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Postpartum Complications
PP complications
47
Nursing
Undergraduate 3
04/19/2016

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Cards

Term
High Risk Factors for Postpartal Complications
Definition
  • PIH
  • DM
  • Cardiac disease
  • Cesarean birth
  • Overdistention of uterus
  • Precipitous labor
  • Prolonged labor
  • Difficult birth/ pushing
Term
Most Common Postpartum Complications
Definition
  1. Postpartum hemorrhage (PPH)
  2. Thromboembolitic disease
  3. Postpartum infections
Term
Postpartum Hemorrhage (PPH)
Definition
  • Loss of:
    • >500 mL blood after vaginal birth
    • >1000 mL blood after cesarean birth
  • 10% decrease in hematocrit b/w admission for labor and PP
  • Need for erythrocyte transfusion
  • Occurs in 18% of women
Term
Early, Acute, or Primary PPH
Definition
  • Occurs in first 24 hours PP
  • Causes:
    • Uterine atony
    • Lacerations of vaginal & cervical areas
    • Retained placental fragments
    • Vulvar, vaginal, or pelvic hematomas
    • Uterine inversion
Term
Late or Secondary PPH
Definition
  • Occurs from 24 hours to 6 weeks PP
  • Causes:
    • Subinvolution of placental site
    • Endometritis
    • Retention of placental fragments
Term
Interventions: PPH
Definition
  • Make sure no placental fragments are retained
  • Observe for uterine atony
  • Observe for lacerations w/ significant bleeding
  • If uterus boggy--> massage vigorously, let mom nurse NB if possible
  • Bimanual compression (one hand in vagina and one on abdomen) to stop bleeding
  • Adminster meds (pitocin, methergine, etc.)
  • Bleeding not stopped--> uterine atony embolization or emergency hysterectomy
Term
Uterine Atony
Definition
  • Leading cause of PPH
  • Marked hypotonia of uterus, occurs in 1/20 births
  • Causes:
    • Multipara, hydramnios, macrosomia, multi-gestation (uterus is over-stretched)
    • Traumatic birth, magnesium sulfat, rapid/prolonged labor, chorioamniotis, placenta previa, and placenta abruption
Term
Lacerations of the Genital Track
Definition
  • Common cause of PPH
  • Bleeding based on laceration site:
    • Cervix: cut shalow, bleeding minimal
    • Vagina: vaginal hematomas
    • Perineum: most common bleeding cause
      • Classified by degree
Term
Degrees of Perineal Lacerations
Definition
  • 1st degree: through skin and superficial structures; up to muscle
  • 2nd degree: through the muscle of the perineal body
  • 3rd degree: through the anal sphincter
  • 4th degree: into the anal rectal wall
Term
Nursing Considerations: Lacerations
Definition
  • No enemas, no rectal temps
  • Encourage fluids and use stool softeners
  • Document degree of laceration
  • Evaluate site
  • Lacerations should heal w/o interventions
Term
Perineal Hematomas
Definition
  • Collection of blood in the subcutaneous tissue of the perineum
  • Cause of severe pain
  • S/S:
    • Purplish discoloration, obvious swelling, tender to palpation
Term
Nursing Interventions: Perineal Hematomas
Definition
  • Document size and degree of discomfort
  • Administer mild analgesic (as ordered)
  • Place ice pack on affected site
  • If severe, site may be incised and vessel ligated 
Term
Nonadherent Retained Placenta
Definition
  • Poor placental separation (may still be attached to endometrial tissue, but normal implantation
  • Managed by manual separation and removal
Term
Adherent Retained Placenta
Definition
  • Abnormal attachment of the placenta into the layers of uterine organ
  • Three types: accreta, increta, and percreta
  • Delivery of the placenta will be unsuccessful and bleeding will be profuse when attempted
Term
Placenta Accreta
Definition
Slight penetration of myometrium
Term
Placenta Increta
Definition
The placental tissues invade the muscle of the uterus
Term
Placenta Percreta
Definition
The placental tissues go all the way into the uterine muscle and may break through (rupture)
Term
Retained Placental Fragments
Definition
  • Part of the placenta is retained in the uterus after delivery
  • Cause of PPH; immediate if large amount retained, up to 10 days PP if small amount retained
  • Uterine not fully contracted
  • Elevated hCG if bloodwork done
Term
Subinvolution of Uterus: Causes and S/S
Definition
  • Causes:
    • Retained placental fragments
    • Pelvis infection
  • S/S:
    • Prolonged lochial discharge
    • Irregular or excessive bleeding
Term
Treatment of PPH
Definition
  • Administer meds to stimulate contractions & O2
  • IV replacement of blood and/or fluids
  • Fundal massage
  • Removal of retained placental pieces
  • Packing uterus with sponges and sterile materials
  • Tying-off of bleeding blood vessels
  • Laparotomy (find cause of bleeding)
  • Hysterectomy (last resort)
Term
S/S of PPH
Definition
  • Excessive or bright-red bleeding
  • Boggy fundus, unresponsive to massage
  • Abnormal clot from vaginal vault
  • Unsual pelvic discomfort or backache
  • Persistent bleeding w/ firm fundus
  • Rise in fundal heigh
  • Increased pulse or decreased BP
  • Decrease in Hct
  • Hematoma formation or bulging, shiny skin in perineal area
Term
Nursing Interventions: PPH
Definition
  • Massage soft & boggy uterus
  • Weigh perineal pads
  • Maintain vascular access
  • Observe for signs of anemia
  • Monitor urinary output
  • Allow adequate rest
  • Administer meds (uterine stimulants, analgesics)
  • Teach self-care
Term
Hemorrhagic Shock
Definition

