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Questions and Answers
A postpartum patient who delivered vaginally is experiencing excessive bleeding. After ruling out lacerations, which of the following is the MOST likely cause of early postpartum hemorrhage (PPH)?
A postpartum patient who delivered vaginally is experiencing excessive bleeding. After ruling out lacerations, which of the following is the MOST likely cause of early postpartum hemorrhage (PPH)?
- Coagulation disorders
- Retained placental fragments
- Hematoma formation
- Uterine atony (correct)
A patient with a history of multiple gestation and prolonged labor is at an increased risk for postpartum hemorrhage. Which intervention is MOST important for the nurse to implement initially?
A patient with a history of multiple gestation and prolonged labor is at an increased risk for postpartum hemorrhage. Which intervention is MOST important for the nurse to implement initially?
- Administering a bolus of intravenous fluids.
- Performing fundal massage. (correct)
- Preparing for a blood transfusion.
- Inserting a Foley catheter.
A postpartum patient is diagnosed with endometritis. Which assessment finding is MOST indicative of this condition?
A postpartum patient is diagnosed with endometritis. Which assessment finding is MOST indicative of this condition?
- Complaints of unilateral leg pain and swelling.
- Foul-smelling lochia and uterine tenderness. (correct)
- Localized redness and warmth at the episiotomy site.
- Sudden onset of chest pain and shortness of breath.
A postpartum patient develops mastitis while breastfeeding. What instruction should the nurse provide to MOST effectively manage this condition?
A postpartum patient develops mastitis while breastfeeding. What instruction should the nurse provide to MOST effectively manage this condition?
Which of the following assessment findings would lead the nurse to suspect a postpartum patient has developed a deep vein thrombosis (DVT)?
Which of the following assessment findings would lead the nurse to suspect a postpartum patient has developed a deep vein thrombosis (DVT)?
A postpartum patient reports feeling persistently sad, having difficulty sleeping, and experiencing a loss of interest in caring for her newborn. What condition is MOST likely affecting this patient?
A postpartum patient reports feeling persistently sad, having difficulty sleeping, and experiencing a loss of interest in caring for her newborn. What condition is MOST likely affecting this patient?
Which symptom is MOST indicative of the hyperthyroid phase of postpartum thyroiditis?
Which symptom is MOST indicative of the hyperthyroid phase of postpartum thyroiditis?
During the third stage of labor, a nurse notes the uterus suddenly inverting. What is the nurse's IMMEDIATE action?
During the third stage of labor, a nurse notes the uterus suddenly inverting. What is the nurse's IMMEDIATE action?
A postpartum patient suddenly develops respiratory distress, hypotension, and cyanosis. Which obstetric emergency is MOST likely occurring?
A postpartum patient suddenly develops respiratory distress, hypotension, and cyanosis. Which obstetric emergency is MOST likely occurring?
Following a cesarean section, a nurse observes that the patient’s abdominal incision has partially separated, with some drainage noted. Which intervention is the MOST appropriate initial action?
Following a cesarean section, a nurse observes that the patient’s abdominal incision has partially separated, with some drainage noted. Which intervention is the MOST appropriate initial action?
A postpartum patient is experiencing severe vulvar pain and significant swelling after an operative vaginal delivery. Which complication is MOST likely occurring?
A postpartum patient is experiencing severe vulvar pain and significant swelling after an operative vaginal delivery. Which complication is MOST likely occurring?
Which of the following uterotonic medications is contraindicated in a postpartum patient with hypertension?
Which of the following uterotonic medications is contraindicated in a postpartum patient with hypertension?
A postpartum patient with a history of preeclampsia is at increased risk for thromboembolic disorders. Besides early ambulation, which intervention is MOST appropriate for preventing deep vein thrombosis (DVT)?
A postpartum patient with a history of preeclampsia is at increased risk for thromboembolic disorders. Besides early ambulation, which intervention is MOST appropriate for preventing deep vein thrombosis (DVT)?
A postpartum patient is diagnosed with postpartum psychosis. Which symptom requires IMMEDIATE intervention to ensure the safety of the patient and her newborn?
A postpartum patient is diagnosed with postpartum psychosis. Which symptom requires IMMEDIATE intervention to ensure the safety of the patient and her newborn?
During assessment, a nurse notes a visible mass protruding from the vagina of a postpartum patient, accompanied by severe abdominal pain and hemorrhage. Which condition is MOST likely occurring?
During assessment, a nurse notes a visible mass protruding from the vagina of a postpartum patient, accompanied by severe abdominal pain and hemorrhage. Which condition is MOST likely occurring?
