Extra practice complications during postpartum period

What is the primary focus of care for maternal clients experiencing postpartum hemorrhage?

To examine the conditions and provide care for clients experiencing postpartum hemorrhage.

What are the key responsibilities of a nurse during the postpartum period?

Provide education, maintain communication, ease fears, involve patients in decision-making, and enhance understanding.

What is postpartum hemorrhage (PPH)?

A leading cause of maternal death in the US, occurring when the myometrium fails to contract and the uterus becomes boggy.

What are the primary risk factors for postpartum hemorrhage?

Uterine atony, retained placenta, subinvolution, genital tract lacerations, hematomas, and prolonged labor.

What is uterine atony?

The primary cause of postpartum hemorrhage, related to risk factors assessed during history and physical examination.

What are some antepartum risk factors for postpartum hemorrhage?

Bleeding disorders, history of PPH, BMI greater than 40, diabetes, and multiple gestation.

What are some intrapartum risk factors for postpartum hemorrhage?

History of PPH, uterine surgery, BMI greater than 40, and prolonged labor.

What clinical manifestations indicate postpartum hemorrhage?

Enlarged, uncontracted uterus, heavy vaginal bleeding, and blood clots larger than a quarter.

How is blood loss quantified in postpartum hemorrhage?

By weighing perineal pads; 1 gram equals 1 milliliter of blood loss.

What are the Four Ts of postpartum hemorrhage?

Tone, Trauma, Tissue, and Thrombin.

What interventions are included in the active management of the third stage of labor?

Uterine massage and umbilical cord traction.

What is the intervention for uterine atony?

Restore contractility via fundal massage and/or oxytocic medication.

What is the intervention for trauma-related postpartum hemorrhage?

Repair trauma via suturing by a healthcare provider.

What is the intervention for retained tissue in postpartum hemorrhage?

Remove tissue via a surgical procedure such as dilation and curettage (D&C).

What are some immediate interventions for postpartum hemorrhage?

Firm fundal massage, IV fluids, and administration of uterotonic medications.

What are some interventions to prevent postpartum hemorrhage?

Prenatal care, fundal massage, good nutrition, and early breastfeeding.

What is the significance of assessing the bladder in postpartum care?

A full bladder can contribute to uterine atony and postpartum hemorrhage.

What should a nurse instruct a patient to report after delivery?

Large or multiple clots and bleeding greater than one pad per hour.

What is the role of oxytocin in postpartum care?

It is administered to help contract the uterus and reduce blood loss.

What is bimanual uterine massage?

A technique used to stimulate uterine contraction and control bleeding.

What is the expected finding in a patient experiencing primary postpartum hemorrhage?

Heavy vaginal bleeding immediately after birth up to 24 hours postpartum.

What is the expected finding in a patient experiencing secondary postpartum hemorrhage?

Heavy vaginal bleeding from 24 hours after delivery up to 6 weeks postpartum.

What should be monitored in a patient with postpartum hemorrhage?

Oxygen saturation, vital signs, and the source of bleeding.

What is the importance of early breastfeeding in postpartum care?

It can help stimulate uterine contractions and reduce the risk of hemorrhage.

What are the signs of a boggy uterus?

A uterus that is enlarged and uncontracted, often palpated as soft.

What is the role of IV fluids in managing postpartum hemorrhage?

To maintain blood volume and support circulation during hemorrhage.

What is the technique used to manage a boggy uterus in postpartum care?

Bimanual massage, involving abdominal massage with one hand and lower uterine segment massage with the other hand.

What is the purpose of bimanual intervention in postpartum hemorrhage?

To stimulate endogenous prostaglandins and promote uterine contractions.

What is the first-line medication given for postpartum hemorrhage?

Pitocin (Oxytocin), administered IV or IM.

What are the adverse effects of Pitocin?

Coma, hyponatremia, placental abruption, seizures, water intoxication, hypotension, and painful contractions.

What is the therapeutic use of Hemabate (Carboprost Tromethamine)?

To treat postpartum hemorrhage.

What are the contraindications for using Hemabate?

History of asthma or active cardiac, hepatic, or renal disease.

What is the action of Misoprostol in obstetrics?

Causes uterine contractions and is used for cervical ripening and induction of labor.

What are the adverse effects of Misoprostol?

Abdominal pain, constipation, diarrhea, headache, menstrual disorders, and miscarriage.

