Postpartum Complications PDF

Nursing Management of Postpartum complications Maternal and Newborn Health Nursing Department outline 1- Postpartum Hemorrhage 2- Postpartum infection 3- DVT 4- Breast problems (mastitis, abscess)  1- Postpartum Hemorrhage Introduction  Postpartum hemorrhage (PPH) is one...

Nursing Management of Postpartum complications Maternal and Newborn Health Nursing Department outline 1- Postpartum Hemorrhage 2- Postpartum infection 3- DVT 4- Breast problems (mastitis, abscess)  1- Postpartum Hemorrhage Introduction  Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality in Egypt, the percent distribution of maternal death by postpartum hemorrhage is 19.7% (Ministry of health and population, 2013).  Uterine atony accounts for 70% of all postpartum hemorrhage  1- Postpartum Hemorrhage Definition It is defined as the loss of more than 500ml of blood following vaginal delivery or more than 1000 ml following cesarean delivery, or results in signs or symptoms of hemodynamic instability.  Types of PPH Early or Primary PPH : Which occurs within 24 hours of delivery. Late or secondary PPH : Which occurs after 24 hours to 6 weeks  Common causes of PPH in each Type 1. Early  Atony  Trauma & laceration to birth canal  Hematoma  Inversion of the Uterus  Placenta Accreta 2. Late  Sub involution  Infection  Retained tissue  PPH predisposing factors  Prolonged labor = tired uterus Retained products of conception- uterus unable to fully contract unless empty  Multiparity- muscle tissue gradually becomes fibrous and therefore cannot contract  Multiple pregnancy: larger placental site & overstretched uterine muscle= reduced contraction  Placenta previa: lower uterine muscle do not contract efficiently  Full bladder- may prevent contraction  PPH predisposing factors cont, Pre-eclampsia or high blood pressure Blood clotting problems Induction of labor  Perineal tear or episiotomy (a surgical cut to help delivery)  Large baby (more than 4kg )  Etiology of Early PPH The causes of postpartum hemorrhage can be thought of as the Four Ts.: Tone – atony (80% of all cases) Tissue – retained part, accreta, uterine inversion Trauma – cervical or vaginal laceration Thrombin events – defects in coagulation (Inherited or acquired). Etiologies Definition Risk factors Signs and symptoms A. Tone Failure of the uterus Prolonged labor (uterine -Soft (boggy) fundus versus uterine muscle fatigue) firm fundus. atony to contract properly Intraamniotic infections -Excessive lochia around blood vessels (e.g., chorioamnionitis) -Blood clots may be present Uterine overdistension: a -Pale color and clammy skin when placenta multiple pregnancy (e.g., -Anxiety and confusion separates. twins), polyhydramnios, -Tachycardia large for gestational age -Hypotension infants Grand multiparity General anesthesia B. Tissue It occurs when small Abnormal placentation: -Sub involution of the uterus (retained portions of the products placenta, that remain oPlacenta accreta -Profuse bleeding that of attached to the oPlacenta previa suddenly occurs after the conception myometrium during ) the third stage of Manual removal of the first postpartum week labor. placenta. -Elevated temperature and The retained placental tissue can interfere Previous cesarean section. uterine tenderness if with involution of the endometritis present uterus and can lead to  1.Uterine Atony Management 1. Massage of the fundus until it is firm & to express clots 2. Catheterization 3. Pharmacologic measures (oxytocin, methergine) 4. Bimanual compression of the uterus 5. If it is failed return women to the delivery area to explore the uterine cavity. 6. Uterine packing: Place balloons 7. Surgery (arterial ligation) 8. A hysterectomy may be necessary to save the life of women Bimanual massage for uterine atony Dr.Walaa Mahmoud FON - CU  2- Retained tissue Treatment & Prevention:  The placenta should be examined Manual removal of the placenta by physician  If manual intervention failed → surgical removal (curettage)  If it failed & bleeding is not control →abdominal hysterectomy is necessary  Uterine contraction drugs  Retained placental Complete placenta parts Manual removal of the placenta  2- Retained tissue Immediate Complications:  Anemia.  Hypovolemic Shock.  Acute renal & liver failure.  Acute pulmonary edema  2- Retained tissue Long term complications:  Infections: puerperal infections  Sheehan’s syndrome (necrosis of anterior pituitary.)  Chronic anemia.  Chronic renal failure.  Asherman’s syndrome (a condition characterized by the presence of adhesions and/or fibrosis within the uterine cavity due to scars)  Etiologies Cont., C. Trauma: Lacerations: Vagina , Perineum , Cervix Uterine rupture (during a vaginal birth after cesarean delivery) Hematoma C. Trauma: Definition Risk factors Signs and symptoms 1. Laceration Which are the Fetal macrosomia A firm uterus that is midline second most Operative vaginal common cause of delivery: Use of with heavier than normal early PPH, can occur forceps or bleeding during childbirth. vacuum  Common types extraction Bleeding is usually bright are perineum, Precipitous labor red without clots. vaginal, cervical and/or birth Tachycardia 2. Hematoma Occur when blood Episiotomy is the Firm uterus collects within the major risk factor No visual external bleeding connective tissues of Use of forceps Women express severe pain in the vagina or Prolonged second the vagina/perineal area. perineal areas related stage Hematomas that are located in to a vessel that the vagina cannot be ruptures and visualized by the nurse. continues to bleed. Hematomas in the perineal area present with swelling, discoloration, and tenderness. Presence of tachycardia and hypotension.  A- Laceration Treatment Careful assessment for lacerations 1. Gauze pack to compress & decrease bleeding 2. Vital sign 3. Suture repair 4. Urinary catheter & remove within 24 hrs 5. Give IV fluid & analgesic to control pain  Treatment of Trauma Cont.,  Hematoma Management: 1- large hematoma (>3cm)  Must be incised, drained and ligation of bleed blood vessels 2- Small hematoma (