A nurse is caring for a postpartum patient who is receiving heparin therapy for a deep vein thrombosis (DVT). Which laboratory value is MOST important to monitor to ensure the therapeutic effectiveness and safety of heparin?
A nurse is caring for a postpartum patient who is receiving heparin therapy for a deep vein thrombosis (DVT). Which laboratory value is MOST important to monitor to ensure the therapeutic effectiveness and safety of heparin?
Which of the following findings would MOST strongly suggest that a postpartum patient is developing endometritis rather than normal postpartum uterine changes?
Which of the following findings would MOST strongly suggest that a postpartum patient is developing endometritis rather than normal postpartum uterine changes?
A patient who had a cesarean section is being discharged. Which instruction regarding wound care is MOST important for the nurse to emphasize to prevent wound dehiscence?
A patient who had a cesarean section is being discharged. Which instruction regarding wound care is MOST important for the nurse to emphasize to prevent wound dehiscence?
A postpartum patient reports feeling overwhelmed, tearful, and anxious in the first few days after delivery. She is still able to care for herself and her baby. What is the MOST likely cause of her symptoms?
A postpartum patient reports feeling overwhelmed, tearful, and anxious in the first few days after delivery. She is still able to care for herself and her baby. What is the MOST likely cause of her symptoms?
A postpartum patient is receiving warfarin for a pulmonary embolism (PE). Which laboratory value should the nurse monitor to evaluate the effectiveness of warfarin?
A postpartum patient is receiving warfarin for a pulmonary embolism (PE). Which laboratory value should the nurse monitor to evaluate the effectiveness of warfarin?
A new mother with postpartum depression (PPD) expresses feelings of hopelessness and worthlessness, and admits to having thoughts of harming herself. What is the nurse's MOST appropriate initial action?
A new mother with postpartum depression (PPD) expresses feelings of hopelessness and worthlessness, and admits to having thoughts of harming herself. What is the nurse's MOST appropriate initial action?
During a home visit, a postpartum patient reports severe, localized breast pain, swelling, and redness, along with flu-like symptoms. What is the MOST likely cause of these symptoms?
During a home visit, a postpartum patient reports severe, localized breast pain, swelling, and redness, along with flu-like symptoms. What is the MOST likely cause of these symptoms?
A nurse is caring for a postpartum patient who experienced uterine inversion during delivery. After the uterus is manually replaced, which medication is MOST important to administer?
A nurse is caring for a postpartum patient who experienced uterine inversion during delivery. After the uterus is manually replaced, which medication is MOST important to administer?
A postpartum patient who is breastfeeding reports experiencing painful contractions while nursing. What is the physiologic explanation for these contractions?
A postpartum patient who is breastfeeding reports experiencing painful contractions while nursing. What is the physiologic explanation for these contractions?
A postpartum patient with a history of obesity undergoes a cesarean section. On the third postpartum day, the nurse observes serosanguineous drainage from the incision site and notes that the wound edges are partially separated. What is the MOST appropriate action?
A postpartum patient with a history of obesity undergoes a cesarean section. On the third postpartum day, the nurse observes serosanguineous drainage from the incision site and notes that the wound edges are partially separated. What is the MOST appropriate action?
A postpartum patient is being treated for postpartum hemorrhage with multiple uterotonic medications. Which assessment finding would warrant the nurse to withhold methylergonovine?
A postpartum patient is being treated for postpartum hemorrhage with multiple uterotonic medications. Which assessment finding would warrant the nurse to withhold methylergonovine?
A nurse is providing discharge teaching to a postpartum patient who developed a deep vein thrombosis (DVT). Besides medication instructions, which lifestyle modification is MOST important to emphasize?
A nurse is providing discharge teaching to a postpartum patient who developed a deep vein thrombosis (DVT). Besides medication instructions, which lifestyle modification is MOST important to emphasize?
A postpartum patient is experiencing symptoms of postpartum psychosis. Which intervention is MOST critical to ensure the safety of the newborn?
A postpartum patient is experiencing symptoms of postpartum psychosis. Which intervention is MOST critical to ensure the safety of the newborn?
A nurse is assessing a postpartum patient who reports persistent fatigue, constipation, and unexplained weight gain. Which condition should the nurse suspect?
A nurse is assessing a postpartum patient who reports persistent fatigue, constipation, and unexplained weight gain. Which condition should the nurse suspect?
