postpartum complications/perinatal loss Flashcards
postpartum hemorrhage can have an early and late onset t or f
true
risk fxr for postpartum hemorrhage
c-section operative vaginal delivery (vacum, forceps) precipitous labor (3 hrs start/finish) atypically attached placenta retained placenta fragments general anesthesia (uterus wont contract) fetal demise hx of postpartum hemorrhage
early postpartum hemorrhage occurs
within 1st hour after birth
the most common cause of early postpartum hemorrhage
***uterine atony (the uterus does not contract)
most likely cause of late postpartum hemorrhage
retained placenta fragments
other causes of early postpartum hemorrhage
lacerations (vagina, cervix, perineum)
hematomas (not necessarily outward)
uterine inversion
retained placenta fragments
risk fxrs for uterine atony
Over distension of the uterus from multiple gestations,
polyhydramnios, fetal macrosomia, or multiple fetuses
Uterine anomaly (fibroid tumors)
Poor uterine tone (long induction w/pitocin, receptors get tired; stops contracting like it should)
s/s of uterine atony
BOGGY fundus
excessive bleeding
mgmt for uterine atony
***massage the fundus, check often
medications (oxytocin, methergine, hemabate)
methergine - action
uterine stimulant
methergine - given
PO
IM
methergine s/e
very crampy - alot of pain
can raise BP
hemabate - action
uterine stimulant - usually used via c-section
methergine and hemabate are NEVER USED FOR INDUCTION t or f
true - only used during postpartum period to stop bleeding
hemabate is given
IM right into uterine muscle/fundus
misoprostil - action
controls post partum hemorrhage
misoprostil is given
PO
assessment findings for lacerations
excessive bleeding w/FIRM uterus
lacerations may be (4 types)
perineal
periurethral
vaginal
cervical
perineal lacerations are graded, how many degrees
four (4) (1, 2, 3, 4)
1st degree perineal laceration s/s
superficial; just subcutaneous tissue; may not need suture
2nd degree perineal laceration s/s
subcutaneous tissue & muscle (episiotomy) - needs suture
3rd degree perineal laceration s/s
extends into external anal sphincter
cold packs
4th degree perineal laceration s/s
extends into internal anal sphincter (local anesthesia)
take colace - no straining
cold packs
mgmt of lacerations
nurse assist in repair
inspect perineum, cervix, vagina
monitor blood loss
retained placental fragments risk fxrs
mismanaging 3rd stage of labor - pulling on placenta/cord - hindering uterine contractions
Placenta malformations -
Abnormal placenta implantation
3 types of abnormal placenta implantation
acreta
increta
percreta
Acreta placenta implantation s/s
placenta starts to invade myometrium - difficult to detach -
increta placenta implantation s/s
invades the myometrium all together
percreta placenta implantation s/s
permeates the entire uterine wall
trt for increta and percreta
hysterectomy to stop bleeding
trt for acreta
manual detachment - likely leave behind pcs of placenta
retained placenta fragments assessment
subinvolution - uterus not contracting the way it should excessive bleeding boggy fundus Risk for DIC u/s detects this during pregnancy
mgmt of placental fragments
d&c and curettage to scrap uterus to ensure all pieces
manually explore the uterus
transfusion for lg amt of blood loss
a d/c procedure will not work w/abnormal placental implantation t or f
true
what level of H/H would require transfusion
7
hematoma assessment findings
usually not outward/visible bld’g; more into tissues
mom complains of pain in perineal/vaginal area; feeling of fullness/pressure in vagina
may see outline of hematoma
trt of hematoma
surgical drainage (severe cases)
antibiotics
analgesics
blood products if excessive loss
late postpartum hemorrhage mgmt
control bleeding prevent hypovolemic shock d/c may require antibiotics massage fundus administer uterine stimulants
late postpartum hemorrhage occurs
sometimes without warning 1-6 weeks postpartum
delivery w/o issues then heavy bld’g
nursing implication for postpartum hemorrhage
assess quantity/quality of bld’g (hourly)
assess level of consciousness
monitor vitals
large bore iv fluids (at least an 18 guage)
administer oxygen, assess saturation
assess urine output (hourly) - decreased
administer/monitor fluids, blood products
draw/monitor labs
emotional support for family (extremely distressful)
educate pt
s/s of hypovolemia
BP drops
HR increases
postpartum infection is also called
puerperal infection
what is postpartum infection
fever of 100.4 or greater occurring days 2-10, 2 days
what is endometritis
infection of uterine lining caused by various organisms including group B strep
s/s endometritis
foul smelling lochia
sub-involution
elevated wbc (after 1st 24hrs)
mgmt of endometritis
broad spectrum IV antibiotics (sometimes double/triple)
going home on PO antibiotics
nursing implications for endometritis
monitor for complications
manage pain
pt education
f/u w/provider earlier than norm
what is mastitis
an infection of the breast (lactating); unilateral
mastitis vs engorgement
mastitis is unilateral
engorgement is bilateral
engorgement occurs
1st few days postpartum due to mom not emptying breast
s/s of mastitis
fever, chills
trt of mastitis
BREASTFEED - empty the breast; or pump
antibiotics (cont. to breastfeed)
what condition should mom not breast feed with
abscess - ruptures - if its in the duct it will pass to baby
thrombophlebitis where can it occur
in legs and pelvis (septic pelvic thromophlebitis due to c-sect and became infected)
what is thrombophlebitis
DVT - clot formation
thrombophlebitis s/s
redness/warmth in abdomen or calf
mgmt of thrombophlebitis
IV heparin (anti-coagulants)
bedrest w/elevation of limb
analgesics
antibiotics w/septic pelvic thrombophlebitis
nursing implications of thrombophlebitis
may be started on warfarin before heparin is stopped
continued for 6 weeks
monitor symptoms
lifestyle changes (do not wear stockings)
when does baby blues occur
first week to 10 days, mom needs TLC
baby blues caused by
hormonal imbalance
feeling overwhelmed, worried
sleep deprivation
postpartum depression onset; s/s
2 weeks or longer (2-4 weeks)
affects ability to take care of self/baby
suicidal ideation
trt for postpartum depression/psychosis
meds
psychotherapy
hospitalization
postpartum psychosis
early onset 2 days postpartum up to 8 weeks manic psychosis depressed mood suicidal ideations delusions (voices)
