WARD SEMI MATERNA Flashcards
what rises and falls during pph
rise in pulse rate and fall of bp
pph occurs within
24 hours of childbirth but can also happen up to 12 weeks postpartum
how much ml of blood does a woman nsvd loses
500 ML
cesarean delivery within 24 hrs loses how much amount of blood
1Liters
Caesarian Hysterectomy blood loss vol
2L
state the
BP:
s&s:
DoS:
BV: 500-1000ml
Normal
palpitate, tachy, dizzy
compensated
state the
BP:
s&s:
DoS:
BV: 1000-1500
fall 80-100
weak, tachy, sweating
Mild
state the
BP:
s&s:
DoS:
BV: 1500-2000
70-80
restlestness, pallor, oliguria
moderate
state the
BP:
s&s:
DoS:
BV: 2000-3000
50-70
collapse, airhunger, anuria
severe
(the 6-week period of time
Classification based on amount of blood loss beginning immediately after birth)
puerperium
Classification based on amount of blood loss
● Minor: less than 1000 mL
● Major: greater than 1000 mL
● Severe: greater than 2000 mL
which stage of pph is where bleeding occurs before the
expulsion of the placenta.
3rd Stage Hemorrhage
which stage of pph is where Bleeding occurs after the expulsion of the placenta.
True Postpartum Hemorrhage
pph that occurs beyond 24 hours and within
puerperium
Secondary PPH
examples of Trauma
laceration
hematomas
uterine rupture
bleeding because the placental sites have
closed. This is referred to as
Tone
Retained placental fragments. This is also referred to as
tissue
DIC meaning
disseminated intravascular coagulation
Development of (DIC). This is also referred to as
Thrombin
four T’s of postpartum hemorrhage
tone, trauma, tissue and
thrombin.
word to describe uterus during tone
boggy
examples on how uterus looks
excessive bright red bleeding
boggy uterus
high fundus
abnormal clot
Causes for tone: Maternal
multipara
previous history of pph
Maternal anemia
Causes for tone : pregnancy compli
Antepartume hemorrhage
overdistention of uterus
Causes of tone: labour
Prolonged labour
induction of labor
Precipitate labor
Causes of tone: drugs
Anesthetic drugs
Magnesium
Nifedipine
therapeutic management of tone
bimanual compression
Administer oxytocin (PITOCIN)
Therapeutic management : tone (drugs)
Carboprost 0.25 IM
Misoprostol 1,000 mg rectally
Methylergonovine 0.2 mg IM
Trauma sites:
○ Vulva
○ Vagina
○ Perineum
○ Cervix
○ Paraurethral region
○ Rupture uterus
Therapeutic management include: Trauma
○ Suture lacerations
○ Drain hematomas > 3 cm
○ Replace inverted uterus
Retained tissue:
Bit of placenta
Blood clot
Therapeutic management include: for retained tissue
○ Manual removal
○ Curettage
○ Methotrexate
cause of thrombin
diminished pro coagulants (washout effect)
or increased
fibrinolytic activity.
Conditions leading to thrombosis:
Placental abruption
Jaundice in pregnancy
Prolonged retention of dead fetus
Thrombocytopenic purpura
Therapeutic management include: Thrombin
○ Fresh frozen plasma
○ Recombinant factor VIIa
○ Platelet transfusion
RISK FACTORS: postpartum
distend the uterus
cervical or uterine lacerations
Inadequate blood coagulation
Uterus could not contract readily
common symptoms of postpartum hemorrhage.
● Uncontrolled bleeding
● Decreased blood pressure
● Increased heart rate
● Decrease in the red blood cell count (hematocrit)
. If the uterus is unable to contract, the physician might prescribe _____ to
maintain the tone of the uterus.
Pitocin
a prostaglandin derivative that could help in
promoting sustained uterine contractions.
Carboprost tromethamine
necessary to replace the blood loss.
Blood transfusion
measurement of o2 to admnister
4L/min via face mask
SURGICAL MANAGEMENT:
Hysterectomy
Suturing
Nursing Assessment: PPH
● Assess the amount of bleeding.
● Assess maternal vital signs
● Assess for signs of shock.
● Assess the condition of the uterus.
Assess ______frequently to determine if the amount discharged is still within the normal limits.
lochia
POSSIBLE COMPLICATIONS:pph
Hypovolemic Shock
Anemia
Coagulation Disorders
Organ Damage
Infection
Prolonged low blood flow can lead to damage in vital organs, such as
kidneys
heart
condition that occurs due to severe blood loss and insufficient blood flow to the pituitary gland
during or after childbirth
SHEEHAN SYNDROME
SHEEHAN SYNDROME is presented as what deficiency
anterior pituitary hormone deficiency
Antenatal: management:
● Improvement of the health status (keep the
Hb level normal, >10 g/dl)
● Blood grouping
● Placental localization must be done
● Women with morbid adherent placenta with
high risk PPH delivered by senior consultant
Intranatal: management
● Active management of 3rd stage of labor
● For cases with induced or augmented labor by
oxytocin, the infusion should be continued for
at least 1 hour after delivery
● Women delivered by caesarean given
oxytocin 5IU slow IV
● Exploration of uterovaginal canal for evidence
of trauma