What is Tranexamic Acid used for in postpartum care?

To control postpartum hemorrhage by stabilizing the fibrin matrix.

What are the contraindications for Tranexamic Acid?

Hypersensitivity, active thromboembolic disease, colorblindness, and intracranial bleeding.

What should a nurse monitor when administering Oxytocin for postpartum hemorrhage?

Vital signs, uterine tone, vaginal bleeding, and signs of water intoxication.

What is the action of Methylergonovine in postpartum care?

Stimulates uterine smooth muscle contractions to prevent or treat postpartum hemorrhage.

What are the adverse effects of Methylergonovine?

Dizziness, headache, hypertension, nausea, stroke, and vomiting.

What is the importance of continuous assessment in postpartum hemorrhage management?

To document client recovery and respond promptly to any changes in condition.

What is the role of iron supplementation in postpartum care?

To treat anemia resulting from blood loss during delivery.

What should a nurse educate a patient about regarding the use of Oxytocin?

The rationale for administration and expected outcomes, such as strong uterine contractions.

What is a potential risk factor for postpartum hemorrhage in a patient who just gave birth?

A prolonged labor, such as one lasting 30 hours.

What is the recommended route for administering Tranexamic Acid?

Intravenous administration.

What should be monitored when administering Misoprostol?

Uterine activity, cervical dilation, and fetal response to uterine activity.

What is a common adverse effect of Hemabate?

Nausea, vomiting, and diarrhea.

What is the therapeutic class of Oxytocin?

Oxytocic.

What is the pharmacologic class of Misoprostol?

Prostaglandins.

What should be done if a patient experiences adverse effects from Methylergonovine?

Monitor for signs of ergotism and notify the healthcare provider.

What is the significance of the term 'boggy uterus' in postpartum care?

It indicates uterine atony, which can lead to postpartum hemorrhage.

What is considered a retained placenta?

A placenta that is not delivered within 30 minutes of delivery, accompanied by severe bleeding.

What ultrasound finding confirms retained placenta?

Ultrasound will confirm placenta fragments remaining in the uterine cavity.

What are some surgical interventions for postpartum hemorrhage?

Compression sutures, hypogastric artery ligation, uterine artery embolization, uterine curettage, bilateral uterine artery ligation, and hysterectomy.

What are the risk factors for retained placenta?

Assisted reproductive technology, multigravida status, history of endometriosis, uterine atony, uterine fibroids, previous endometrial surgery, low-lying placenta, and placenta previa.

What is Morbidly Adherent Placenta (MAP)?

A condition where the placenta attaches too deeply into the uterine wall, leading to complications during delivery.

What are the maternal complications associated with MAP?

Abdominal organ injury, anemia, death, end-organ damage, hemorrhage, infection, and need for hysterectomy.

What are the neonatal complications associated with MAP?

Death, late preterm birth, small for gestational age, and fetal demise.

What is uterine inversion?

A rare and serious postpartum complication where the uterus turns inside out, often leading to high maternal mortality.

What are the types of uterine inversion?

Incomplete inversion, complete inversion, prolapse inversion, and total inversion.

What are the risk factors for uterine inversion?

Diagnosed connective tissue disorder, fetal macrosomia, manual removal of the placenta, MAP, nulliparity, overdistended uterus, placenta previa, previous history of uterine inversion, and short umbilical cord.

What nursing interventions are required for uterine inversion?

Call for assistance, maintain hemodynamic stability with IVF, monitor vital signs, prepare for surgery if manual replacement fails, and administer uterotonics.

What is subinvolution of the uterus?

Failure of the uterus to return to its normal size after pregnancy, usually indicated by prolonged lochia rubra.

What are the clinical manifestations of subinvolution?

Enlarged, boggy uterus and sudden onset of vaginal bleeding occurring between 24 hours and 6 weeks postpartum.

What are the risk factors for genital tract lacerations during childbirth?

Asian ethnicity, age over 25, nulliparity, short perineum, use of epidural, pushing in lithotomy position, and use of forceps or vacuum.

What is the REEDA mnemonic used for?

To assess perineal lacerations: Redness, Edema, Ecchymosis, Drainage, Approximation.

What medications are prescribed for managing perineal trauma?

NSAIDs for pain, laxatives and stool softeners for bowel management, and antibiotics for OASIS injuries

What is the role of oxytocin in postpartum management?

