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• Postpartum complications can include postpartum hemorrhage and psychological disorders.
• Nursing care involves identifying causes, understanding pathophysiology, demonstrating interventions, and educating patients and their families.

Postpartum Hemorrhage

• Postpartum hemorrhage is excessive bleeding following childbirth.

Uterine Atony

• Uterine atony is the failure of the uterus to contract effectively after childbirth, leading to postpartum hemorrhage.
• It is the most common cause of excessive postpartum bleeding.
• Risk factors include overdistended uterus, prolonged or rapid labor, use of uterine relaxants, grand multiparity (≥5 births), retained placental fragments, and chorioamnionitis.
• Signs and symptoms include a soft, boggy uterus upon palpation, heavy vaginal bleeding, hypotension and tachycardia, pallor, dizziness, or weakness, and increased fundal height.
• Medical interventions consist of uterotonic agents like Oxytocin, Methylergonovine, Carboprost, Misoprostol, bimanual uterine massage, IV fluid resuscitation, uterine tamponade with a balloon catheter (Bakri balloon), and surgical interventions (uterine artery ligation, hysterectomy).
• Nursing care includes monitoring vital signs, fundal massage, administering uterotonic drugs, maintaining IV access, monitoring urine output, and educating the mother.
• Possible nursing diagnoses could include risk for deficient fluid volume, ineffective tissue perfusion, and risk for infection.

Lacerations

• Lacerations are tears that occur in the cervix, vagina, perineum, or surrounding structures during childbirth.
• Lacerations causes are rapid or forceful delivery, large fetal head, use of forceps or vacuum extraction, insufficient stretching of the perineum, and episiotomy extension.
• Signs and symptoms include continuous bright red vaginal bleeding despite a firm uterus, pain and tenderness at the site, swelling or bruising, and difficulty urinating or defecating.
• Medical interventions are surgical repair and pain management with NSAIDs and ice packs.
• Antibiotics are indicated to prevent infection.
• Nursing care involves assessing bleeding and wound healing, applying ice packs, administering pain medications, encouraging perineal hygiene, and educating about signs of infection.
• Potential nursing diagnoses are acute pain, risk for infection, and impaired skin integrity.

Retained Placental Fragments

• Retained placental fragments results in retention of placental tissue in the uterus after delivery, leading to postpartum hemorrhage and infection risk.
• Causes of placental fragments are incomplete placental separation, abnormal placental attachment (placenta accreta, increta, percreta), and uterine atony preventing expulsion.
• Signs and symptoms are prolonged or excessive bleeding, uterine subinvolution, persistent lower abdominal pain, and foul-smelling lochia.
• Medical interventions are manual removal of retained fragments, uterotonics, Dilation and Curettage (D&C), and antibiotics if infection is suspected.
• Nursing care includes monitoring bleeding and fundal height, preparing for potential surgical removal, educating the mother, and ensuring adherence to medications.
• Potential nursing diagnoses are risk for deficient fluid volume and risk for infection.

Disseminated Intravascular Coagulation (DIC)

• DIC is a life-threatening condition involving widespread clotting and bleeding due to excessive activation of the coagulation system.
• Causes include obstetric complications, infections, and severe hemorrhage.
• Signs and symptoms include uncontrolled bleeding from IV sites, gums, nose, surgical wounds, petechiae, ecchymosis, purpura, hypotension, tachycardia, and organ dysfunction.
• Medical interventions are treating the underlying cause, blood transfusions and, in early stages, anticoagulants.
• Nursing care consists of frequent monitoring of vital signs and bleeding, preparing for blood transfusion, maintaining strict fluid balance, and monitoring coagulation studies.
• Possible nursing diagnoses are risk for bleeding and risk for impaired tissue perfusion.

Subinvolution

• Subinvolution is the delayed return of the uterus to its pre-pregnancy size and condition.
• Causes are retained placental fragments, uterine infection, and uterine atony.
• Signs and symptoms include prolonged lochia discharge, a larger-than-normal uterus on palpation, and intermittent postpartum bleeding.
• Medical interventions involve uterotonics, antibiotics for infection, and D&C for retained tissue.
• Nursing care consists of monitoring lochia patterns, encouraging breastfeeding, and educating on the importance of follow-up check-ups.
• Possible nursing diagnoses are risk for bleeding and risk for infection.

Hematomas

• Hematomas are localized collections of blood, usually in the perineum, vagina, or pelvis after childbirth.
• Causes are birth trauma, use of forceps or vacuum extraction, and prolonged second stage of labor.
• Signs and symptoms include severe perineal or vaginal pain, swelling or discoloration, pressure sensation, and signs of hypovolemic shock if large.
• Medical interventions are conservative management for small hematomas (ice packs, analgesia) or incision and drainage for large hematomas, and blood transfusion.
• Nursing care involves assessing for hidden bleeding, applying cold compresses, monitoring vital signs, and educating on signs of worsening hematoma.
• Possible nursing diagnoses are acute pain and risk for bleeding.

Puerperal Infection

• Puerperal infection is an infection occurring after childbirth.

