Unit 6 EXAM PREP
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Questions and Answers

What is the primary cause of postpartum hemorrhage after vaginal delivery or C-section?

  • Infection of the uterus
  • Retained placenta
  • Uterine atony (correct)
  • Traumatic lacerations

    • Which clinical manifestation indicates severe shock due to blood loss after delivery?

  • Tachycardia
  • Maternal anxiety
  • Cold extremities
  • Confusion and agitation (correct)

    • What immediate action is required when a patient presents with symptoms of amniotic fluid embolism syndrome?

  • Immediate delivery of the fetus (correct)
  • Aggressive hydration therapy
  • Long-term monitoring
  • Administration of blood products

    • Which factor is NOT associated with an increased risk of thromboembolic disease postpartum?

    <p>Increased mobility</p> Signup and view all the answers

    What are the common symptoms of postpartum infections that typically occur within 2-4 days after delivery?

    <p>Flu-like symptoms and inflammation of mammary glands</p> Signup and view all the answers

    What nursing interventions should be prioritized when managing postpartum hemorrhage?

    <p>Maintaining IV access and emptying the bladder</p> Signup and view all the answers

    What characterizes Gestational Diabetes?

    <p>Glucose intolerance during pregnancy.</p> Signup and view all the answers

    Which factor is a significant risk for developing preeclampsia?

    <p>Genetic predisposition.</p> Signup and view all the answers

    What is a common symptom of severe preeclampsia?

    <p>Oliguria.</p> Signup and view all the answers

    Which of the following hypertensive medications is indicated for managing hypertension in pregnancy?

    <p>Labetalol.</p> Signup and view all the answers

    What does the acronym HELLP syndrome stand for?

    <p>Hemolysis, elevated liver function tests, low platelet count.</p> Signup and view all the answers

    In the context of Iron Deficiency Anemia during pregnancy, which symptom is most concerning?

    <p>Sharp, one-sided abdominal pain.</p> Signup and view all the answers

    What is a defining parameter for diagnosing gestational hypertension?

    <p>Systolic blood pressure over 140 on two occasions.</p> Signup and view all the answers

    Which intervention is NOT typically recommended for mild preeclampsia management?

    <p>Increased sodium intake.</p> Signup and view all the answers

    Which of the following interventions is used for the treatment of severe preeclampsia?

    <p>Magnesium sulfate.</p> Signup and view all the answers

    Which condition is characterized by painless dilation of the cervix without contractions?

    <p>Cervical insufficiency</p> Signup and view all the answers

    What is the immediate management strategy for severe abruptio placentae?

    <p>Plan for birth of the fetus, usually via C-section</p> Signup and view all the answers

    What is the primary risk associated with polyhydramnios in a pregnant woman?

    <p>Shortness of breath and edema</p> Signup and view all the answers

    How is severe hyperemesis gravidarum classified?

    <p>Severe dehydration leading to hypotension</p> Signup and view all the answers

    What signifies a complete placenta previa?

    <p>Placenta covers the internal cervical os completely</p> Signup and view all the answers

    What primary fetal complication arises from oligohydramnios?

    <p>Pulmonary hypoplasia</p> Signup and view all the answers

    Which term describes spontaneous rupture of membranes before the onset of labor?

    <p>Prelabor rupture of membranes</p> Signup and view all the answers

    What is the main reason for using corticosteroids early in cases of preterm labor?

    <p>To enhance fetal lung development</p> Signup and view all the answers

    Which complication is associated with shoulder dystocia during delivery?

    <p>Failure of the anterior shoulder to deliver</p> Signup and view all the answers

    What is the potential fetal risk associated with post-term pregnancy?

    <p>Increased risk of stillbirth</p> Signup and view all the answers

    What are the symptoms of Anaphylactoid Syndrome of Pregnancy?

    <p>Dyspnea, cyanosis, and circulatory collapse</p> Signup and view all the answers

    Which of the following is a primary symptom of severe postpartum hemorrhage?

    <p>Hypotension and irritability</p> Signup and view all the answers

    What is the appropriate nursing management intervention for a patient with boggy uterine tone?