During assessment of a postpartum patient, the nurse notes a boggy uterus that is not responding to fundal massage and observes a steady trickle of blood. What is the priority nursing intervention?
During assessment of a postpartum patient, the nurse notes a boggy uterus that is not responding to fundal massage and observes a steady trickle of blood. What is the priority nursing intervention?
A postpartum patient reports experiencing intense perineal pain and pressure after a prolonged second stage of labor. Upon assessment, the nurse notes a bulging, discolored area on the perineum. What is the MOST likely cause of the patient's discomfort?
A postpartum patient reports experiencing intense perineal pain and pressure after a prolonged second stage of labor. Upon assessment, the nurse notes a bulging, discolored area on the perineum. What is the MOST likely cause of the patient's discomfort?
A postpartum patient suddenly complains of chest pain and shortness of breath. The nurse suspects a pulmonary embolism (PE). What is the INITIAL nursing action?
A postpartum patient suddenly complains of chest pain and shortness of breath. The nurse suspects a pulmonary embolism (PE). What is the INITIAL nursing action?
A postpartum patient expresses concern about the changes in her body after childbirth. She states, “I don’t feel like myself anymore.” What is the MOST appropriate nursing response?
A postpartum patient expresses concern about the changes in her body after childbirth. She states, “I don’t feel like myself anymore.” What is the MOST appropriate nursing response?
A postpartum patient is diagnosed with mastitis and is prescribed antibiotics. What additional instruction should the nurse provide to promote comfort and healing?
A postpartum patient is diagnosed with mastitis and is prescribed antibiotics. What additional instruction should the nurse provide to promote comfort and healing?
A multigravida postpartum patient is being treated for uterine atony with oxytocin. The nurse observes that the patient's uterus remains boggy, and heavy lochia is present. What is the next appropriate intervention?
A multigravida postpartum patient is being treated for uterine atony with oxytocin. The nurse observes that the patient's uterus remains boggy, and heavy lochia is present. What is the next appropriate intervention?
A postpartum patient who underwent a cesarean section develops a fever, abdominal pain, and purulent drainage from the incision site on the fourth postpartum day. Which condition is MOST likely causing these symptoms?
A postpartum patient who underwent a cesarean section develops a fever, abdominal pain, and purulent drainage from the incision site on the fourth postpartum day. Which condition is MOST likely causing these symptoms?
A postpartum patient is experiencing postpartum blues. Which nursing intervention is MOST appropriate?
A postpartum patient is experiencing postpartum blues. Which nursing intervention is MOST appropriate?
A postpartum patient with a history of intravenous drug use develops a fever, chills, and pelvic pain. Which condition should the nurse suspect?
A postpartum patient with a history of intravenous drug use develops a fever, chills, and pelvic pain. Which condition should the nurse suspect?
Flashcards
Postpartum Complications
Postpartum Complications
Physical and psychological issues after childbirth.
Postpartum Hemorrhage (PPH)
Postpartum Hemorrhage (PPH)
Blood loss >500 mL after vaginal birth or >1000 mL post-cesarean.
Uterine Atony
Uterine Atony
Failure of uterus to contract adequately after delivery; most frequent cause of PPH.
Risk factors for uterine atony
Risk factors for uterine atony
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PPH Assessment
PPH Assessment
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PPH Interventions
PPH Interventions
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Postpartum Infections
Postpartum Infections
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Endometritis
Endometritis
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Risk factors for endometritis
Risk factors for endometritis
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Postpartum Infection Assessment
Postpartum Infection Assessment
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Postpartum Infection Interventions
Postpartum Infection Interventions
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Mastitis
Mastitis
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Postpartum Infection Prevention
Postpartum Infection Prevention
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Virchow's Triad
Virchow's Triad
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Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis (DVT)
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Pulmonary Embolism (PE)
Pulmonary Embolism (PE)
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Thromboembolic Disorder Interventions
Thromboembolic Disorder Interventions
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Thromboembolic Disorder Prevention
Thromboembolic Disorder Prevention
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Postpartum Blues
Postpartum Blues
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Postpartum Depression (PPD)
Postpartum Depression (PPD)
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Postpartum Psychosis
Postpartum Psychosis
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Risk factors for postpartum psychiatric disorders
Risk factors for postpartum psychiatric disorders
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Postpartum Psychiatric Disorder Interventions
Postpartum Psychiatric Disorder Interventions
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Postpartum Thyroiditis
Postpartum Thyroiditis
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Hyperthyroidism Symptoms
Hyperthyroidism Symptoms
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Hypothyroidism Symptoms
Hypothyroidism Symptoms
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Postpartum Thyroiditis Assessment
Postpartum Thyroiditis Assessment
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Uterine Inversion
Uterine Inversion
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Uterine Inversion Symptoms
Uterine Inversion Symptoms
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Uterine Inversion Interventions
Uterine Inversion Interventions
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Amniotic Fluid Embolism (AFE)
Amniotic Fluid Embolism (AFE)
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Amniotic Fluid Embolism (AFE) Symptoms
Amniotic Fluid Embolism (AFE) Symptoms
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Amniotic Fluid Embolism (AFE) Interventions
Amniotic Fluid Embolism (AFE) Interventions
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Wound Dehiscence
Wound Dehiscence
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Wound Evisceration
Wound Evisceration
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Wound Dehiscence/Evisceration Interventions
Wound Dehiscence/Evisceration Interventions
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Hematomas
Hematomas
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Hematoma Symptoms
Hematoma Symptoms
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Large Hematoma Intervention
Large Hematoma Intervention
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Study Notes
- Postpartum complications encompass a range of physical and psychological issues that can arise after childbirth, impacting the mother's health and well-being.