Oxytocin is administered to contract the uterus and prevent reoccurrence of hemorrhage.

What should be done if the placenta is not expelled after 30 minutes?

Notify the charge nurse for assistance.

What is the importance of accurate documentation in postpartum care?

To track the time of delivery and expulsion of the placenta, which is critical for managing complications.

What are common interventions for managing subinvolution?

Insertion of large bore IV, administration of uterotonics, blood products, and D&C if necessary.

What is the expected rate of fundal descent postpartum?

The fundus descends approximately 1 cm per day after birth.

What are the signs of excessive bleeding postpartum?

Prolonged lochia rubra lasting more than 2 weeks and sudden onset of vaginal bleeding.

What are common complications of the genital tract during childbirth?

Lacerations and hematomas

What is the most common type of hematoma associated with childbirth?

Vulvar hematomas

What can hematomas lead to?

Anemia, infection, necrotizing fasciitis, postpartum hemorrhage (PPH), and prolonged hospitalization

What are some risk factors for the development of hematomas?

Coagulopathies, hypertensive disorders of pregnancy, macrosomia, operative vaginal birth, precipitous birth, prolonged second stage of labor, and vulvar varicosities

What are clinical manifestations of hematomas?

Localized pain, unilateral swelling, intermittent bleeding, difficulty sitting, voiding issues, and urinary retention

How can visible vulvar hematomas be identified?

Through physical examination

What vital signs indicate potential hemodynamic instability in hematoma patients?

Abnormal vital signs indicating instability

What is the medical management for small hematomas?

Expectant management with compression, ice packs, analgesics, and bed rest

What is the medical intervention for large hematomas?

Surgical intervention, analgesics, antibiotics, and wound care

What are the nursing interventions for managing hematomas?

Maintain hemodynamic stability, frequent vital sign assessments, and communication with the multidisciplinary team

What is postpartum hypovolemic shock?

A condition with high risk in patients experiencing postpartum hemorrhage (PPH) and hemodynamic changes post-birth

What are the clinical manifestations of postpartum hypovolemic shock?

Blood pressure < 85/45 mm Hg, heart rate > 110/min, SpO2 < 95%, delayed capillary refill, decreased urinary output, pallor, excessive thirst, restlessness, and fear

What are the risk factors for postpartum hypovolemic shock?

Previous PPH, high BMI, and coagulopathies

What is the shock index (SI) and its significance?

A hemodynamic indicator calculated as heart rate/systolic blood pressure; SI > 1.1 indicates increased need for blood products

What is deep vein thrombosis (DVT) and its significance in pregnancy?

A major cause of maternal morbidity and mortality, with half of pregnancy-related VTEs occurring postpartum

What are the risk factors for developing DVT during pregnancy?

Assisted reproductive technology, preterm labor and delivery, cesarean section, PPH, postpartum infection, and preeclampsia

What are the signs and symptoms of DVT?

Unilateral leg pitting edema, calf tenderness, pain, reddened skin, warmth, and swelling

What nursing interventions are recommended for DVT prevention?

Pneumatic compression devices, pharmacologic prophylaxis, and assessment of affected areas

What client education is important for DVT prevention?

Avoid sitting for long periods, elevate legs, adopt a healthy diet, and wear compression stockings during activity

What is the therapeutic use of low molecular weight heparins?

Prevention of thrombus formation by interrupting the clotting cascade

What are common adverse effects of low molecular weight heparins?

Anemia, constipation, dizziness, elevated liver enzymes, edema, headache, pruritus, and urinary retention

What contraindications should be noted for low molecular weight heparins?

Hypersensitivity

What laboratory tests are recommended for suspected VTE?

D-dimer test and compression ultrasound for diagnosis

What are the most common postpartum infections?

Endometritis, mastitis, sepsis, and wound infections.

How can postpartum infections affect new mothers?

They can impact maternal bonding, breastfeeding success, and increase maternal anxiety.

What are common sites for bacteria to enter and cause postpartum infections?

Abdominal wall during cesarean section, reproductive and urinary tracts during vaginal births.

What is endometritis?

Inflammation of the endometrium, often characterized by vaginal discharge, uterine tenderness, and flu-like symptoms.

What percentage of women experience endometritis after vaginal delivery?
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2-5% of women