    <p>Perform fundal massage and assess for bladder distension</p> Signup and view all the answers

    Which complication results from a small tear in the uterus in pregnancy?

    <p>Amniotic fluid embolism syndrome</p> Signup and view all the answers

    What is the recommended treatment for respiratory distress due to Anaphylactoid Syndrome of Pregnancy?

    <p>Immediate delivery of the fetus</p> Signup and view all the answers

    What condition is characterized by blood loss exceeding 1000 ml following delivery?

    <p>Postpartum Hemorrhage</p> Signup and view all the answers

    What is a primary maternal implication of abruptio placentae?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What immediate intervention is needed for a fetus with a prolapsed umbilical cord?

    <p>Have the mother lay flat</p> Signup and view all the answers

    Which statement describes the characteristic feature of placenta previa?

    <p>Bleeding often occurs with dilation</p> Signup and view all the answers

    What combination of clinical signs is characteristic of hyperemesis gravidarum?

    <p>Excessive vomiting and dehydration</p> Signup and view all the answers

    Which medication is classified as a uterine relaxant to prevent preterm labor?

    <p>Magnesium sulfate</p> Signup and view all the answers

    What is a potential fetal consequence of oligohydramnios?

    <p>Cord compression</p> Signup and view all the answers

    Which management strategy is important for a woman experiencing prelabor rupture of membranes (PPROM)?

    <p>Antibiotics for infection prophylaxis</p> Signup and view all the answers

    Which complication frequently arises in multiple gestations during pregnancy?

    <p>Preterm labor</p> Signup and view all the answers

    What is the expected fundal height in a pregnancy with multiple gestations?

    <p>Greater than expected</p> Signup and view all the answers

    What is a common symptom of preterm labor?

    <p>Regular contractions with cervical change</p> Signup and view all the answers

    What is the primary difference between pre-gestational diabetes and gestational diabetes?

    <p>Pre-gestational diabetes is an alteration in carbohydrate metabolism before conception, while gestational diabetes is glucose intolerance during pregnancy.</p> Signup and view all the answers

    Which of the following is NOT a symptom of severe preeclampsia?

    <p>Mild proteinuria of less than 1g in 24 hours</p> Signup and view all the answers

    In managing preeclampsia, which intervention is considered appropriate for mild symptoms?

    <p>Lifestyle modifications and monitoring</p> Signup and view all the answers

    What does the acronym HELLP syndrome refer to in the context of preeclampsia?

    <p>Hemolysis, Elevated Liver function tests, Low Platelet count</p> Signup and view all the answers

    When is gestational diabetes typically diagnosed during pregnancy?

    <p>Late second trimester, around 24-28 weeks</p> Signup and view all the answers

    Which factor is commonly associated with reduced blood flow in preeclampsia?

    <p>Imbalance between thromboxane and prostacyclin</p> Signup and view all the answers

    What is a significant risk associated with iron deficiency anemia during pregnancy?

    <p>Reduced red blood cell count</p> Signup and view all the answers

    What is the recommended position for a mother experiencing gestational hypertension?

    <p>Left lateral recumbent position to reduce pressure on blood vessels</p> Signup and view all the answers

    Which of the following symptoms best represents the late-stage complications of preeclampsia?

    <p>Oliguria and fluid retention</p> Signup and view all the answers

    Study Notes

    Pre-Gestational Diabetes

    • Occurs before pregnancy
    • Involves alterations in carbohydrate metabolism
    • Can be managed with lifestyle changes, medications, and regular monitoring.

    Gestational Diabetes

    • Onset during pregnancy
    • Usually diagnosed between the second to third trimester(24-28 weeks)
    • Can lead to neonatal complications like excessive weight gain.

    Hypertension in Pregnancy

    • Gestational hypertension is diagnosed with at least 2 separate occasions of blood pressure readings over 140 systolic or 90 diastolic after 20 weeks.
    • Can be managed with lifestyle changes like left lateral recumbent positioning, sodium reduction, and antihypertensive medication.

