Postpartum Complications PDF

Postpartum complications  Hemorrhage  Coagulation Disorders  Infection  Psych Complications Copyright ©2022 F.A. Davis Company  Same concepts apply Copyright ©2022 F.A. Davis Company  Postpartum Hemorrhage  Postpartum Hemorrh...

Postpartum complications  Hemorrhage  Coagulation Disorders  Infection  Psych Complications Copyright ©2022 F.A. Davis Company  Same concepts apply Copyright ©2022 F.A. Davis Company  Postpartum Hemorrhage  Postpartum Hemorrhage (PPH) is defined as blood loss greater than 500 ml for vaginal deliveries and 1000 ml for C/S with a 10% drop in Hemoglobin and/or Hematocrit.  Classified into Primary (early) Occurs in first 24 hr Due to uterine atony, lacerations or hematomas 99% fall into this category  Secondary (late) Occurs after 24 hrs post-birth Due to hematomas, subinvolution or retained placenta tissue Copyright ©2022 F.A. Davis Company  Quantify Blood loss Copyright ©2022 F.A. Davis Company  Estimating blood loss Copyright ©2022 F.A. Davis Company  RISK Factors  Placental abruption or previa  PIH, Pre-eclampsia, Eclampsia, HELLP, DIC  Use of Magnesium Sulfate (or anything else that vasodilates)  Uterine rupture  Any uterine overdistention  Prolonged or precipitous delivery  Maternal anemia  Chorioamnionitis  Multiparty  Prolonged use of oxytocin (induction) Uterus is tired from prolonged contractions  Also see box 12-1 p. 407 Copyright ©2022 F.A. Davis Company  Causes of PPH – the 4 “T’s” Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Uterine Tone  Uterine Atony Major cause of primary PPH  Findings: Boggy uterus Assess Bladder (is the bladder the cause?) Saturation of pad within 15 min ‒ Dime – quarter-sized clots are normal, anything larger, or several can indicate collection/atony Tachycardia Hypotension Copyright ©2022 F.A. Davis Company  Blood Loss and Vital Signs  Signs of shock may or may not be present Restlessness/Anxiety Pallor, blue hue Cool, clammy skin Increased pulse Tachypnea Shaking Decreased BP – know trends (take q15min) Decreased SaO2 Copyright ©2022 F.A. Davis Company  Trauma  Lacerations/tears  Cesarean Section  VBAC  Uterine rupture  Abruption  Use of forceps/vacuums  Risk Factors See box 12-2 p. 408 Copyright ©2022 F.A. Davis Company  Tissue  Retained placenta tissue is the primary cause of secondary PPH Will happen over and over again with other interventions Happens later than the 4 hrs.  Placenta – abruption or previa  Anyone with pre-e Parts of the placenta w/o perfusion may break off  C/S – manual removal of placenta Copyright ©2022 F.A. Davis Company  Thrombin  Dysfunction in maternal coagulation  HELLP and DIC  Cues Prolonged, uncontrolled bleeding Other sites bleeding – IV, incision, nose, gums Labs Petechia and Purpuric areas S/S of shock Copyright ©2022 F.A. Davis Company  Petechiae and pupura Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Characteristics of Postpartal Bleeding  Color of blood  Consistency of blood Dark red with clots: uterine atony or retained placental fragments Bright red without clots: lacerations from the perineum, cervix, or vagina Copyright ©2022 F.A. Davis Company  Assessment  VS, fundus, lochia – frequently q 15min  Know baseline VS – NL for BP to drop some  Estimated blood loss at birth  Pad counts, measure time to soak  Bladder – cath if need to  Fatigue vs LOC  Labs – see p. 412 Copyright ©2022 F.A. Davis Company  Interventions for PPH  Message the uterus – aggressively and continuously – 1st priority  Straight cath if she cannot get up  meds  IV Fluids - LR bolus  2nd large bore IV  Oxygen even if they are in normal saturation Desat is a late sign Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Treatment Copyright ©2022 F.A. Davis Company  Medications for PPH in order  Oxytocin (Pitocin) – 1st line  Misoprostol (Cytotec) – given once Vaginal, po, sublingual, or rectal  Tranexamic Acid (TXA) - antifibrinolytic 1gm in 10ml IV over 10min - may repeat in 30min  Methergine Causes contractions Contraindicated in any form of HTN ‒ Can cause a stroke Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Hematomas  Localized collection of blood under the skin  Risk factors lacerations, episiotomies, vacuum, forceps, difficult or prolonged second stage of labor  Cues Constant pain and pressure – vaginal and rectal S/S of hypovolemia yet firm uterus and minimal bleeding Tender vagina, perineum Visible bulge Copyright ©2022 F.A. Davis Company  