Conditions Occurring After Delivery- Ch 23

Early warning signs in Postpartum

Agitation

Confusion

Unresponsiveness

Persistent headache (preeclampsia)

How much urine output should postpartum women be having

at least 35 mL- if not can indicate kidneys shutting down

Typical amount of blood loss after vaginal birth

500 mL

Typical amount of blood loss after c-section

1000 mL

Postpartum hemorrhage

continual bleeding from the site where the placenta separated after delivery

Early postpartum hemorrhage

occurs within 24 hours of birth

Delayed/Secondary postpartum hemorrhage

occurs 24 hours- 12 weeks after delivery

What is important for the uterus postpartum

Maintains hemostasis and prevents PPH by clotting and contraction of the myometrium of the uterus

How to make sure the uterus maintains hemostasis

Massage the uterus and hand oxcytocin

#1 cause of PPH

uterine tone/ uterine atony

Risk factors for PPH

Retained placenta and/ or membranes

Failure to progress

Adherent placenta

Lacerations

Hypertensive disorder of pregnancy

Fetal demise

Uterine Atony signs

Boggy uterus

Heavy bleeding

Saturated peripad within 15-30 mins

Blood clots

Disoriented and anxious

How is Uterine Atony confirmed

Bimanual exam

Most important lab to look at

Hemoglobin and hematocrit (baseline)

When to stop fundal massage

Once the uterus has become firm

Check for clots or blood coming out

Risk factors for Lacerations

Instrumented vaginal delivery

Malpresentation

Macrosomia

Episiotomy

Precipitous delivery

Shoulder dystocia

Laceration

steady stream of bleeding despite firm fundus, trickle of blood no clots

Prevention of laceration

Minimal use of instrumentation

Limited use of episiotomy

Offer c-section

Hematoma

a solid swelling of clotted blood within the tissues.

Risk Factors of Hematoma

•Episiotomy

•Instrumental delivery

•Difficult or prolonged second stage of labor

Sign of hematoma

Severe pain in the vaginal or perineal areas

Treatment of postpartum hemorrhage

Fundal massage (if boggy)

Assess for lacerations or hematoma (if fundus is firm)

Bladder catheterization (full bladder prevents involution)

Establish IV access

Get baseline labs

Oxytocin administeredH

How to administer Cytotec

Rectally or under the tongue

(not put in the vagina because they are bleeding and it will come right out)

Who can hemabate not be given to

People with asthma

Who can methergine not be given to

Hypertensive patient

How his methergine administered

IM

Hypovolemic shock

triggered when the volume of circulating blood decreases to a degree that the bodys organs do not have enough oxygen to function properly

Hypovolemic Shock symptoms

- Hypotension

- Tachycardia

- Tachypnea

- Oliguria

- Mental status changes

- Cool, pale, and clammy skin

- Slowed capillary refill

Venous thromboembolism (VTE)

Blood clot or multiple clots that form within a vein

Where do vte form

may be limited to superficial veins or form in deeper veins of the lower extremities (Deep vein thrombosis)

Pulmonary embolism

DVT broke off and traveled to the pulmonary artery

Symptoms of DVT

Swelling

Pain

Localized redness

Warmth

Tenderness

Treatment of DVT

Anticoagulation therapy or surgery

Start on aspirin for next pregnancy

Symptoms of a pulmonary embolism

Dyspnea

Cough

Sweating

Pleuritic chest pain

Preventative actions of a DVT & PE

early ambulation (getting out of bed)

Postpartum infections

Related to perineal wounds, cesarean wounds, endometritis, mastitis, UTI

Symptoms of postpartum infections

-A fever that persists beyond the initial 24 hours after birth (100.4)

-Elevated WBC that rises instead of falling

-Fever starting 2-10 days after birth

Risk factors of perineal wounds

Operative vaginal delivery

Prolonged second stage of labor

Third or fourth degree laceration

Meconium-stained fluid

Signs of perineal wounds

Tenderness

Redness

Swelling

Purulent discharge

Treatment of perineal wound

Removal of sutures and opening hte wound

Signs and symptoms of Endometritis

Fever

Uterine tenderness

Flu-like symptoms

Tachycardia (Uterus become soft and sub involuted)

Risk factors of endometritis

Chorioamnionitis

Prolonged labor

Prolonged rupture of membranes

Lactational Mastitis

Inflammation of the breast tissue often associated with infection

Factors contributing to mastitis

Delayed breast emptying

Poor drainage of one or more ducts

Inconsistent pressure on breasts

Oversupply of milk

Nipple trauma

Bacteria most commonly causing lactation mastitis

Staph aureus

What is important with breastfeeding

That the baby empties both breasts completely

Why do we only ice breasts for a short mount of time

Can dry out the breastmilk

Symptoms of mastitis

Tender

Red area of breast

Malaise

High fever

Treatment of mastitis

Cold compress

NSAIDs

Regular and complete emptying of the breast

Antibiotics

Why are postpartum women prone to UTIs

The frequency of bladder catheterization and genital procedures

Symptoms of UTI

Urinary urgency and pain with urination

Symptoms of pyelonephritis

FLANK PAIN

Nausea/vomiting

Fever

Treatment of UTI & pyelonephritis

Antibiotics and HYDRATION

How long is it normal to have a fever for

up to 24 hours

Postpartum blues

2-3 days after delivery and resolved within 2 weeks

Postpartum depression

Major depression with onset during pregnancy

first 4 weeks after birth

Postpartum psychosis

Affects a womans sense of reality

occur within 48 hours of delivery

Risk factors of postpartum depression

History of depression

Depression in pregnancy

Postpartum blues