    Preeclampsia/Eclampsia

    • Characterized by an imbalance of thromboxane and prostacyclin, resulting in reduced blood flow to vital organs.
    • Can lead to decreased urine output, sodium retention, and edema.
    • Symptoms include severe headache, seizures, hypertension, vision changes, and proteinuria.
    • Nursing management: Monitoring vital signs, weight, urine protein, and fetal movement; administering anticonvulsants, corticosteroids, and antihypertensives; considering labor induction or Cesarean delivery for severe cases.

    HELLP Syndrome

    • A serious complication of preeclampsia involving liver involvement.
    • Characterized by:
    • Hemolysis (H)
    • Elevated (E) liver enzymes
    • Low (L) platelet count

    Iron Deficiency Anemia

    • Reduction in red blood cell count
    • Causes: blood loss from causes such as vaginal bleeding.
    • Can impact fetal growth and development, and increase risk of prematurity.

    Ectopic Pregnancy

    • Occurs when an embryo implants outside the uterus.
    • Can be life-threatening.
    • Symptoms include: sharp, one-sided pain, syncope, referred right shoulder pain, and adnexal pain.
    • Diagnosis is through a thorough history, pelvic exam, and ultrasounds.

    Cervical Insufficiency

    • Weak cervix leading to premature delivery.
    • Characterized by painless dilation of the cervix without contractions.
    • Can be managed with a cervical cerclage.

    Placenta Previa

    • Abnormal implantation of the placenta in the lower uterine segment or over the internal cervical os.
    • Can lead to painless and bright red vaginal bleeding.
    • Management depends on the severity and location of the placenta previa, ranging from watchful waiting to emergency Cesarean delivery.

    Abruptio Placentae

    • Premature separation of a normally implanted placenta from the uterine wall.
    • A catastrophic event due to the severity of resulting hemorrhage.
    • Classification based on the extent and location of separation.
    • Maternal implications include DIC and hemorrhagic shock.
    • Fetal implications include fetal death, especially with complete separation.
    • Immediate priorities include maintaining maternal cardiovascular status and expediting delivery of the fetus, often via Cesarean section.

    Hyperemesis Gravidarum

    • Excessive vomiting during pregnancy leading to dehydration, electrolyte imbalance, and weight loss.
    • Can result in fetal death.
    • Management includes controlling vomiting, correcting dehydration, restoring electrolytes, and maintaining nutrition.

    Rh Incompatibility

    • Occurs when a Rh-negative mother is exposed to Rh-positive fetal blood.
    • Causes the mother to develop antibodies that can harm subsequent Rh-positive pregnancies.
    • Prevention through Rh immunoglobulin after exposure, such as during delivery.

    Polyhydramnios

    • Excessive amniotic fluid.
    • Associated with fetal malformations.
    • Maternal implications include shortness of breath, edema, and compression of the vena cava.
    • Fetal implications include preterm birth, cord prolapse, and malpresentations.

    Oligohydramnios

    • Reduced amniotic fluid.
    • Fetal implications include skin/skeletal abnormalities, pulmonary hypoplasia, and cord compression.

    Multiple Gestations

    • Pregnancy with more than one fetus (e.g., twins, triplets).
    • Maternal implications include shortness of breath, fatigue, backaches, and pedal edema.
    • Fetal implications include increased risk of prematurity, low birth weight, and fetal abnormalities.
    • Management includes increased monitoring and often Cesarean delivery.

    Prelabor Rupture of Membranes (PROM)

    • Spontaneous rupture of membranes before the onset of labor.
    • Preterm PROM (PPROM) occurs before 37 weeks, with increased risk of complications before 30 weeks.
    • Maternal risks include infection.
    • Management includes monitoring fetal well-being, providing antibiotics for PPROM, and using corticosteroids in preterm cases.

    Shoulder Dystocia

    • An obstetrical emergency occurring after the birth of the head, where the anterior shoulder fails to deliver spontaneously.
    • Managed with maneuvers such as the McRoberts maneuver.
    • Can be associated with macrosomia (large infant size).

