Chapter 22 – Nursing Management of the Postpartum Patient at Risk

Vocabulary flashcards summarizing key terms and definitions related to postpartum risk conditions, assessment, and nursing management.

Postpartum Hemorrhage (PPH)

Excessive bleeding after birth; >500 mL (vaginal) or >1,000 mL (cesarean) or any loss causing hemodynamic jeopardy.

Blood-loss Threshold – Vaginal Birth

More than 500 mL of blood lost following a vaginal delivery.

Blood-loss Threshold – Cesarean Birth

More than 1,000 mL of blood lost following a cesarean delivery.

Uterine Atony

Lack of adequate uterine muscle tone leading to failure of uterine contraction and most common cause of PPH.

Four Ts of PPH

Mnemonic for PPH causes: Tone, Tissue, Trauma, Thrombin.

Tone (Four Ts)

Uterine atony or distended bladder preventing effective uterine contraction.

Tissue (Four Ts)

Retained placenta or clots inhibiting uterine contraction.

Trauma (Four Ts)

Injury to vagina, cervix, uterus, or perineum such as lacerations or episiotomy.

Thrombin (Four Ts)

Pre-existing or acquired coagulopathy that impairs clotting.

Mild Shock (15–25 % loss)

Diaphoresis, weakness, tachycardia, slight drop in blood pressure.

Moderate Shock (25–35 % loss)

Pallor, restlessness, oliguria, moderate fall in blood pressure.

Severe Shock (35–50 % loss)

Marked hypotension, agitation or confusion, hemodynamic instability, anuria.

Fundal Massage

Manual stimulation of uterine fundus to promote contraction and reduce bleeding.

Uterotonic Agent

Drug (e.g., oxytocin) administered to stimulate uterine contraction and control hemorrhage.

Subinvolution

Incomplete return of the uterus to its pre-pregnant size; may cause late PPH.

Hematoma (Postpartum)

Collection of blood in vulva, vagina or subperitoneal area causing pain and potential blood loss.

Thromboembolic Disease

Formation of blood clots in vessels postpartum; includes superficial thrombosis and DVT.

Superficial Thrombosis

Clot confined to the saphenous vein in the lower leg with localized pain and redness.

Deep Vein Thrombosis (DVT)

Clot in deep leg veins that may embolize to lungs; characterized by unilateral leg pain, swelling, warmth.

Pulmonary Embolism

Obstruction of pulmonary artery by clot, potentially fatal complication of DVT.

Heparin

Anticoagulant drug of choice for treating postpartum DVT and preventing further clot formation.

Venous Stasis

Slowed blood flow in veins predisposing to clot formation during pregnancy/postpartum.

Hypercoagulation

Increased tendency of blood to clot, contributing to thromboembolic risk postpartum.

Metritis

Infection of endometrium, decidua, and adjacent myometrium resulting in postpartum fever.

Mastitis

Inflammation/infection of breast tissue, often caused by Staphylococcus aureus; presents with pain, redness, fever.

Postpartum Wound Infection

Bacterial infection of episiotomy, laceration, or cesarean incision site.

Broad-Spectrum Antibiotics

Medications used to treat metritis and other postpartum infections until organism identified.

REEDA Method

System for assessing perineal healing: Redness, Edema, Ecchymosis, Discharge, Approximation.

Redness (REEDA)

Assessment of erythema around incision; scored 0–3 based on extent.

Edema (REEDA)

Measurement of swelling extending from incision; scored 0–3.

Ecchymosis (REEDA)

Degree of bruising near incision; scored 0–3.

Discharge (REEDA)

Type/amount of exudate from wound; scored 0–3.

Approximation (REEDA)

Degree to which wound edges are closed; scored 0–3.

Postpartum (Baby) Blues

Transient mood swings, irritability, and insomnia resolving by postpartum day 10.

Postpartum Depression

Major depressive episode lasting beyond 6 weeks after birth and progressively worsening.

Postpartum Psychosis

Most severe postpartum mood disorder; onset within 3 weeks, includes hallucinations, delusions, and risk of harm.