PART 1 (postpartum hemorrhage, subinvolution, puerperal infection)

500 ml

blood loss of postpartum hemorrhage is more than ___ml birth of a newborn

uterine atony

lacerrations

retained placental fragments

early postpartum hemorrhage is usually due to? (3)

first 24hrs

late postpartum hemorrhages occurs after ___hrs caused by retained placental fragment and bleeding disorders

1. uterine atony (most frequent)

2. lacerations

3. retained placental fragments

4. disseminated intravascular coagulation (DIC)

main causes of postpartum hemorrhage (4)

1. labor initiated/ assisted with oxytocin

2. age 30y/o

3. high parity

4. previous uterine surgery

5. possible chorioamnionitis

6. secondary maternal illness e.g. anemia

7. endometritis

8. prolonged used of MgSO4 or other tocolytic drugs

causes of atony (8)

1. operative birth

2. rapid birth

causes of lacerations (2)

1. cervical

2. vaginal

3. perineal

types of lacerations (3)

• vaginal bleeding

• signs of impending cjock including changes in temperature and color and latered LOC

clinical manifestations of postpartum hemorrhage

• prevent excessive blood loss

• massage uterus, facilitate voiding, report blood loss

• monitor BP and PR for 5-15 minutes

• prepare IV, oxytocin, BT if needed

• admin meds as Rx

• measure I&O

• prepare for D&C

• assist client and family in dealing with physical and emotional stress

nursing management for postpartum hemorrhage

tone (70% of PPH)

tissue (10% of PPH)

trauma (20% of PPH)

thrombin (<1% of PPH)

4 T’s of postpartum hemorrhage

subinvolution

is the delayed return of the uterus to its

prepregnant size and shape at 4-6 weeks

post partum visit.

Prolonged lochial discharge

Irregular or excessive bleeding

Larger than normal uterus

Boggy uterus (occasionally)

clinical manifeststions of subinvolution

Retained placental fragments and

membranes

 Endometritis

 Uterine fibroid tumor

causes of subinvolution

 Avoid prelacteal feeding

 Initiate breast feeding early and unrestricted

 Exclusive breast feeding on demand

 Feeding in correct position

preventive measures of subinvolution

1. Administration of oxytocic medication to

improve uterine muscle tone, includes:

a. Methergine – a drug of choice (PO)

b. Pitocin

c. Ergotrate

2. Dilation and curettage (D&C) to remove any

placental fragments.

3. Antimicrobial therapy for endometritis

treatment of subinvolution

puerperial infection

 Infection developing in the reproductive tract

after delivery.

 Usually begins as local infection and can

spread to involve the peritoneum or

circulatory system.

Localized vaginal, vulval, and perimeal infection

what is the common type of PUERPERAL INFECTION where pain, elevated temp, edema, redness, firmness and tenderness at the site of the wound, sensation of heat, burning on urination is present

endometritis

Inflammation of the endometrium. Elevated temp for several days. malaise, headache, backache, general discomfort, loss of appetite, large and tender uterus. Severe postpartum cramping and brownish red, foul-smelling lochia. Associated with chorioamnionitis.

Parametritis (pelvic cellulitis)

elevated temp,

chills, abdominal pain, subinvolution of

uterus, tachycardia and lethargy.

Peritonitis

infection of the peritoneal cavity usually extension of endometritis. often accompanied by paralytic ileus (blockage of inflamed intestines)

 form abscess in the cul-de-dac of Douglas

(the lower point of peritoneal cavity)

 high fever, rapid pulse, abdominal pains,

nausea, vomiting and restlessness.

 Poor sterile technique

 Delivery with significant manipulation

 CS

 Over growth of local flora

causes of puerperal infection?

1. Aerobic organisms - Escherichia coli,

Klebsiella, Proteus mirabilis, Pseudomonas,

Staphylococcus aureus and Neisseria

organisms.

2. Anaerobic organisms - Bacteroides,

Peptostreptococcus and Peptococcus and

Clostridium perfringens

causative agents of puerperal infection