Postpartum Hemorrhage (PPH)
- PPH is defined as blood loss of more than 500 mL after vaginal birth or more than 1000 mL after cesarean birth.
- Early PPH occurs within the first 24 hours postpartum with late PPH occurring from 24 hours up to 12 weeks postpartum.
- Uterine atony, lacerations, retained placental fragments, and coagulation disorders are common causes.
- Uterine atony, or failure of the uterus to contract adequately after delivery, is the most frequent cause.
- Risk factors for uterine atony include multiple gestation, polyhydramnios, high parity, prolonged or precipitous labor, use of oxytocin during labor, and history of uterine atony.
- Lacerations of the genital tract, including the cervix, vagina, and perineum, can cause significant bleeding.
- Retained placental fragments prevent the uterus from contracting fully.
- Coagulation disorders such as von Willebrand disease and disseminated intravascular coagulation (DIC) interfere with the body's ability to form clots.
- Assessment involves monitoring vital signs, assessing the fundus for firmness and location, and observing the amount and character of lochia.
- Interventions include fundal massage to stimulate uterine contraction, administration of uterotonic medications (oxytocin, misoprostol, methylergonovine, carboprost), and assessment for the source of bleeding.
- In cases of persistent bleeding, interventions such as manual removal of placental fragments, uterine packing, balloon tamponade, or surgical intervention (uterine artery embolization, ligation, or hysterectomy) may be necessary.
Postpartum Infections
- Postpartum infections, also known as puerperal infections, are infections of the reproductive tract that occur within 28 days after childbirth or abortion.
- Common types of postpartum infections include endometritis, wound infections, urinary tract infections (UTIs), and mastitis.
- Endometritis is an infection of the uterine lining, often caused by bacteria ascending from the vagina into the uterus.
- Risk factors for endometritis include cesarean birth, prolonged labor, prolonged rupture of membranes, multiple vaginal examinations during labor, and manual removal of the placenta.
- Wound infections can occur at the site of episiotomy, laceration repair, or cesarean incision.
- UTIs are common postpartum due to urinary stasis and catheterization during labor.
- Mastitis is an infection of the breast tissue, usually caused by bacteria entering through cracked nipples.
- Assessment involves monitoring vital signs, assessing the uterus for tenderness, observing lochia for foul odor or purulence, and assessing wound sites for signs of infection (redness, swelling, drainage).
- Interventions include administration of antibiotics, wound care, pain management, and promotion of breastfeeding (in the case of mastitis).
- Prevention strategies include good hygiene practices, proper perineal care, and early ambulation.
Thromboembolic Disorders
- Thromboembolic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are potential complications during the postpartum period due to hypercoagulability.
- Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) contributes to the increased risk of thromboembolism.
- Risk factors include cesarean birth, obesity, immobility, history of thromboembolism, and preeclampsia.
- DVT typically presents with unilateral leg pain, swelling, warmth, and redness.
- PE occurs when a blood clot travels to the lungs, causing symptoms such as sudden onset of shortness of breath, chest pain, cough, and hemoptysis.
- Assessment involves assessing for signs and symptoms of DVT and PE, as well as risk factors.
- Diagnostic tests may include Doppler ultrasound, computed tomography angiography (CTA), and ventilation-perfusion (V/Q) scan.
- Interventions include anticoagulation therapy (heparin, enoxaparin, warfarin), bed rest, elevation of the affected extremity, and monitoring for signs of bleeding.
