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Questions and Answers
What is the primary cause of postpartum hemorrhage after vaginal delivery or C-section?
Which clinical manifestation indicates severe shock due to blood loss after delivery?
What immediate action is required when a patient presents with symptoms of amniotic fluid embolism syndrome?
Which factor is NOT associated with an increased risk of thromboembolic disease postpartum?
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What are the common symptoms of postpartum infections that typically occur within 2-4 days after delivery?
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What nursing interventions should be prioritized when managing postpartum hemorrhage?
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What characterizes Gestational Diabetes?
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Which factor is a significant risk for developing preeclampsia?
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What is a common symptom of severe preeclampsia?
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Which of the following hypertensive medications is indicated for managing hypertension in pregnancy?
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What does the acronym HELLP syndrome stand for?
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In the context of Iron Deficiency Anemia during pregnancy, which symptom is most concerning?
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What is a defining parameter for diagnosing gestational hypertension?
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Which intervention is NOT typically recommended for mild preeclampsia management?
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Which of the following interventions is used for the treatment of severe preeclampsia?
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Which condition is characterized by painless dilation of the cervix without contractions?
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What is the immediate management strategy for severe abruptio placentae?
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What is the primary risk associated with polyhydramnios in a pregnant woman?
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How is severe hyperemesis gravidarum classified?
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What signifies a complete placenta previa?
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What primary fetal complication arises from oligohydramnios?
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Which term describes spontaneous rupture of membranes before the onset of labor?
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What is the main reason for using corticosteroids early in cases of preterm labor?
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Which complication is associated with shoulder dystocia during delivery?
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What is the potential fetal risk associated with post-term pregnancy?
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What are the symptoms of Anaphylactoid Syndrome of Pregnancy?
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Which of the following is a primary symptom of severe postpartum hemorrhage?
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What is the appropriate nursing management intervention for a patient with boggy uterine tone?
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Which complication results from a small tear in the uterus in pregnancy?
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What is the recommended treatment for respiratory distress due to Anaphylactoid Syndrome of Pregnancy?
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What condition is characterized by blood loss exceeding 1000 ml following delivery?
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What is a primary maternal implication of abruptio placentae?
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What immediate intervention is needed for a fetus with a prolapsed umbilical cord?
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Which statement describes the characteristic feature of placenta previa?
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What combination of clinical signs is characteristic of hyperemesis gravidarum?
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Which medication is classified as a uterine relaxant to prevent preterm labor?
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What is a potential fetal consequence of oligohydramnios?
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Which management strategy is important for a woman experiencing prelabor rupture of membranes (PPROM)?
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Which complication frequently arises in multiple gestations during pregnancy?
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What is the expected fundal height in a pregnancy with multiple gestations?
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What is a common symptom of preterm labor?
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What is the primary difference between pre-gestational diabetes and gestational diabetes?
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Which of the following is NOT a symptom of severe preeclampsia?
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In managing preeclampsia, which intervention is considered appropriate for mild symptoms?
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What does the acronym HELLP syndrome refer to in the context of preeclampsia?
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When is gestational diabetes typically diagnosed during pregnancy?
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Which factor is commonly associated with reduced blood flow in preeclampsia?
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What is a significant risk associated with iron deficiency anemia during pregnancy?
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What is the recommended position for a mother experiencing gestational hypertension?
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Which of the following symptoms best represents the late-stage complications of preeclampsia?
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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).
Signs of Shock (related to blood loss):
- 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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Description
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.
