PP COMP PART 1 (HEMORRHAGE - PUERPERAL INFECTION) Flashcards
- any blood loss form the uterus > 500 ml, within 24 hr period
- either ealry or late
postpartum hemorrhage
conditions that distend the uterus beyond capacity
- multipe ges
- hydramnios
- macrosomia
- uterine myomas
condition that could have caused cervical or uterine lacerations
- operative birth
- rapid birth
conditions with varied placental site or attachment
- p. previa
- p. accreta
- premature separation of the placenta
- retained placental fragments
conditions that lead to inadequate blood coagulation
- fetal death
- DIC
4 main causes of postpartum hemorrhage
- uterine atony
- lacerations
- retained placental fragments
- DIC
- relaxation of the uterus
- most frequent cause of postpartal hemorrhage
uterine atony
uterus must remain in a ___ after birth
contracted state
uterine atony s/sx
- abrupt vaginal bleeding
- shock (hypotension, tachycardia, weak pulse, pale clammy skin, anxiety)
management for uterine atony
- fundal massage
- bimanual massage
- oxytocin and methergine
- prostglandin
- blood replacement
- hysterectomy
- performed by placing one hand in the vagina and pushing against the body of the uterus while the other hand compresses the fundus from above through the abdominal wall
bimanual massage
posteriori aspect of the uterus is massaged with the abdominal hand and the anterior aspect with the vaginal hand
bimanual massage
oxytocin administration
- 10-40 U / 1 liter D5W
- short duration of action (1 hr)
- promotes strong, sustained uterine contractions
- WOF nausea, diarrhea, tachycardia, and HTN
prostaglandin F
- surgical removal of the uterus
- last resort
- provide comfort and support
- open lines of communication
hysterectomy
in hemorrhage - adminster O2 at ___
4 lpm
lacerations occur most often due to
- precipitate birth
- primigravida
- macrosomia
- lithotomy position and instruments
suspect ___ is there is bleeding even if the uterus is firm
lacerations
degree of laceration: vaginal mucus membrane and skin of perineum to fourchette
1st degree
degree of laceration: vagina, perineal skin, fascia, levator ani muscle, and perineal body
second degree
degree of laceration: entire perineum and reches the external sphincter of the rectum
third degree
degree of laceration: entire perineum, rectal sphincter, and some of the mucous membrane of the rectum
fourth degree
management of lacerations
- suturing
- high fluid diet
- stool softener
what to avoid after laceration
- enema or rectal suppository
- rectal thermometer
- incomplete delivery of placenta
- fragments separate and are left behind
retained placental fragments
retained placenta happens with ___ and ___
succenturiate placenta
placenta accreta
a serum sample that contains ___ reveals that aprt of placenta is still present
hCG
if retained fragment is ___, bleeding will be appraent in the immediate postpartal period
large
if fragment is small, bleeding may not be detected until postpartum day ___, the woman willnotice abrupt discharge and a large amount of blood
day 6-10
management for retained placenta
- D&C
- methotrexate
- client should know how to observe lochia
- incomplete return of uterus to its prepregnant size and shape
- at 4-5 week postpartal visit uterus still enlarged and soft
- lochia is still present
subinvolution
management for subinvolution
- methergine 0.2 mg PO
- oral antibiotic for possible endometritis
- WOF bleeding
- collection of blood in the SQ layer of perineum
- may be caused by injury to perineal blood vessels
- usually represent minor bleeding
perineal hematoma
perineal hematoma is most likely to occur after
- rapid births
- women with perineal varicosiies
- episiotomy or laceration repair
if the hematoma continues to increase in size, site may be incised and the ____ is ___ under local anesthesia.
bleeding vessel is ligated
if an episiotomy incision is opened to drain a hematoma, it may be ___ rather than sutured
left open and packed with gauze
packed episiotomy incision after reopening is removed within ___
24-48 hours
- infection of the reporductive tract associated with childbirth that occurs any time up to 6 weeks postpartum
puerperal infection
conditions that increase a woman’s risk for postpartal infection
- ROM > 24 hours before birth
- retained placental fragments
- postpartal hemorrhage
- preexisting anemia
conditions that increase a woman’s risk for postpartal infection
- prolonged and difficult labor
- instrument births
- internal fetal heart monitoring
- local vagina infection during birth
- uterine exploration after birth
management for postpartal infection
- BCS
- antibiotics
common microbes postpartally
- group B strep
- aerobic gram-negative bacilli (e.coli)
staph infections are common that can cause ___
toxic shock syndrome
- bacteria gain access to the uterus through the vagina and ente the uterus either at the time of birth or during the postpartal period
endometritis
may occur with any birth, but is associated with chorioamnionitis and CS birth
endometritis
endometritis - the WBC is increased to ___
20,000 to 30,000 cells/mm3
signs of abdominal wound infection
- erythema
- warmth
- skin discoloration
- tenderness
- fever, pain
- malodorous lochia
- abd distention
after drainage of abcess, the cavity may be packed with ___ to promote drainage and facilitate healing
iodoform gauze
the woman with ___ is acutely ill and may require care in an ICU
severe systemic infection
supportive therapy after drainage
- adequate IV hydration
- analgesic
- continuous nasogastric suctioning if paralytic ileus develops
endometriosis - inspect woman’s perineum every ___ for signs of early infection
8-12 hours
endometriosis - immediately report any degree of ___ to clinician
induration (hardening)
