Postpartum Complications Quiz

Postpartum Complications

• Postpartum Hemorrhage (PPH) is a leading cause of maternal mortality.
• Blood loss varies between vaginal and Cesarean births.
  • Normal vaginal blood loss is 500mL.
  • Normal Cesarean blood loss is 1000mL.
• Primary hemorrhage: Occurs within the first 24 hours.
• Secondary hemorrhage: Occurs after 24 hours and up to 6 weeks postpartum.
• Risk factors for PPH:
  • Subinvolution (failure of the uterus to return to its normal size and shape).
  • Retained placenta
  • Problems during the second stage of labor (e.g., failure to progress).
  • Placenta accreta (placenta attaches too deeply to the uterine wall).
  • Lacerations (tears in the cervix, vagina, or perineum).
  • Large for gestational age (LGA) newborns.
  • Instrumental delivery (e.g., forceps).
  • Hypertension.
  • Induced labor.
  • Oxytocin augmentation.
  • Uterine overdistention/overstretching.
  • BMI over 40.
• Mnemonic for the 4 T's of hemorrhage:
  • Tone (uterine atony): Most common cause; uterine muscles fail to contract after delivery of the placenta; hypovolemic shock.
  • Tissue (retained placenta/products of conception): Common cause of late PPH (postpartum hemorrhage).
  • Trauma (lacerations): Forceps delivery or other trauma can cause tears and bleeding.
  • Thrombosis (coagulation disorders/platelet disorders): Fibrin not creating clots properly can lead to excessive bleeding.

Signs and Symptoms of PPH

• Heavy vaginal bleeding (including trickling or oozing).
• Passing clots larger than a quarter.
• Return of lochia rubra (dark red vaginal discharge).
• Cool, clammy, pale skin.
• Tachycardia (rapid heart rate) and decreased blood pressure (late sign due to substantial loss of blood).

Nursing Care for PPH

• Collaborative care from the healthcare team.
• Identify excessive bleeding.
• Notify rapid response team.

Uterine Infection (Endometritis)

• Risk Factors:
  • Prolonged labor.
  • Rupture of membranes.
  • Cesarean delivery.
  • Frequent vaginal infections.
• Organisms: E. coli, Klebsiella, Proteus, Enterobacter.
• Signs and symptoms:
  • Temperature at or above 100.4F for 2+ days.
  • Foul-smelling lochia.
  • Lower abdominal tenderness.

Care of Women With a Hematoma

• Hematoma is a collection of blood outside a blood vessel.
• Common locations: vaginal wall, vulvar area.
• Risk factors: episiotomy, lacerations, instrumental delivery, nulliparity, prolonged/difficult second stage of labor.
• Symptoms: Constant pain, pressure, discoloration, bulging tissue, tenderness, feeling of needing to defecate, urinary incontinence.
• Medical Management: Observation, ice packs (for hematomas less than 3-5cm), Sitz baths, pain management.
• Nursing Care: Monitor for signs of infection and pain.

Management of Postpartum Complications

• Fundal massage: Supporting the lower uterine segment to contract.
• Vital signs assessment: Continuously assessing maternal status.
• IV fluids and blood products: To address blood loss.
• Oxygen monitoring.
• Elevated legs: Promoting blood return to the heart.
• Assess the bladder and ensure adequate output.

Postpartum Thromboembolic Disease

• Thromboembolism: Inflammation and clotting of blood vessels.
• Risk factors: Obesity, venous stasis, hypercoagulable blood, injury to the endothelial surface of blood vessels.
• Signs and Symptoms: Swelling, pain, tenderness, erythema, stiffness, or pain on ambulation, large cordlike vein.
• Diagnosis: Doppler ultrasound, MRI.
• Medical Management: IV heparin therapy or low-molecular weight heparin (lovenox), TED hose, bed rest, and analgesics.

Postpartum Depression

• Signs and Symptoms: Intense sadness with crying, feeling overwhelmed, feelings of guilt/inadequacy, ambivalence, lack of motivation for self-care or infant care, anhedonia (lack of pleasure), appetite disturbances, insomnia, fatigue, thoughts of hurting self or baby.
• High-risk factors: History of depression, lack of social support, stressful life events, unintended pregnancy, financial factors.
• Medical Management: Counseling, antidepressant medications.
• Nursing Care: Monitor for symptoms of suicidal thoughts or harming a baby, encourage antidepressant compliance, encourage follow-up appointments, provide encouragement and support to mother.

Postpartum Psychiatric Disorder/ Postpartum Psychosis

• Signs and symptoms: Rapidly shifting moods, delusions, hallucinations, incoherent speech, rapid/unstable mood changes.
• Risk factors: History of bipolar disorder, previous postpartum psychosis episode.
• Medical Management: Arrange admission to Psychiatric Facility
• Nursing Care: Immediate reporting, reorienting the patient. Provide safety. Organize for admission to psychiatric facility. Provide emotional support.