W4 Flashcards
Postpartum hemorrhage has been defined as any blood loss from the uterus greater than
_______within a 24-hour period.
500 mL
In specific agencies, the loss may not be considered hemorrhage until it reaches______
mL.
1000
There are five main causes for postpartum hemorrhage
uterine atony,
lacerations,
and unprotected uterine area left after detachment of the placenta.
retained placental fragments,
uterine inversion, and
disseminated intravascular coagulation
most frequent cause of postpartum hemorrhage
Uterine atony, or relaxation of the uterus,
the physician or nurse-midwife inserts one hand into a woman’s vagina while pushing against the fundus through the abdominal wall with the other hand.
Bimanual Massage
promote strong, sustained uterine contractions.
Intramuscular injection of prostaglandin F22 is another way to initiate uterine contractions
Prostaglandin Administration
replace blood loss with postpartum hemorrhage
may be necessary.
Blood Replacement
Open lines of communication between the couple and health care providers that allow a
family to vent its feelings are most helpful to a couple in this crisis.
Hysterectomy or Suturing
near the branches of the uterine artery.
If the artery is torn, the blood loss may be so great that blood gushes from the vaginal opening.
Because this is arterial bleeding, it is brighter red than the venous blood lost with uterine atony.
Cervical Lacerations
If the cervical laceration appears to be extensive or difficult to repair, it may be necessary for the woman to be given a ________to relax the uterine
muscle and to prevent pain
regional anesthetic
They are easier to assess than cervical lacerations because they are easier to view.
Vaginal Lacerations
Lacerations of the perineum usually occur when a woman is placed in a________ position for birth, because this position increases tension on the
perineum.
lithotomy
Perineal lacerations are sutured
and treated as an_______ repair.
episiotomy
Occasionally, a placenta does not deliver in its entirety; fragments of it separate
and are left behind. Because the portion retained keeps the uterus from contracting
fully, uterine bleeding occurs
Retained Placental Fragments
Retained placental fragments may also be detected by
ultrasound
A blood serum sample that contains _______also reveals that part of a placenta is still present.
human chorionic gonadotropin hormone (hCG)
Usually, a __________is performed to remove the placental fragment
dilatation and curettage (D&C)
may be prescribed to destroy the retained placental tissue.
Methotrexate
deficiency in clotting ability caused by vascular injury. It may occur in any woman in the postpartum period, but it is usually associated with premature separation of the placenta, a missed early
miscarriage, or fetal death in utero.
Disseminated Intravascular Coagulation
incomplete return of the uterus to its prepregnant size and shape. With subinvolution, at a 4- or 6week postpartum visit, the uterus is still enlarged
and soft.
Subinvolution
Oral administration of_________, 0.2 mg four times daily, usually is prescribed to improve uterine tone and complete involution.
methylergonovine
collection of blood in the subcutaneous layer of tissue of the perineum. The overlying skin, as a rule, is intact with no noticeable trauma.
perineal hematoma
Infection of the reproductive tract is another leading cause of maternal mortality
Puerperal Infection
is an infection of the endometrium, the lining of the uterus. Bacteria gain access to the uterus through the vagina and enter the uterus either at the time of birth or during the postpartum period.
Endometritis
An increase in oral temperature to more than 100.4° F (38° C) for two consecutive
24-hour periods
infection
Treatment of endometritis consists of the administration of an appropriate
antibiotic, such as
clindamycin (Cleocin),
Sitting in a ______or walking encourages
lochia drainage by gravity and helps prevent pooling of infected secretions.
Fowler’s position
infection of the peritoneal cavity, usually occurs as an extension of endometritis. It is one of the gravest complications of childbearing and is a major cause
of death from puerperal infection.
Peritonitis
An abscess may form in the ________of Douglas because this is the lowest point of the
peritoneal cavity and gravity causes infected material to localize there.
cul-de-sac
The occurrence of a rigid abdomen (_______) is
one of the first symptoms of peritonitis.
guarding
Peritonitis is often accompanied by__________ (blockage of inflamed intestines).
paralytic ileus
inflammation with the formation of blood clots.
Thrombophlebitis
Prevention of endometritis by the use of good______ during birth helps to prevent thrombophlebitis.
aseptic technique
The condition was, therefore, formerly called milk leg or_______ (“white inflammation”).
phlegmasia alba
dolens
(pain in the calf of the leg on dorsiflexion of the foot)
Homans’ sign
thrombolytic agent such as __________________is prescribed to dissolve the clot through the activation of fibrinolytic precursors and prevent further clot formation.
streptokinase or urokinase
, the antagonist for heparin, should be readily available any time heparin is administered.
Protamine sulfate
woman notices symptoms of burning on
urination, possibly blood in the urine (hematuria), and a feeling of frequency or that
she always must void.
Urinary Tract Infection
Almost every woman notices some immediate (1 to 10 days postpartum) feelings of sadness (_________) after childbirth.
postpartum “blues”
When the illness coincides with the
postpartum period, it is called
postpartum psychosis