- Prevention strategies include early ambulation, use of compression stockings, and prophylactic anticoagulation in high-risk women.
Postpartum Psychiatric Disorders
- Postpartum psychiatric disorders include postpartum blues, postpartum depression (PPD), and postpartum psychosis.
- Postpartum blues are a transient period of mild depressive symptoms that occur in the first few weeks postpartum.
- Symptoms of postpartum blues include mood swings, irritability, tearfulness, anxiety, and difficulty concentrating.
- PPD is a more severe and persistent form of depression that can develop within the first year postpartum.
- Symptoms of PPD include persistent sadness, loss of interest in activities, changes in appetite and sleep, fatigue, feelings of guilt or worthlessness, and thoughts of harming oneself or the baby.
- Postpartum psychosis is a rare but serious psychiatric emergency characterized by hallucinations, delusions, disorganized thinking, and bizarre behavior.
- Risk factors for postpartum psychiatric disorders include history of mental illness, stressful life events, lack of social support, and hormonal changes.
- Assessment involves screening for symptoms of depression and psychosis using standardized tools such as the Edinburgh Postnatal Depression Scale (EPDS).
- Interventions include psychotherapy, medication (antidepressants, antipsychotics), and hospitalization (in severe cases).
- Support groups, counseling, and education can help women and their families cope with postpartum psychiatric disorders.
Postpartum Thyroiditis
- Postpartum thyroiditis is an inflammatory disorder of the thyroid gland that can occur within the first year postpartum.
- It typically presents with transient hyperthyroidism followed by hypothyroidism.
- Symptoms of hyperthyroidism include anxiety, irritability, palpitations, weight loss, and fatigue.
- Symptoms of hypothyroidism include fatigue, constipation, dry skin, weight gain, and depression.
- Assessment involves monitoring thyroid function tests (TSH, T4, T3) and assessing for symptoms of hyperthyroidism and hypothyroidism.
- Treatment may include beta-blockers for symptomatic relief during the hyperthyroid phase and thyroid hormone replacement therapy during the hypothyroid phase.
- Most women with postpartum thyroiditis recover normal thyroid function within 12-18 months.
Uterine Inversion
- Uterine inversion is a rare but life-threatening obstetric emergency in which the uterus turns inside out, usually during the third stage of labor.
- Risk factors include uterine atony, excessive traction on the umbilical cord, and fundal pressure.
- Symptoms include sudden onset of severe abdominal pain, hemorrhage, shock, and visible mass protruding from the vagina.
- Assessment involves recognizing the signs and symptoms of uterine inversion and prompt intervention.
- Interventions include manual replacement of the uterus, administration of uterotonic medications, fluid resuscitation, and blood transfusion.
- In some cases, surgical intervention may be necessary to reposition the uterus.
Amniotic Fluid Embolism (AFE)
- Amniotic fluid embolism (AFE) is a rare and unpredictable obstetric emergency in which amniotic fluid, fetal cells, and other debris enter the maternal circulation, causing a massive inflammatory response and cardiovascular collapse.
- Risk factors are difficult to predict, but include advanced maternal age, multiparity, tumultuous labor, and placental abnormalities.
- Symptoms include sudden onset of respiratory distress, cyanosis, hypotension, cardiac arrest, and coagulopathy.
- Assessment involves recognizing the signs and symptoms of AFE and initiating immediate resuscitation measures.
- Interventions include cardiopulmonary resuscitation (CPR), oxygen therapy, intravenous fluids, blood products, and vasopressors.
- Despite aggressive treatment, AFE has a high mortality rate.
Postpartum Wound Dehiscence/Evisceration
- Wound dehiscence is the partial or complete separation of wound edges, while evisceration is the protrusion of internal organs through the separated wound.
- Risk factors include infection, obesity, malnutrition, and poor wound closure technique.
- Assessment involves inspecting the wound for signs of dehiscence or evisceration, such as drainage, redness, swelling, and separation of wound edges.
- Interventions include covering the wound with sterile saline-soaked gauze, notifying the physician, and preparing for surgical repair.
Hematomas
- Hematomas are collections of blood in the soft tissues, which can occur in the vulva, vagina, or retroperitoneal space after delivery.
- Risk factors include operative vaginal delivery, episiotomy, and prolonged labor.
- Assessment involves assessing for pain, swelling, and discoloration in the affected area.
- Small hematomas may resolve spontaneously, while larger hematomas may require incision and drainage.
- Pain management and monitoring for signs of infection are important aspects of care.
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