Postoartum Disorders

Key Complications

• Deep-Vein Thrombosis (DVT): Thrombus formation in deep veins, especially in the legs, potentially leading to pulmonary embolism.
• Pulmonary Embolism (PE): A clot from a DVT traveling to the lungs, blocking blood flow and causing respiratory distress.
• Coagulopathies: Disorders affecting blood clotting, including ITP and DIC, leading to abnormal bleeding or clotting.
• Postpartum Hemorrhage: Significant blood loss after childbirth, requiring immediate intervention (caused by uterine atony, failure of the uterus to contract effectively).
• Uterine Atony: Failure of the uterus to contract effectively, increasing risk of postpartum hemorrhage.

Key Assessment Techniques

• Physical assessment: Monitor for signs of DVT (leg pain, swelling, warmth) and postpartum hemorrhage (uterine tone, lochia).
• Diagnostic procedures: Use Doppler ultrasound for DVT and complete blood count (CBC) for coagulopathy assessment.
• Vital signs monitoring: Regularly check for tachycardia and hypotension, indicators of hemorrhage or shock.

Key Risk Factors

• Deep-Vein Thrombosis (DVT): Pregnancy, cesarean birth, immobility, obesity, smoking, age over 35, history of thromboembolism.
• Postpartum Hemorrhage: Uterine atony, overdistended uterus, prolonged labor, high parity, retained placental fragments, genetic factors (ITP), abruptio placentae, severe preeclampsia, infection, and hemorrhage.

Facts to Memorize

• Postpartum hemorrhage: Defined as losing more than 500 mL blood after vaginal birth or more than 1,000 mL after cesarean birth.
• Heparin antidote: Protamine sulfate.
• Warfarin antidote: Phytonadione.
• Normal aPTT range: 30 to 40 seconds (therapeutic range for DVT: 1.5 to 2.5 times the control level).
• Normal PT range: 11 to 13.5 seconds (therapeutic range for warfarin: INR 2.0 to 3.0).

Reference Information

• Risk factors for DVT: Pregnancy, cesarean birth, immobility, obesity, smoking, and age over 35
• Common medications for postpartum hemorrhage: Oxytocin, Methylergonovine, Misoprostol, and Carboprost tromethamine.

Concept Comparisons

• Deep Vein Thrombosis: A thrombus associated with inflammation, primarily in the deep veins.

Cause and Effect

• Uterine Atony: Leads to postpartum hemorrhage due to inadequate uterine contractions.
• Retained placental fragments: Can cause subinvolution of the uterus and prolonged bleeding, increasing the risk of hemorrhage.
• Coagulopathies: Increase risk of both simultaneous clotting and bleeding, leading to hemorrhage.

Key Terms/Concepts

• Postpartum Disorders: Unexpected events or occurrences during the postpartum period requiring nursing intervention.
• Deep-Vein Thrombosis (DVT): A thrombus associated with inflammation, primarily occurring in the lower extremities.
• Pulmonary Embolism: A clot dislodges and obstructs blood flow to the lungs, a complication of DVT.
• Coagulopathies: Disorders affecting blood coagulation (including ITP and DIC).
• Postpartum Hemorrhage: Excessive bleeding after childbirth (defined as more than 500 mL after vaginal birth or more than 1000 mL after cesarean birth).