Postpartum Complications and Hemorrhage (PPH)

• Postpartum complications encompass a range of physical and psychological conditions that can arise following childbirth, impacting the mother's health and well-being

Postpartum Hemorrhage (PPH)

• PPH is defined as excessive bleeding after childbirth, typically more than 500 mL following a vaginal birth or more than 1000 mL after a cesarean birth
• Primary PPH occurs within the first 24 hours after delivery, while secondary PPH occurs from 24 hours up to 12 weeks postpartum
• Uterine atony, where the uterus fails to contract adequately after delivery, is the most common cause of PPH
• Other causes include retained placental fragments, lacerations of the genital tract, and coagulation disorders
• Risk factors for PPH include multiple gestations, polyhydramnios, prior history of PPH, prolonged labor, use of oxytocin for induction or augmentation of labor, and operative delivery
• Signs and symptoms of PPH include excessive vaginal bleeding, a boggy (soft) uterus, tachycardia, hypotension, pallor, and decreased urine output
• Management of PPH involves fundal massage to stimulate uterine contraction
• Medications such as oxytocin, misoprostol, methylergonovine, and carboprost may be administered to promote uterine contraction
• In cases of PPH unresponsive to medications, interventions such as uterine tamponade, uterine artery embolization, or hysterectomy may be necessary
• Nursing interventions for PPH include monitoring vital signs, assessing the amount of vaginal bleeding, administering medications as prescribed, providing emotional support, and ensuring adequate hydration

Postpartum Infections

• Postpartum infections, also known as puerperal infections, are infections that occur in the genital tract within 28 days after childbirth or abortion
• Endometritis, an infection of the uterine lining, is the most common postpartum infection
• Other postpartum infections include wound infections (e.g., cesarean incision or episiotomy), urinary tract infections (UTIs), and mastitis (breast infection)
• Risk factors for postpartum infections include cesarean delivery, prolonged labor, premature rupture of membranes, multiple vaginal examinations during labor, and presence of bacterial vaginosis
• Signs and symptoms of endometritis include fever, chills, abdominal pain, uterine tenderness, and foul-smelling lochia (postpartum vaginal discharge)
• Wound infections may present with redness, swelling, pain, drainage, and fever
• UTIs may cause dysuria (painful urination), urinary frequency, urgency, and suprapubic pain
• Mastitis typically manifests as breast pain, redness, warmth, swelling, and flu-like symptoms
• Treatment of postpartum infections usually involves antibiotic therapy
• Wound infections may require drainage and debridement
• Nursing interventions for postpartum infections include monitoring vital signs, assessing wound appearance, administering antibiotics as prescribed, providing perineal care, promoting comfort, and educating the patient on infection prevention

Thromboembolic Disorders

• Thromboembolic disorders, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), are potential complications in the postpartum period due to increased clotting factors and venous stasis
• Risk factors for thromboembolic disorders include cesarean delivery, obesity, immobility, history of thromboembolism, and inherited thrombophilias
• Signs and symptoms of DVT include pain, swelling, redness, and warmth in the affected leg
• PE may present with sudden onset of dyspnea (shortness of breath), chest pain, cough, and hemoptysis (coughing up blood)
• Diagnosis of DVT is typically made by ultrasound, while PE is diagnosed by CT angiography or ventilation-perfusion scan
• Treatment of thromboembolic disorders involves anticoagulation therapy with heparin or low-molecular-weight heparin (LMWH), followed by oral anticoagulants such as warfarin
• Nursing interventions include assessing for signs and symptoms of DVT and PE, administering anticoagulants as prescribed, monitoring coagulation studies, providing education on anticoagulant therapy, and promoting ambulation and leg exercises

Postpartum Psychiatric Disorders

• Postpartum psychiatric disorders encompass a range of mood and anxiety disorders that can occur following childbirth, including postpartum blues, postpartum depression (PPD), and postpartum psychosis
• Postpartum blues, characterized by mild mood swings, tearfulness, anxiety, and irritability, typically resolve within a few weeks after delivery
• PPD is a more severe and persistent mood disorder that can interfere with a woman's ability to care for herself and her baby
• Postpartum psychosis is a rare but serious psychiatric emergency characterized by delusions, hallucinations, disorganized thinking, and bizarre behavior
• Risk factors for postpartum psychiatric disorders include a history of mental illness, stressful life events, lack of social support, and hormonal fluctuations
• Symptoms of PPD may include persistent sadness, loss of interest in activities, changes in appetite and sleep, fatigue, difficulty bonding with the baby, and thoughts of self-harm or harming the baby
• Postpartum psychosis may present with rapid mood swings, confusion, paranoia, delusions, and hallucinations
• Treatment of PPD typically involves psychotherapy, antidepressant medications, or a combination of both
• Postpartum psychosis requires immediate psychiatric hospitalization and treatment with antipsychotic medications and mood stabilizers
• Nursing interventions include screening for postpartum psychiatric disorders, providing emotional support, educating the patient and family about the disorders, and facilitating referrals to mental health professionals

Postpartum Thyroiditis

• Postpartum thyroiditis is an inflammation of the thyroid gland that can occur within the first year after childbirth
• It typically presents in two phases: an initial hyperthyroid phase followed by a hypothyroid phase
• During the hyperthyroid phase, symptoms may include anxiety, irritability, palpitations, weight loss, and fatigue
• In the hypothyroid phase, symptoms may include fatigue, weight gain, constipation, dry skin, and depression
• Diagnosis is made based on thyroid function tests (TSH, T4, T3) and thyroid antibody levels
• Treatment may involve beta-blockers to manage hyperthyroid symptoms, thyroid hormone replacement therapy for hypothyroidism, or observation in mild cases
• Nursing interventions include monitoring thyroid function tests, educating the patient about the condition, and providing support and reassurance

Other Postpartum Concerns

• Perineal pain and discomfort are common after vaginal delivery, especially if an episiotomy or laceration occurred
• Hemorrhoids are swollen veins in the rectum or anus that can cause pain, itching, and bleeding
• Constipation is a frequent complaint in the postpartum period due to hormonal changes, decreased activity, and medication use
• Urinary incontinence, or involuntary leakage of urine, can occur due to weakened pelvic floor muscles
• Diastasis recti is a separation of the abdominal muscles that can occur during pregnancy and may persist postpartum
• Nursing interventions for these concerns include providing pain relief measures, promoting perineal hygiene, encouraging fluid intake and fiber consumption, teaching pelvic floor exercises (Kegel exercises), and providing education and support