week 9: postpartum complications Flashcards
what is the difference between mood changes (postpartum blues) and mood disorders
Baby Blues
- within 3-5 days postpartum
- common and temporary emotional state that many women experience in first few days to wks after childbirth.
- mood swings, fatigue, anxiety, weepiness, impaired concentration, diff sleeping or eating
- typically resolves in 2 weeks
- due to hormonal changes
Postpartum Mood Disorders
- affect daily functioning
- more severe, long lasting
- typically emerges within 4-6 wks after childbirth
- persistent sadness, severe mood swings, loss of interest, fatigue, changes in appetite or sleep patterns, feelings of worthlessness or guilt, difficulty bonding
potential risk factors for perinatal mood disorders
- relocation
- problems w infertility, and anxiety
- spontaneous abortion
- change in birth plan
- NICU admission can be stressful
- low milk supply
give examples of cognitive domain
- what is diff btwn postpartum depression, baby blues
- resources for lactation support and possible referrals
- teaching about baby cues
give examples of affective domain
- support groups
- mom baby class
- talking about importance of emotional expression
- birth story share circle
give examples of behavioural domain
- establishing a routine
- responding to cues
- time management
what is the edinburg postnatal depression screen
10 statements about individual reflex about each statement in the last week, they choose the responsiveness that looks like what they felt the past week. individuals should be screening themselves.
perinatal depression + treatment options
- characterized by low mood and lack of interest in activities, can be mild to severe
- intense, pervasive sadness and labile mood swings that last longer than 2 wks
treatment options:
- psychotherapy, CBT, psychodynamic therapy
- antidepressants, anti anxiety meds, and electroconvulsive therapy
health teaching practices for baby blues and postpartum depression
- what are somes signs of baby blues? when should the symptoms go away?
- what are symptoms of postpartum depression and when can they begin?
- what are some ways to support wellbeing in the postpartum period?
- what are warning signs that clients and families should be aware of that require urgent immediate care?
risk factors + s/s for perinatal mood disorders in partners
risk factors:
- previous history
- partner w mood disorder
- work or financial stress
- poor social and relationship
- difference w parenting expectations vs reality
s/s:
- fatigue, frustration, anger, irritability
postpartum psychosis
- most severe
- rare 0.1% of postpartum patients
- onset tends to show within 2 weeks postpartum, small number develop symptoms later
- rapid onset of unusual behaviour, hallucinations, paranoia, disorientation, high levels of impulsivity, increase risk for suicide
postpartum psychosis care
- inpatient psychiatric care, antipsychotics, mood stabilizers, benzodiazepines, electroshock therapy
what is a PPH defined as for v birth and c section
loss of > 500mL of blood after v birth
loss of >1000 mL after c section
- any blood loss that has the potential to cause hemodynamic instability
- blood loss is difficult to estimate and is frequently underestimated
- amount of blood loss required to cause hemodynamic instability depends on pre-existing condition of the client
described early, acute, primary PPH
occurs within 24 hrs of birth
describe late or secondary PPH
occurs 24 hrs but less than 6 wks after birth
PPH prevention
active management in 3rd stage of labour
- oxytocin after delivery of anterior shoulder
- gentle cord traction (no pulling)
- immediate fundal assessment after birth
if 3rd stage of labour takes longer than 30 min, risk of PPH increase 6-fold
4 T’s of PPH
tone - uterine activity
trauma - retained placenta
tissue - lacerations
thrombin - coagulation
describe tone for PPH + risk factors
Most common cause of PPH
Lack of uterine tone*
- Soft, spongy, boggy - slow and steady loss of blood
- Higher amount of blood loss than wed expect
Myometrium: smooth muscle
Contractions -> placental arteries - allows blood vessels to constrict
If too much amniotic fluid, carrying multiples: uterus has been overdistended so takes more work to contract
Why someone who had oxytocin during labour is at more risk for PPH: could be hyperstim of uterus, oversaturation of synthetic oxytocin so body becomes desensitized to it
Mag sulfate: prevention of eclampsia, and preterm labour for neuroprotection, tocolytics (diff tocolytics - mag sulfate to relax the uterus) smooth muscle relaxant make sit more difficult to uterus to relax post birth
Inflammation makes it harder for muscle to contract in chorioamnionitis
uterine atony
- marked hypotonia of uterus
- leading cause of early PPH (around 70%)
risk factors
- overdistended uterus (macrosomia, multiples, polyhydramnios)
- high parity
- prolonged labour, oxytocin induced labour
- MgSO4 administration
- chorioamnionitis