    Cephalopelvic Disproportion

    • Condition where the fetal head is too large to fit through the pelvic opening.
    • Can lead to prolonged labor, excessive molding of the fetal head, and traumatic forceps delivery .

    Post-Term Pregnancy

    • Pregnancy that extends beyond 42 weeks gestation.
    • Increased maternal risks due to the size of the fetus.
    • Fetal risks include post-maturity syndrome.

    Preterm Labor

    • Labor that occurs between 20-36 weeks gestation.
    • Can lead to increased morbidity and mortality for the fetus and neonate.
    • Medical management includes providing education on preterm labor symptoms, utilizing uterine relaxants, and administering corticosteroids to promote fetal lung development.

    Prolapsed Umbilical Cord

    • Occurs when the umbilical cord becomes compressed, cutting off oxygen supply to the fetus.
    • An obstetrical emergency requiring immediate intervention.
    • Management includes repositioning the mother to relieve pressure on the cord and rapid delivery of the baby.

    Anaphylactoid Syndrome of Pregnancy

    • A rare but life-threatening condition occurring due to a tear in the amnion or chorion, allowing amniotic fluid to enter the maternal circulation.
    • Symptoms include sudden respiratory distress, circulatory collapse, and acute hemorrhage.
    • Requires immediate delivery of the fetus and life-saving measures.

    DIC (Disseminated Intravascular Coagulation)

    • Life-threatening condition characterized by widespread clotting in the blood vessels, leading to excessive bleeding.
    • Often associated with complications like abruptio placentae and sepsis.
    • Management involves addressing the underlying cause and replacing clotting factors.

    Perinatal Loss

    • Loss of a fetus or baby from the time of conception to 28 days after birth.
    • Includes intrauterine fetal demise (IUFD) after 20 weeks gestation.
    • Requires induction of labor and careful support for the family.

    Postpartum Hemorrhage

    • Leading cause of maternal death after delivery.
    • Defined as blood loss exceeding 1000 ml or signs of hypovolemia.
    • Most common cause is uterine atony (lack of uterine muscle tone).
    • Mild Shock (20% blood loss): diaphoresis, anxiety, cold extremities, increased capillary refill time.
    • Moderate Shock (20-40% blood loss): tachycardia, postural hypotension, oliguria.
    • Severe Shock (>40% blood loss): hemodynamic instability, hypotension, irritability/agitation/confusion.

    Causes of Postpartum Hemorrhage

    • Tone: Uterine atony (lack of tone)
    • Tissue: Retained placenta
    • Trauma: Lacerations
    • Thrombin: Clotting factor deficiency
    • Traction: Excessive pulling on the umbilical cord

    Nursing Management of Postpartum Hemorrhage

    • Assess fundal height, uterine tone, and bladder distension.
    • Monitor pad counts and weigh the pads.
    • Massage the uterus if boggy.
    • Empty the bladder or catheterize if necessary.
    • Maintain IV access.
    • Administer uterotonics like oxytocin, misoprostol, carboprost, and methylergonovine.

    Postpartum Infections

    • Endometritis: uterine infection occurring within 2-4 days, more common in Cesarean births.
    • Surgical Site Infections: infections associated with surgical procedures.
    • Urinary Tract Infections (UTIs): linked to invasive manipulation of the urethra and frequent vaginal exams.
    • Mastitis: Inflammation of the mammary glands. Risk factors include milk stasis, infrequent feeding, nipple breakdown, oversupply, and rapid weaning.

    Thromboembolic Disease

    • Changes in maternal coagulation system can lead to hypercoagulability and compression of iliac veins.
    • Results in venous stasis.
    • Risk factors: Cesarean birth, immobility, obesity, varicose veins, family history.
    • Signs and symptoms: edema, tenderness, pain, palpable cord, changes in limb color.
    • Treatment: Heparin or low-molecular-weight heparin (LMWH).

    Postpartum Affective Disorders

    • Postpartum Blues: mild mood changes that typically resolve within a few weeks.
    • Postpartum Depression (PPD): more serious and persistent mood disorder requiring treatment.
    • Postpartum Psychosis: most severe form, characterized by psychotic symptoms like delusions, hallucinations, and severe anxiety.
    • Early identification and support are crucial.

