Exam 3 management of postpartum at risk

What is the four T’s of postpartum hemorrhage?

TONE, TISSUE, TRAUMA, THROMBIN

What are risk factors for uterine tone during hemorrhage?

tired out, stretched out or crowded out

What are risk factors for uterine tissue during hemorrhage?

retained tissue causes subinvolution, abnormal placenta implantation and fibroids

What are risk factors for uterine trauma during hemorrhage?

assisted delivery, macrosomia and prolonged stage 2

What are risk factors for uterine thrombin during hemorrhage?

bleeding disorders, preeclampsia/HELLP

What is management for postpartum hemorrhage?

massage fundus, empty bladder, administer uterotonics, evaluate for hematoma/laceration, inspect placenta at delivery

What are the hemorrhage medications?

OXYTOCIN, MISOPROSTOL, METHERGINE, HEMABATE, DINOPROTONE, TRANEXAMIC ACID

What is the surgical management of PPH?

uterine tamponade with bakri balloon, uterine artery ligation, JADA or hysterectomy

What is venous thromboembolism?

from blood clot formation inside blood vessel (manage by anticoagulant therapy and compression stockings)

What are signs of deep vein thrombosis leading to PE?

chest pain on ambulation with differences of size in legs

How do we manage postpartum infections?

use aseptic technique/hand hygiene, rest, hydration, healthy diet, perineal hygiene

What is endometritis?

infection of the endometrium, decidua and adjacent myometrium (may be because of a retained placenta)

What is mastitis?

inflammation of the breasts (poor latching, cracks on nipple, red and warm) ANTIBIOTICS

What are some other postpartum infections to keep an eye out for?

UTI and wound infections

Who is susceptible to more infection during pregnancy?

anemic women,

What do we need to know for wound infections?

weeping, odor, gaping, c-section, repair of lacerations, REEDA, use clean technique and sterile environment when needed

What do we need to know about UTI?

flank pain that extends from upper butt to down the leg when palpated, pitocin retains fluid and can cause this