Management of Uterine Atony Quiz

Uterine Atony Management

• Massage the uterus gently when a relaxed and boggy uterus is palpated
• Keep the bladder empty to facilitate effective uterine contractions
• Monitor vital signs and blood loss during the early postpartal period
• Weigh perineal pad before and after use to measure blood loss accurately
• Check under the hips for pooled blood
• Tachycardia (PR > 100) and hypotension are significant vital signs changes in hemorrhage
• Administer oxytocin as ordered if sustained uterine contractions are not achieved by massage
• Perform blood transfusion and IVF to replace blood loss
• Conduct manual exploration of the uterine cavity, cervix, and vagina for retained placental fragments and laceration
• Perform bimanual uterine compression if bleeding cannot be controlled
• Hysterectomy is performed as a last resort if bleeding cannot be controlled

Small for Gestational Age (SGA)

• An infant is SGA if the birth weight is below the 10th percentile on an intrauterine growth curve for that age
• SGA infants are small for their age due to intrauterine growth restriction or retardation (IUGR) or failed to grow at the expected rate in utero
• Causes of SGA include mother's nutrition, placental anomaly, systemic diseases, smoking, and chromosomal abnormalities
• Assessment of SGA includes fundic height, sonogram, biophysical profile, and ultrasound
• Appearance of SGA infants includes below-average weight, length, and head circumference, wasted appearance, and small liver
• Nursing diagnoses for SGA include ineffective breathing pattern, risk for ineffective thermoregulation, and risk for impaired parenting

Hematomas

• Large hematomas are potentially dangerous because they may rupture and cause severe bleeding and infection
• Treatment for hematomas includes bringing the woman back to the DR for incision and ligation of bleeding vessels, analgesics for pain, application of ice packs, broad-spectrum antibiotics, and blood transfusion

Puerperal Infection

• Puerperal infection is a general term used to describe infection of the genital tract after delivery
• Predisposing factors include prolonged labor, postpartum hemorrhage, anemia, retained placental fragments, intrauterine manipulation, and malnutrition
• Infecting organisms include anaerobic streptococci, Escherichia coli, Chlamydia trachomatis, and Staphylococci
• Assessment of puerperal infection includes the presence of infection elsewhere in the body or in the genital tract during labor, delivery, and puerperium

Infant of Diabetic Mother

• Effects of poor glycemic control in pregnant diabetic women include congenital abnormalities, macrosomia, birth trauma, perinatal asphyxia, RDS, hypoglycemia, and hyperbilirubinemia
• Therapeutic management includes penicillin, erythromycin, anti-inflammatory agents, and secondary prophylaxis for 5 years or through age 21-25 years

Test your knowledge on managing uterine atony, including the first actions to take when a relaxed and boggy uterus is palpated, the importance of keeping the bladder empty, and monitoring vital signs and blood loss postpartum.