Complications during the Postpartum period

what are some postpartum complications

postpartum hemorrhage, DVT, infections, coagulopathies

what factors increase the uterine size

polyhydramnios, multiparity, macrosomia

what is the primary cause of PPH

uterine atony

what is uterine atony

uterine tone is soft and weak because it cant contract

risk factors of antepartum

bleeding disorders, history of PPH, BMI greater than 40, diabetes, hx of uterine fibroids/previous uterine surgery, mult gestation, uterine distention, nifedipine during pregnancy

what is nifedipine used for

used to patient with chronic hypertention to control BP during pregnancy

what is nifedipine

calcium channel blocker that relaxes smooth muscle

• used as tocolytic to decrease contractions for preterm labor

clients with an epidural and voiding

diminished sensation of need to void which leads to overdistention of bladder and uterine displacement = decreased uterine tone

primary PPH

Presentation of heavy vaginal bleeding immediately after birth up to 24 hr postpartum

secondary PPH

presents with heavy vaginal bleeding from 24 hrs after delivery up to 6 weeks postpartum

expected findings of primary and secondary PPH

presents with enlarged and uncontrolled uterus

A nurse is caring for a postpartum patient who just used the bathroom for the first time following birth. The patient's perineal pad contains sanguineous discharge. Following the quantification of blood loss policy, the nurse weighs the perineal pad with a value of 400 g. Knowing the dry weight of a perineal pad is 30 g, calculate the client's blood loss in milliliters.

400-30= 370mL

how to calculate blood loss
subtract the dry weight from the wet weight to = the gram weight

1gm=1mL

is estimated blood loss (EBL) subjective

yes, to make it less subjective - weight pads, sponges, and chux

what should you instruct pt to report with PPH

large or multiple clots (bigger than golf ball or plum)

what is excessive bleeding

more than 1 pad every 15 min

how to manage third stage of labor

breastfeeding immediately after birth, use of uterotonic meds, uterine massage, umbilical cord traction

what happens if placenta is not delivered within 15 min of birth

additional 5 unit IV dose of oxytocin is administered - considered RETAINED PLACENTA AFTER 30 MIN

what is given during the third stage of labor immediately after birth of infant

5-unit IV dose of oxytocin

immediate intervention of a PPH related to uterine atony

4 T's , uterine massage, IV fluids, uterotonic meds

what are the 4 t's

tone, trauma, tissue, thrombin

cause of tone

uterine atony

intervention of tone

restore contractility with fundal massage or oxytocic meds

trauma cause

lacerations

trauma interventions

repair trauma (suturing)

tissue cause

retained products of conception

tissue interventions

remove tissue via a surgical procedure completed by the provider

thrombin cause

coagulation

thrombin intervention

decrease blood loss with fuindal massage or oxytocic meds

if a person starts to bleed, what do we do?

- Check vs and fundus
- Massage fundus if needed
- weight the chux and pads
- Notify md or team

what meds for PPH

Pitocin, methergine, hemabate, cytotec, Txa

nursing interventions for PPH

start 2 IVs with 1 being an 18g with blood tubing

what might MD do for PPH

balloon tamponade

what should we watch for following a PPH

orthostatic hypotension

good interventions to prevent PPH

good prenatal care w/ good nutrition, avoid traumatic procedures, no pulling on umbilicus cord, fundal massage, early breastfeeding

what would be the first action you would do if patient called for excessive bleeding

check fundus and massage if necessary

how can you avoid overdistention on the bladder

instruct pt to void every 2 hrs while awake

what do we give after placenta is delivered to prevent PP

oxytocin