    Pre-Gestational Diabetes

    • Occurs before conception
    • Involves alteration in carbohydrate metabolism
    • Managed with insulin, diet, and exercise

    Gestation Diabetes

    • Glucose intolerance develops during pregnancy
    • Diagnosed between the second and third trimesters (24-28 weeks)
    • Can lead to neonatal complications like excessive weight gain

    Hypertension in Pregnancy

    • Diagnosed when blood pressure is consistently over 140 systolic or 90 diastolic after 20 weeks (at least 2 readings, 4 hours apart)
    • Lifestyle changes like limiting sodium intake and elevating legs are recommended
    • Antihypertensives may be prescribed

    Preeclampsia/Eclampsia

    • Characterized by an imbalance of blood-clotting substances (thromboxane and prostacyclin)
    • Leads to reduced blood flow to vital organs (brain, liver, kidneys, and lungs)
    • Symptoms include severe headache, seizures, hypertension, vision changes, and proteinuria

    Mild Preeclampsia

    • Few symptoms
    • Blood pressure consistently over 140/90
    • Proteinuria less than 1g in 24 hours

    Severe Preeclampsia

    • Blood pressure over 160/110 on at least two occasions 6 hours apart
    • Proteinuria over 5g in 24 hours, vision changes, low urine output, severe headache, low platelet count
    • Management includes bed rest on the left side

    Monitoring and Treatment of Preeclampsia

    • Regular monitoring of blood pressure, weight, urine protein, and fetal movement
    • Medications include anticonvulsants (magnesium sulfate), corticosteroids, and antihypertensives (labetalol and hydralazine)
    • Labor induction may be necessary, with a c-section considered in severe cases
    • HELLP syndrome is a severe complication of Preeclampsia involving the liver

    HELLP syndrome

    • Stands for: Hemolysis (breakdown of red blood cells), Elevated liver enzymes, Low platelet count

    Iron Deficiency Anemia

    • Reduction in red blood cell count
    • Often presents with low hemoglobin levels
    • Vaginal bleeding can contribute to the condition

    Ectopic Pregnancy

    • Embryo implants outside the uterus, typically in the fallopian tube
    • The growing embryo outgrows the space, causing the tube to rupture and bleed into the abdominal cavity
    • Symptoms include sharp, one-sided pain, fainting, referred right shoulder pain, and pelvic pain
    • Diagnosis involves assessing the last menstrual period and examining the pelvis for masses and tenderness

    Cervical Insufficiency

    • Cervical tissue weakness leading to premature delivery of an otherwise healthy pregnancy
    • Characterized by painless dilation of the cervix without contractions
    • Cervical effacement progresses from the internal os outwards, creating a funnel shape

    Placenta Previa

    • Placenta implants in the lower uterine segment or over the internal cervical os
    • With contractions and dilation, placental villi detach from the uterine wall, exposing uterine sinuses at the placental site, leading to bleeding
    • Symptoms include painless, bright red vaginal bleeding
    • Management involves assessing blood loss, pain, contractions, vital signs, lab work, and fetal heart rate
    • C-section is often required in the case of a massive hemorrhage, a hysterectomy may be needed

    Abruptio Placentae

    • Premature separation of a normally implanted placenta from the uterine wall
    • A catastrophic event due to severe resulting hemorrhage
    • Classified based on the extent and location of the separation
    • Severe cases involve blood invading myometrial tissues, causing uterine irritability and a bluish discoloration of the uterus

    Maternal Implications of Abruptio Placentae

    • Large amounts of thromboplastin are released into the maternal bloodstream,
    • Can lead to Disseminated Intravascular Coagulation (DIC)
    • Resulting hypofibrinogeneamia may cause hemorrhagic shock

    Fetal Implications of Abruptio Placentae

    • Fetal death, particularly with complete placental separation

    Immediate Priorities in Abruptio Placentae

    • Maintaining maternal cardiovascular status
    • Planning for the birth of the fetus (C-section is common)
    • Administering blood products

