pp complications Flashcards
Traditionally, postpartum
hemorrhage (PPH) has been
defined as greater than _______
mL estimated blood loss associated
with vaginal delivery or greater
than ________estimated blood loss
associated with cesarean delivery.
500 ml and 1000 ml
Meds Route
* oxytocin (Pitocin * BRAND*):
* methogonovine (Methergine):
* carboprost (Hemabate):
* misoprostol (Cytotec):
IV, oral
IM
IM
RECTAL/ ANTI ULCER
UTERINE TAMPONADE & CURETTE
DNC
stop post-partum hemorrhage due to a relaxed uterus
& to remove the uterine tissues during surgical procedures.
scrapping
Bimanual Compression done by:
Physician
1gm = _____ ml blood loss
dry-wet
1ml
hematoma
a bad bruise. It happens when an injury causes blood to collect and pool under the skin
PUERPERAL INFECTION
postpartum infection
infection of the genital tract occurring at labour or within 42 days of the postpartum period
.bacteria infect the uterus and surrounding areas after a female gives birth. It’s also known as a postpartum infection.
postion to put pt in shock in
trendelenburg position
CYSTITIS
* Prevention!!!
* Hand washing – NURSE and Patient
Cystitis is inflammation of the bladder, usually caused by a bladder infection
There is also increased pressure on your bladder, which can reduce the flow of your urine and lead to an infection.
GESTATIONAL HTN ( this is the base) * when can you diagnosis/ values*
After 20 weeks in normotensive women
140/90 x 2 taken at least 4 hrs apart
PRE-ECLAMPSIA ( branch of gestational diabetes)
( when/ how long/ signs)
After 20 weeks
Can happen up to 6 weeks PP
Warning signs: Severe headache, visual
changes, epigastric pain, Proteinuria, swelling
Mild VS Severe PRE-ECLAMPSIA
BP>140/90 , Proteinuria>300mg/24
hr or 30 dipstick
BP > 160/110, Proteinuria>2
g/24hr
Risk Factors
preeclampsia/ 11
HISTORY OF :
-HIGH BLOOD PRESSURE,
- KIDNEY DISEASE
- DIABETES
-EXPECTING MULTIPLES
FAMILY HISTORY OF PREECLAMPSIA
*AUTOIMMUNE CONDITIONS
*AMA
*AFRICAN AMERICAN
*1ST PREGNANCY
*IVF
*PCOS
*OBESITY
Taking a baby aspirin
purpose…think about major complications
daily starting
in early pregnancy (by 12 weeks
gestation) has been demonstrated
to decrease the risk of developing
preeclampsia by approximately 15% .
MAP –MEAN ARTERIAL Pressure
Systolic BP + 2 (diastolic BP)
3
120/80 = 120 + 160 = 93
Preeclampsia MAP > 105
Normal pregnancy is a vasodilated state
50% >blood volume
30% cardiac output
> GFR
Pre-eclampsia
Vasoconstriction
Can affect all organ systems
Renal, hepatic, coagulation, CNS
Hyperreflexia with pre-eclampsia
a person’s reflexes become unusually active. Increasing blood pressure will lead to increasing hyperreflexia (overactive reflexes), until eventually uncontrollable seizures result
Normal reflex is
+2
ECLAMPSIA (whats the sign to say this is eccmaplmsia)
Signs- Headache, blurred vision, severe
epigastric/abdominal pain, altered LOC
Convulsions
Maintain airway
Fetal monitoring
Magnesium Sulfate (MgS04) ; IV
* Toxicity
* Level >
- anditote for mg toxicity =
Level > 9.6 mg/dl
< RR, hyporeflexia, fetal distress
- Antidote; calcium gluconate Calcium
antagonizes the action of magnesium at a cellular
level. It is very effective in reversing the clinical
effects of magnesium toxicity
MAGNESIUM SULFATE
*
Prevents convulsions by depressing the
central nervous system and blocking the
transmission of nerve signals to the
muscles to make them contract
* Reduces the release of acetylcholine, a
chemical that nerve cells secrete to
make muscles contract
MAINTAIN UTERINE PERFUSION
Left side lying
* O2 if Pulse ox < 95%
* FHT with doppler
HELLP SYNDROME
- Hemolysis
Hbg < - Low Platelet Count
<
- Hemolysis
Hbg <6 - Elevated Liver Enzymes
AST/LST (MIRCO THROBMIN IN LIVER DAMAGE HEPATIC CELLS) - Low Platelet Count
< 100,000
INTERVENTIONS Preeclampsia
Deliver if still pregnant
Assess for hemorrhage if newly PP
Plasma volume expander
* Antihypertensive – labetalol
* Weekly BP x6weeks PP
* Liver function tests up to 3-6weeks PP
lassitude
It’s a signal from your body to slow down and give it time to adjust to the incredible changes happening inside.
Coagulation Disorders( causes 5)
Coagulation pathways are hyperstimulated
Depletes clotting factors leading to hemorrhage
* Causes:
* Abruptio placenta (primary cause)
* HELLP
* Amniotic Fluid Embolism (AFE)
* Anaphylactic syndrome of pregnancy
* Sudden Dyspnea
* Can occur during pregnancy, labor, birth or within
the first 24hours of PP period
* Two stage process when amniotic fluid that
contains fetal cells enters the maternal vascular
Abruptio placenta
a serious condition in which the placenta separates from the wall of the uterus before birth.
Disseminated (all over the place) intravascular (within the blood vessels) coagulation (blood clots).
( s/s , whats going on)
Coagulation Disorders: coagulation pathways hyper-stimulated and woman’s body breaks down clots faster than can form them- quickly depletes body of clotting factors, leading to massive hemorrhage and deat
Purpura at pressure sites
Abnormal clotting study
* Anxious
* Signs of shock r/t to blood
loss
- Panic, Pale and clammy
skin, tachycardia,
tachypnea, hypotension
INTERVENTIONS DIC
- Emergency- treat for shock
- VS
- Foley, I&O
- Oxygen
- Fluids/Blood
- D-Dimer
- IV Heparin
POSTPARTUM
CARDIOMYOPATHY
Can be due to fluid volume
overload during labor
* Risk factors
BABY BLUES
- Education needs to start in the prenatal period
- The baby blues can be affected by lack of
sleep, stress and hormonal changes - Baby blues tend to peak in that first week
after delivery and resolve within the first two
weeks - The key is severity
early hemorrhage vs late
early: 1 to 24 hrs
late: after 24 hrs
PRIMARY CAUSES OF PPH - 4 T’S
Tone-
Tissue-
Trauma-
Thrombin disorders-
- Tone- Uterine Atony
- Tissue- Retained tissue fragments
- Trauma- Lower genital tract
lacerations - Thrombin disorders- Disseminated
Intravascular Coagulation (DIC)
Anaphylactoid syndrome of pregnancy
is a rare emergency with significant mortality and morbidity, in which the amniotic fluid and fetal cells enter the maternal circulation leading to respiratory failure, altered mental status, hypotension, and disseminated intravascular coagulation
endometriumitis
. Inflammation of the uterus can cause scarring
mastitis
Mastitis is inflammation (swelling) in the breast, which is usually caused by an infection. It is most common when a woman is breastfeeding, but it can happen at other times as well. A clogged milk duct that doesn’t let milk fully drain from the breast, or breaks in the skin of the nipple can lead to infection.
MAP
SBP + 2 (DBP)/ 3
medication to avoid :
aspirin
Imminent Convulsion
subcapsular hemorrhage
an accumulation of blood between Glisson’s capsule and the liver parenchyma;
