri Balloon: Uterine Tamponade
Stays in for 24 hours
If Uterine Artery Embolization fails what is the next treatment…
Hysterectomy
Care for a Hematoma…
Surgically drained & Blood vessels ligated
Presents as a very painful perineal lump
Lacerations
Describe the degrees..
1st
2nd
3rd
4th
1st
Superficial vaginal mucosa or perineal skin
2nd
Above plus, deeper tissues may include muscles
3rd
2nd degree plus sphincter
4th
3rd degree plus, rectal mucosa
Sub Involution…
Slower than expected return of the uterus to its non-pregnancy size.
Subinvolution
Involves the uterus retuning to its pre pregnancy size slower than expected.
How fast should the uterus descend?
When should it be no longer palpable
Descend 1 cm daily
No longer palpable in 2 weeks time
Cause…
SS…
TX….
Subinvolution
Causes: Placental fragments & Pelvic Infection
SS Prolonged lochia, excessive bleeding, Pelvis pain, large & soft uterus
Tx: Methergine, antibiotics (if Infected), removal of retained tissue
Thrombus vs Thrombophlebitis
Thrombus = Blood clot
Thrombophlebitis = inflammation of the vessel wall
Lovenox is given during pregnancy and Coumadin is given postpartum to prevent DVT.
WHY?
Coumadin is Contradicted during pregnancy
Varicosities ( Varicose Veins)
Tx…
Compression Hose
Puerperal Infection (Postpartum Infection)
Risk factors: CS, Prolonged ROM, Bladder catherization, hemorrhage, Poor nutrition, DM
Describe Fever criteria….
38 or 100.4 with in first 24-hour and up to 10 days postpartum
Metritis (Infection of the Uterus)
Onset: with in 2 - 7 days postpartum
Labs WBC >20,000
TX: Ampicillim, cephalosporin, clindamycin, gentamycin
Could spread to….
Salpingitis, oophoritis, peritonitis
Wound infection at episiotomy or CS
Can baby stay with mom?
Most important teaching
Yes
Teach mom Hand Hygine
Don’t dispel milk when mastitis is present
False
Empty chest of milk
Baby Blues goes away how quickly…
If it doesn’t go away?
Why baby blues…
2 weeks
It’s called postpartum depression
Drop of estrogen & progesterone
Postpartum Depression
Onset with in first year Postpartum
Last how long?
Atleast 6 weeks
Can you take Zolfot while breast feeding
Yes
Use this screening for postpartum affective disorders
Edinburgh
Postpartum Patient is out of touch with reality.
When is it safe to leave them alone?
Never
Don’t leave them alone
Teen moms growth needs compete with her growing baby
True
Neonatal increased risk with teen pregnancy (4)
Premature
Low birth weight
Low APGAR
Neonatal death
2 goals of sex education
Teach how to set limits
Instruct in effective contraceptive & prevent STIs
Most common form of substance abuse in pregnancy?
Maternal Effects?
Infant Effects?
Tobacco
Decreased placental perfusion, anemia, PROM, Preterm labor, spontaneous abortion
Premature, LBW,death, dev delays, SIDS, pneumonia
Leading cause of preventable retardation
Alcohol when preggers
FAE…
Milder form of FAS Fetal Alcohol Syndrome
Fetal Alcohol Effects
Born with congenital anomalies
How should nurses speak of infant?
When should parents hold infant?
Praise and call it special
Hold ASAP
Percent of women who are physically or sexual abused by partner…
High incidences in teenagers
White women most likely
31.5
Human trafficking
How many annually…
Average age….
2.5 million
12 - 14
Stages of Greif
1st stage during first 2 weeks
Denial
Stage 2
Searching & Yearing
Duration….
2nd week - 4th month
Stage 3 Disorientation
Duration….
5th - 9th month
Stage 4
Reorganization / Resolution
Duration…
18th - 24th month
Do you present a stillborn to their parents?
Yes, just as you would any infant
Communication interventions for a Still Born
Listen more than talk
Call baby by its name.
Focus on positive traits
🥺
Methergovine 2nd choice for hemorrhage med.
Contradicted with …
HTN / preE
Carboprost hemorrhage
Contradicted with this problem…
Asthma
Which hemorrhage medication is considered last choice but no SE
TXA
Longest time you can leave Bakri Balloon in…
24 hrs
Newest intervention for PPH
Jada
Uses vacuum to increase tone
How long is Postpartum bleeding normal…
4 - 6 weeks
Why is stool used in shoulder dystocia…
To stand on to allow Suprapubic pressure
FFN Test results
Postive / Negative
Negative result means there’s less than a 1% chance of delivering within the next two weeks.
A positive result indicates a higher risk of preterm delivery
Everyone who has HELLP has preE but not everyone with preE has HELLP
T / F
T
HELLP Meds (mother)
Fetus. Meds & test
Mag & Antihypertensive
Steroids/ BPP
Cure for HELLP & preE
Delivery
What are the urine test looking for in mom….
Protein & Bacteria
TORCH Test…
Toxoplasmosis, rubella, cytomegalovirus, and herpes simplex.
The TORCH test detects antibodies to the various diseases
Use a speculum to inspect for lesions of Herpes before vag birth
True
Acyclovir how long before giving vag birth with Herpes
30 days
Fetus is viable at ___ weeks
24
Marginal cord insertion = risk of…
Tearing
Myomectomy is…
Removal of fibroids (noncancerous growths) from uterus
How long after CS to get pregnant?
Min…
Preferred…
18 months
2 - 3 years
Contractions suddenly stop with this problem…
Uterine Rupture
What does station receding mean…
It goes up.
Describe what happens in Anaphylactoid Syndrome.
How dangerous is it…
An embolism of amniotic fluid enters moms blood vessels.
Deadly
How long to monitor fetus min. After trauma to momma
4 hrs min
How long after ROM does the risk of infection increase
18 hrs
Can a distended bladder cause uterine atony…
Yes
When giving a fundal massage ensure that…
You support the nexk of the uterus
Hcg is secreted by…
Trophoblast
(This hormone) Keeps the pregnancy going and thickens the cervix
Progesterone
Is there a fetus with a Molar pregnancy…
No
Can metformin/ glyburide be used safely during pregnancy
Yes
Changing partners can increase the risk of preeclampsia in a subsequent pregnancy, especially for women who haven’t had preeclampsia before.
However, changing partners can reduce the risk for women who’ve had preeclampsia before
T or F
T