Treatment of hematoma  Less than 5cm Ice, Motrin, sitz baths after 12 hours  Greater than 5cm Surgical evacuation Serious internal bleeding Can lead to hypovolemia and shock Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Recognizing Signs and Symptoms of DVT  Unilateral leg pain  Calf tenderness  Swelling  Positive Homans’ sign  Potential Pulmonary emboli  Lab test for venous thrombosis D-dimer (NOT PT and pTT) Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Prevention/Treatment of DVT  Early and often ambulation  Prophylaxis – Lovenox  Compression stockings/device  Encourage fluids  Patient education  Heparin initially  Warfarin (Coumadin) and taper Heparin Copyright ©2022 F.A. Davis Company  Puerperal (Postpartum) Infections  Bacterial infection that occurs within 28 days after miscarriage, induced abortion, or childbirth  Most commonly involve Endometrium ‒ Foul-smelling lochia ‒ Pain, especially during fundus massage Operative wound Urinary tract Breasts Copyright ©2022 F.A. Davis Company  Risk Factors for Puerperal Infections  Poor hygiene  Low socioeconomic status  Smoking  Malnutrition  Obesity  Comorbidities  PROM  Infections in pregnancy – STD’s, UTI’s, GBS  GDM Copyright ©2022 F.A. Davis Company  Prevention of Infection  Hand washing  Squeeze bottle of water to cleanse perinium  Change peripad at least every 3 to 4 hours  Drink extra fluids to increase urine production  Wash incisions with soap and water  Maintain glycemic control  Lifestyle changes Copyright ©2022 F.A. Davis Company  Patient Education  Notify your health-care provider if you develop pain, redness, or swelling at the site of any incision.  Notify your health-care provider if you develop a fever of 100.4°F (38°C)  If you are breastfeeding, a temperature elevation to 100.4°F [38°C] may occur when your milk production begins, the temperature will not last past a day.  Easily treated with early identification and antibiotics Copyright ©2022 F.A. Davis Company  Cues of infection  Fever, chills  Tachycardia  Foul-smelling lochia  UTI – burning, frequency, backpain, cloudy  Uterine tenderness  Fatigue (malaise)  Drainage  WBC  More p. 418 & 419 Copyright ©2022 F.A. Davis Company  Postpartum Psychosocial Complications  A flood of emotional, spiritual, relational, and socioeconomic concerns  Physical exhaustion, pain, lack of sleep, stress, hormonal changes  May not recognize need for help  May be reluctant to ask for help  Nurse can be a lifeline for the woman experiencing postpartum psychosocial complications Copyright ©2022 F.A. Davis Company  Postpartum Blues  d/t lack of sleep, bleeding, hormonal changes  Common emotional response of periods of happiness followed by periods of tearfulness  Self-limiting and resolve by 10 days postpartum Peak: 5-10 days  Signs and symptoms: tearfulness, mood swings, anxiety, fatigue, sadness, insomnia, forgetfulness, and confusion  Alleviating factors – encouragement, Copyright ©2022 F.A. Davis Company  Postpartum Depression (PPD)  Occurs within 6 months postpartum 10 days – 6 months  10 – 20% incidence  Significant health effect on the woman, infant, and other family members  Those with a history of PPD are more likely to experience mental health disorders  Peaks 1-2 weeks postpartum Copyright ©2022 F.A. Davis Company  Cues Significant weight loss or gain Insomnia or hypersomnia Changes in psychomotor activity- agitation Decreased energy or fatigue Feelings of worthlessness or guilt Decreased ability to concentrate Recurrent thoughts of death or suicide attempt Edinburg scale See p. 421 Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company Copyright ©2022 F.A. Davis Company  Treatment  Early identification  Therapeutic communication/listening  Counseling  Support  Family support  Antidepressants Copyright ©2022 F.A. Davis Company  Postpartum Psychosis  Rare but severe form of mental illness  Occurs 3-6 days postpartum  Greatest risk in those with pre-existing mental health – bipolar, schizo  Behavioral cues that signal postpartum psychosis – involves hallucinations, delusions, confusion  Infanticide higher in psychosis Copyright ©2022 F.A. Davis Company  Childbirth-Induced Post-traumatic Stress Disorder  Reaction occurring after experiencing a highly stressful event – traumatic birth, negative outcomes  Characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of the event  Risk factors – see p. 423 Copyright ©2022 F.A. Davis Company