Emergency situation

Hypovolemic shock

Perfusion of organs may become severely compromised

Possibly fatal

Term
Nursing Assessment: Hemorrhagic Shock
Definition
  • Respirations rapid and shallow
  • Pulse rapid, weak, and irregular
  • BP decreasing (late sign)
  • Skin cool, pale, and clammy
  • Urinary output decreases
  • LOC decreases, from lethargy to coma
  • Becomes anxious
  • Central venous pressure decreases
Term
Nursing Interventions: Hemorrhagic Shock
Definition
  • Summon assistance and equipment
  • Start IV fluids and/or blood (per standing orders)
  • Ensure patient airway
  • Administer O2
  • Continue to monitor status
Term
Thromboembolic Disease
Definition
  • Blood clot or clots inside a blood vessel
  • Caused by inflammation or partial obstruction of vessel
  • Part of the blood clot disloges--> carried to the pulmonary artery--> occludes the vessel and obstructs blood flow to the lungs
Term
Superficial Venous Thrombosis
Definition
  • Type of thromboembolic disease
  • Most frequent form of PP thrombophlebitis
  • Pain and tenderness in the lower extremity
  • Physical exam:
    • Warmth, redness, and an enlarged, hardened vein over the site of the thrombosis
Term
Deep Venous Thrombosis
Definition
  • Type of thromboembolic disease
  • Can extend from the foot to the iliofemoral region
  • Will have unilateral leg pain, calf tenderness, and swelling
  • Physical exam:
    • Redness and warmth
    • Homan's sign may be positive
Term
Homan's Sign
Definition

Indicator of deep venous thrombosis

Present if pain in the calf is produced by passive dorsiflexion of the foot

Term
Pulmonary Embolism
Definition
  • Rare
  • Dyspnea and tachypnea
  • Apprehension, cough, tachycardia, elevated temperature, and chest pain
Term
Thrombosis
Definition

Obstruction of the pulmonary artery with a blood clot

Usually a complication of thrombophlebitis

Emergency !

Term
Assessment of Thrombosis
Definition
  • Sudden, sharp chest pain
  • Tachypnea
  • Tachycardia
  • Orthopnea
  • Cyanosis
Term
Treatment of Thrombosis
Definition
  • Administer O2
  • ICU transfer
  • CPR if indicated
Term
Treatment: Superficial Venous Thrombosis
Definition
  • Analgesia
  • Rest w/ affected leg elevated
  • Compression hose
  • Local application of heat
Term
Treatment: Deep Venous Thrombosis
Definition
  • Initially give anticoagulant (usually IV heparin, continuously for 5-7 days)
  • Oral anticoagulant therapy (warfarin) started w/ heparin, continue use for 3 months
  • Bed rest w/ affected leg elevated
  • Analgesia
  • After symptoms decrease, compression hose when ambulating 
Term
Treatment: Pulmonary Embolism
Definition
  • Continuous IV heparin until symptoms resolve
  • Intermittent SQ heparin or oral anticoagulants for 6 months
Term
Anticoagulant Overdose
Definition
  • Heparin:
    • Administer proatmine sulfate
  • Warfarin:
    • Administer vitamin K
Term
Use of Warfarin Postpartum
Definition
Okay, little is passed through breast milk
Term
Endometritis
Definition
  • Most common cause of PP infection
  • Usually begins at placental site
  • Incident is higher after c-section
Term
S/S of Endometritis
Definition
  • Fever (usually on 3rd or 4th day PP), chills
  • Increased WBCs 
  • Increased pulse
  • Anorexia, nausea
  • Fatigue and lethargy
  • pelvic pain
  • uterine tenderness
  • Foul-smelling, profuse lochia
  • Positive blood cultures or utracervical or itnrauterine bacterial cultures
Term
Treatment: Endometritis
Definition
  • Vaginal culture
  • Antibiotics and/or excission of perineal sutures
  • Encourage fluids
  • Fowler's position or ambulation
  • Document color, consistency, odor of discharge
Term
Wound Infections
Definition
  • Often develop after women go home
  • Sites:
    • C-section site
    • Episiotomy site
    • Repaired laceration site
Term
UTIs: Risk Factors
Definition
  • Urinary catheterization
  • Frequent pelvic exams
  • Epidural anesthesia
  • Genital tract injury
  • History of UTI
  • C-section birth
Term
Mastitis
Definition
  • Infection of breast
  • Unilateral
  • Mostly in first-time moms who are breastfeeding
  • Develops after flow of milk is established
  • Starts with nipple fissure--> ductal system--> milk flow blocked
  • May lead to breast abscess
Term
Peritonitis
Definition
Infection of the peritoneal cavity
Spreads through the lymphatic system or directly throuhg the reproductive tract
Term
S/S of Peritonitis
Definition
  • Rigid abdomen
  • Abdominal pain
  • High fever
  • Tachycardia
  • Vomiting
Term
Treatment of Peritonitis
Definition
  • If paralytic ileus presents--> NG tube
  • IVF or TPN
  • Antibiotics
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