Chapter 33 - PP Complications

PP Hemorrhage (PPH)

• QBL > 500 =mL after VB

• QBL > 1000mL after cesarean

• cumm. blood loss >1000mL

• bleeding with s/s of hypovolemia within 24hrs of birth

Early/Acute/Primary PPH

Within 24hrs of birth

Late/Secondary PPH

• >24hrs after birth

• up to 12wks after birth

What time period is the woman at greatest risk for PPH?

1st hour after birth (recovery window)

Meds for Manual Placenta Removal

• Light nitrous oxide

• IV pain meds

Placenta Accreta

Slight penetration of myometrium

**⬆ in cesarean birth

Placenta Increta

Deep penetration of myometrium

Placenta Percreta

Perforation of myometrium, uterine serosa, & involves adjacent organs

In the case of placenta adherance^, when may a hysterectomy be needed?

• For all 3 types with uncontrolled bleeding

• 100% for percreta and increta

Laceration Induced PPH

• Slow trickle

• Oozing

• Frank

When are ice packs recommended for lacerations?

The first 24hrs

What should pt be taught abt BMs with lacerations?

Having a BM won’t disrupt sutures

Pelvic Hematomas

Collection of blood in connective tissue

Most common type of hematoma?

Vulvar hematoma

Hematoma

• surgical eval

• replacing fluids

Uterine Inversion

Fundus turns inside out

Causes of Subinvolution of Uterus

• Retained placenta

• Pelvic infection

Tx for Subinvolution of Uterus

• Ergonovine (Ergotrate)

• Methylergonovine (Methergine)

• Bx therapy

• D&C

Misoprostol (Cytotec)

• various sources

• ✅ for PPH

Methylergonovine

• Produces sustained contractions

  • se: HTN

  • contraindications: HTN, CVD

Tranexamic Acid (TXA)

• antifibronolytic agent

• contraindication: past thromboembolic events

Who can perform bimanual compression and manual exploration?

HCP

What may the pp pt be educated about?

• may feel tired

• increase dietary iron and protein intake

Carboprost (Hemabate)

• ✅ for PPH

• se: tachyc, htn

• contraindications: asthma

Neonatal thrombocytopenia can result from what maternal condition?

ITP

DDAVP (desmopressin acetate)

• IV admin for von Willebrand Disease

DVT related Syncope may indicate…

Massive embolism

Anticoagulation Stopped/Resumed Timeline

• Discontinue 12hrs b4 inductions or cesarean

• Resume 4 to 6hrs after VB

• Resume 12hrs after cesarean

Why should pp pt avoid flexing knees in a sharp position?

It causes pooling of blood in the lower extremities

Why should an area NOT be rubbed?

May dislodge clot

What may the RN do if clotting times are outside therapeutic lvl?

Inform HCP

Why should contraception be taken while taking warfarin?

It is considered teratogenic

Puerperal Infection

• infection within 28 days of miscarriage, abortion, or birth

• fever > 100.4

Wound Infection Tx

• IV Bx

• Opening and draining with NS (secondary intention)

• Wound Vac

Endometritis

• most common puerperal infection

  • uterine lining infection spreads to entire endometrium

Incomplete Inversion

• cannot be seen

• smooth mass palpated

Complete Inversion

• fundus crosses cervical os

• vaginal mass formed

Prolapsed Inversion

• large, rounded mass

• protrudes

Hypovolemic Shock Tx (Ratio)

3:1 (3mL of fluid for every 1mL of blood lost)

McRoberts Maneuver

• changes maternal pelvic angle

• reduces force needed to extract shoulders

Erb Palsy

Brachial plexus birth injury