Endometritis

• Endometritis is an infection of the uterine lining (endometrium), common after cesarean delivery.
• Causes are cesarean section, prolonged labor or rupture of membranes, retained placental fragments, multiple vaginal examinations during labor, chorioamnionitis, poor perineal hygiene, and intrauterine devices (IUDs).
• Signs and symptoms are fever (≥38°C or 100.4°F) in the first 24-48 hours, lower abdominal pain, foul-smelling lochia, tachycardia, chills, and malaise.
• Medical interventions involve broad-spectrum IV antibiotics, antipyretics, uterotonic agents, and D&C if retained products of conception are present.
• Nursing care includes monitoring vital signs, assessing uterine tenderness and lochia, maintaining IV access, encouraging hydration and ambulation, and educating the patient.
• Possible nursing diagnoses are risk for infection, acute pain, and hyperthermia.

Perineal Infection

• Perineal infection occurs in the perineal area due to episiotomy, lacerations, or poor hygiene.
• Causes are perineal tears or episiotomy wounds, poor perineal hygiene, prolonged rupture of membranes, use of contaminated obstetric instruments, and immunocompromised conditions.
• Signs and symptoms include redness, warmth, swelling, persistent pain, purulent discharge, fever, and delayed wound healing.
• Medical interventions are broad-spectrum antibiotics, analgesics, incision and drainage, and frequent wound care.
• Nursing care involves assessing the wound, educating on perineal hygiene, encouraging sitz baths, providing pain management, and monitoring for systemic infection.
• Possible nursing diagnoses are impaired skin integrity, acute pain, and risk for infection.

Thrombophlebitis

• Thrombophlebitis is inflammation of a vein associated with blood clot formation, occurring in the legs postpartum and includes superficial thrombophlebitis and deep vein thrombosis (DVT).
• Causes are venous stasis, hypercoagulability of pregnancy, endothelial injury, obesity, smoking, and history of thrombosis.
• Signs and symptoms are localized pain, tenderness, swelling, warmth, redness, a positive Homan's sign, and low-grade fever.
• Medical interventions are anticoagulants, analgesics, compression stockings, bed rest with elevation of the affected extremity, and thrombectomy.
• Nursing care involves assessing for signs of DVT, monitoring for complications, educating on leg exercises, encouraging hydration, and administering anticoagulants.
• Possible nursing diagnoses are ineffective peripheral tissue perfusion, risk for impaired physical mobility, and risk for bleeding.

Urinary Tract Infection (UTI)

• UTI is bacterial infection affecting the urinary system.
• Causes are urinary stasis due to bladder distension, catheterization, perineal contamination, hormonal changes, and incomplete bladder emptying.
• Signs and symptoms include dysuria, urinary frequency and urgency, suprapubic pain, cloudy urine, and low-grade fever.
• Medical interventions are antibiotics, increased fluid intake, and urinary analgesics.
• Nursing care is to encourage fluid intake (>2L/day), monitor urine output, teach perineal hygiene, educate about antibiotics, and encourage voiding.
• Possible nursing diagnoses are acute pain, impaired urinary elimination, and risk for fluid volume deficit.

Emotional & Psychological Complications of Puerperium

• Emotional and psychological complications are postpartum depression and psychosis.

Postpartum Depression (PPD)

• PPD is a mood disorder characterized by sadness, anxiety, and exhaustion.
• Causes are hormonal changes, history of depression or anxiety, stressful life events, sleep deprivation, difficult pregnancy or delivery, and thyroid dysfunction.
• Signs and symptoms include persistent sadness, loss of interest, difficulty bonding, irritability, fatigue, sleep disturbances, appetite changes, anxiety, and thoughts of self-harm.
• Medical interventions involve antidepressants, hormone therapy, psychotherapy, and support groups.
• Nursing care includes assessing for signs of PPD, emotional support, promoting self-care, educating the patient and family, encouraging bonding, monitoring medication adherence, and referring to mental health professionals.
• Possible nursing diagnoses are risk for impaired parent-infant attachment, ineffective coping, risk for self-harm, disturbed sleep pattern, and social isolation.

Postpartum Psychosis (PPP)

• PPP is a rare but severe psychiatric emergency characterized by delusions, hallucinations, and disorganized behavior.
• Causes are hormonal shifts, history of bipolar disorder or psychosis, genetic predisposition, sleep deprivation, and extreme stress or trauma during childbirth.
• Signs and symptoms include sudden confusion, hallucinations, delusions, rapid mood swings, paranoia, agitation, incoherent speech, and suicidal thoughts.
• Medical interventions involve hospitalization, antipsychotics, mood stabilizers, benzodiazepines, and electroconvulsive therapy.
• Nursing care includes ensuring safety, administering medications as prescribed, providing a calm environment, monitoring mood and behavior, facilitating family involvement, and encouraging adherence to follow-up care.
• Possible nursing diagnoses are risk for self-directed violence, risk for other-directed violence, disturbed thought processes, impaired parenting, and deficient knowledge.