postpartum health challenges Flashcards
what are some postpartum health challenges?
- postpartum hemorrhage
- thrombosis
- infection
- mental health
what time frame is considered an early postpartum hemorrhage?
-birth to 24 hours
what time frame is considered late postpartum hemorrhage?
-after 24 hours up to and including 6 weeks
how frequently does postpartum hemorrhage occur?
-in 5-15% of deliveries
what are risk factors for a postpartum hemorrhage?
- precipitous labor (less than 3 hours)
- uterine atony
- placenta previa or abruptio placentae
- labour induction or augmentation
- operative procedures (vacuum, forceps, C/S)
- retained placental fragments
- prolonged third stage of labour (more than 30 minutes)
- multiparity, more than 3 births closely spaced
- uterine overdistention (large infant, twins, hydraminos)
what is given after the anterior shoulder is delivered and why?
- oxytocin
- given to prevent pph
why can it be difficult to define a postpartum hemorrhage?
- estimation of blood loss can be challenging
- normal for vaginal is less than 500mL
- normal for c/s is less than 1000mL
what are the 4 Ts that can cause a postpartum hemorrhage?
Tone (70%)
Trauma (20%)
Tissue (10%)
Thrombin (<1%)
Tone is the most common reason for a postpartum hemorrhage, how commonly is it the cause and what does it mean?
- 70% of pph are r/t tone
- means there is uterine atony or a lack of uterine muscle tone
what are possible causes of uterine atony?
- over-distended uterus
- multiple pregnancies
- carrying multiples
- previous history of pph
- induction of labour, prolonged labour, augmented labour
- some placental tissue remaining or manual removal of placenta
- age greater than 35 years
- obesity
- antepartum hemorrhage (placental abruption or previa)
what are some treatments for uterine atony?
- fundal massage
- empty bladder
- administer uterine stimulants (oxytocin, cytotec aka misoprostil, carbetocin if c/x, hemabate)
how frequently are postpartum hemorrhages caused by trauma and what are some examples of trauma that may cause a pph?
- 20% of the time
- cervical, vaginal, perineal lacerations
- hematoma
- uterine inversion
- uterine rupture
what is one way a hematoma can be prevented in a postpartum woman?
-applying ice packs
how frequently are postpartum hemorrhages caused by tissue and what are some examples of this?
- 10% of the time
- retained placental lobes or membranes
- retained blood clots
- commonly the cause of late pph
how frequently does retained placenta occur in vaginal births?
2-3% of the time
what is defined as retention of the placenta?
- not delivering the placenta within 30 minutes after birth of child
- if not expelled, manually removed (this required general anesthesia if no epidural)
how frequently are postpartum hemorrhage caused by thrombin and what is this usually related to?
- less than 1% of the time
- related to pre-existing or acquired bleeding disorders
what is included in the initial treatment of postpartum hemorrhage?
- early recognition
- prompt attention to any needed resuscitation (ABCs)
- identification of the cause of the bleeding
- appropriate treatment based on etiology
- fundal massage to stimulate contraction and evacuation
- identify and suture any lacerations
what can be done if bleeding from a pph doesn’t stop?
- give 20-40 units IV oxytocin in 1000mLs at 125mL/hr in a large bore IV (like 18 gauge)
- give uterotonic medications (cytotec, ergometrine, hemabate, carbetocin)
- take a CBC, do a crossmatch, prep a blood transfusion
- foley, oxygen, NPO
- vital signs to watch for signs of shock
- pack uterus/bakri ballon
- cauterization
- finally - hysterectomy
why are postpartum women at risk of thrombosis?
- venous stasis
- hypercoagulation state created during pregnancy
what is the risk of a pulmonary embolism postpartum?
5/1,000,000
what are ways to prevent thrombosis?
- avoid smoking
- encourage early activity
- leg exercises
- compression devices
- avoid sitting/standing in one place for long periods
- avoid oral contraceptives
- anticoagulant therapy (especially in C/S moms)
what are some postpartum danger signs that should be watched for/ a woman should seek medical attention for?
- fever greater than or equal to 38 degrees
- foul odor to lochia or unexpected change in colour or amount
- soaking more than 2 pads in an hour with lochia
- visual changes or headaches
- calf pain
- swelling, redness, discharge at incision site
- dysuria, burning on voiding
- SOB or difficulty breathing
- depression or extreme mood swings
what are some infections that postpartum women are at risk for?
- metritis (inflammation of the uterus)
- wound infection to laceration, episiotomy or surgical site
- UTI
- mastitis