    Hyperemesis Gravidarum

    • Excessive vomiting during pregnancy
    • Can lead to severe dehydration, hypovolemia, hypotension, and tachycardia
    • Elevated hematocrit, blood urea nitrogen, and reduced urine output
    • Weight loss exceeding 5% of pre-pregnancy weight can occur
    • Fetal death is a potential risk
    • Management focuses on controlling vomiting, correcting dehydration, restoring electrolytes, and maintaining nutrition

    RH Compatibility

    • Maternal indirect Coombs test is used to assess RH compatibility between mother and fetus
    • If the mother is Rh-negative and the fetus is Rh-positive, there is a risk of maternal antibodies attacking the fetus' red blood cells
    • This can lead to hemolytic disease of the newborn

    Polyhydramnios

    • Excessive amniotic fluid, exceeding 2000 ml (normal is about 500 ml)
    • Commonly associated with fetal malformations
    • Maternal effects include shortness of breath and edema due to compression of the vena cava
    • Fetal complications: preterm birth, umbilical cord prolapse, and abnormal fetal presentations

    Oligohydramnios

    • Insufficient amniotic fluid
    • Fetal implications: skin and skeletal abnormalities, underdeveloped lungs (pulmonary hypoplasia), and cord compression
    • Requires management

    Multiple Gestations

    • Fundal height significantly greater than expected
    • Maternal effects: shortness of breath, fatigue, backaches, pedal edema
    • Fetal implications: decreased fetal growth, increased fetal abnormalities, higher risk of prematurity
    • Frequent prenatal visits are necessary
    • Often requires C-section delivery
    • Babies are labeled A (firstborn) and B (second born)

    Prelabor Rupture of Membranes

    • Amniotic sac ruptures before the onset of labor
    • Premature Prelabor Rupture of Membranes (PPROM) occurs before 37 weeks of gestation
    • Increased risk of complications, particularly before 30 weeks
    • Maternal risk of infection
    • Management includes examination to detect amniotic fluid in the vagina using nitrazine paper and the ferning test, ultrasound to assess gestational age, amniotic fluid volume, and fetal wellbeing
    • Antibiotics are administered for PPROM and GBS prophylaxis
    • Corticosteroids are given to accelerate fetal lung development in early gestational ages

    Shoulder Dystocia

    • An emergency occurring after the birth of the head when the anterior shoulder fails to deliver spontaneously or with gentle traction
    • Often caused by fetal macrosomia (large baby)
    • Management includes maneuvers like the McRoberts maneuver to relieve the obstructed shoulder

    Cephalopelvic Disproportion

    • Fetal head size is too large for the pelvic diameter
    • Labor is prolonged, excessive molding of the fetal head may occur, and forceps may be necessary
    • Fetal malposition may also contribute

    Post Term Pregnancy

    • Pregnancy extending beyond 42 weeks
    • Increased maternal risks associated with fetal size
    • Fetal risks include postmaturity syndrome, due to overly large size

    Preterm Labor

    • Occurs between 20-36 weeks of gestation
    • Characterized by uterine contractions (4 in 20 minutes or 8 in an hour) and documented cervical change
    • High risk of fetal/neonatal morbidity and mortality

    10/10 Lecture

    Preterm Labor

    • Occurs between 20 and 36 weeks
    • Increased morbidity/mortality for the fetus/neonate
    • Education on recognizing preterm labor symptoms is vital
    • Goal is to prevent PTL from progressing to a point where it no longer responds to treatment
    • Corticosteroids help accelerate fetal lung development

    Uterine Relaxants

    • Indomethacin (NSAID)
    • Nifedipine (Calcium Channel Blocker)
    • Magnesium sulfate (can cause toxicity, monitor and use calcium gluconate as antidote)
    • Terbutaline (Adrenergic agonist)

    Prolapsed Umbilical Cord

    • Cord becomes compressed, restricting blood flow to the fetus
    • Time-sensitive situation requiring prompt intervention to save the baby
    • Mother should lie flat to combat gravity
    • Monitor fetal heart rate closely for bradycardia
    • If a loop is discovered, maintain firm pressure on it to relieve the pressure on the cord
    • Consider knee-chest position, Trendelenburg, and immediate cesarean delivery

    Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)

    • A small tear in the uterus (amnion or chorion) allows a small amount of amniotic fluid to leak into the maternal circulation
    • Symptoms include sudden respiratory distress, circulatory collapse, and acute hemorrhage
    • Treatment includes immediate delivery, life-saving measures, and CPR
    • DIC (Disseminated Intravascular Coagulation) is a potential complication associated with amniotic fluid embolism

    Perinatal Loss

    • Death of the fetus from conception until 28 days after birth
    • Intrauterine fetal demise (IUFD) - fetal death after 20 weeks, typically requires delivery (stillbirth)
    • Induce labor as needed
    • Support the family and provide counseling services
    • Special training for nurses to support families through mourning and cope with loss

    Postpartum Hemorrhage

    • Potentially life-threatening complication occurring after vaginal or cesarean delivery
    • Leading cause of maternal death
    • Defined as cumulative blood loss exceeding 1000 ml with signs of hypovolemia
    • Uterine atony (lack of uterine tone) is the most frequent cause

    Clinical Manifestations of Shock

    • 20% blood loss: mild shock, diaphoresis, anxiety, cold extremities, increased capillary refill time
    • 20-40% blood loss: moderate shock, tachycardia, postural hypotension, reduced urine output

    • 40% blood loss: severe shock, hemodynamic instability, hypotension, irritability/agitation/confusion

    Causes of Postpartum Hemorrhage

    • Tone: Uterine atony (lack of tone)
    • Tissue: Retained placental fragments
    • Trauma: Lacerations
    • Thrombin: Clotting factor deficiencies
    • Traction: Excessive pulling on the umbilical cord

    Nursing Management of Postpartum Hemorrhage

    • Assess fundal height, uterine tone, and bladder distension
    • Monitor pad counts and weigh saturated pads
    • Massage the uterus to control bleeding if it is "boggy"
    • Empty the bladder or catheterize
    • Maintain IV access
    • Assess for orthostatic hypotension
    • Administer uterotonics like Oxytocin, Misoprostol, Carboprost, or Methylergonovine

    Jada Technique

    • A new technique to prevent postpartum hemorrhage
    • Involves suctioning the uterus to control bleeding
    • Demonstrated high effectiveness so far

    Postpartum Infections

    • Endometritis: Uterine infection, more common after cesarean deliveries, occurs within 2-4 days
    • Surgical Site Infections: Infections at the surgical incision site
    • Urinary Tract Infections: Frequent vaginal exams and invasive manipulation of the urethra increase risk
    • Mastitis: Inflammation of the mammary glands
    • Risk factors for mastitis: milk stasis, inconsistent feeding, nipple breakdown, oversupply, rapid weaning
    • Symptoms include flu-like symptoms

    Thromboembolic Disease

    • Changes in maternal coagulation system lead to a hypercoagulable state and compression of the common iliac vein by the gravid uterus
    • Results in venous stasis
    • Risk factors: cesarean birth, immobility, obesity, varicose veins, family history
    • Signs/symptoms: Edema, tenderness, pain, palpable cord, changes in limb color
    • Treatment: Heparin or low-molecular-weight heparin (LMWH)

    Postpartum Affective Disorders

    • Postpartum Blues: Transient mood swings and emotional instability
    • Postpartum Depression (PPD): More serious mood disorder characterized by persistent low mood, anxiety, and difficulty functioning
    • Postpartum Psychosis: Most dangerous form, characterized by delusions, hallucinations, and impaired thought processes

    Postpartum Affective Disorder Management

    • Prioritize safety and education
    • Use the Edinburgh Postnatal Depression Scale to assess risk
    • Provide appropriate support, therapy, and medication as needed

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    This quiz covers key topics related to maternal health, focusing on pre-gestational diabetes, gestational diabetes, hypertension during pregnancy, and preeclampsia/eclampsia. Learn about the conditions' symptoms, diagnosis, and management strategies to support pregnant individuals effectively.

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