OB module 4

• postpartum hemorrhage: more than 500mL in vaginal delivery and more than 1000mL in c-section
• postpartum hemorrhage complications: hypovolemic shock and anemia
• postpartum hemorrhage risk factors: uterine atony (**), lacerations or hematomas, retained placenta, coagulopathies, placenta abnormalities, inversion of uterus
• uterine atony: soft and weak uterus after birth; boggy uterus
• PPH atony: over distended uterus (LGA, uterine fibroids, polyhydramnios, multifetal), high parity, ruptured uterus, prolonged labor, mag, general anesthesia
• oxytocin is given after birth to contract the uterus and prevent bleeding
• PPH lacerations and hematoma manifestations: pain and pressure unrelieved with pain medication
• PPH retained placenta S&S: bleeding, odor, clots (**)
• if placenta parts are left in the uterus a DIC will be performed to remove the pieces
• PPH coagulopathies: suspected when measures to stimulate uterine contractions fail to stop vaginal bleeding
• treatment for coagulopathies: assess for bleeding, hemodynamic status, transfusions and fluid volume replacement, urinary output, oxygen
• PPH placental abnormalities: abruption, previa, implantation abnormalities
• PPH uterine inversion: uterus turns inside out
• PPH uterine inversion risks: excessive traction on cord and fundal pressure during birth
• PPH uterine inversion S&S: visualization of uterus, massive hemorrhage, shock, pain
• PPH uterine inversion treatment: replace uterus, uterine relaxants (terbutaline), hysterectomy
• PPH treatment: oxytocin, methylergonovine (DO NOT use with hypertensive pts), misoprostol (cytotec), carboprost tromethamine (DO NOT use with asthmatics), TXA, blood transfusions, IV fluids
• postpartum infection risk factors: history of infection, c-section, trauma, prolonged labor, catheterization, excessive vaginal examinations, retained placenta, poor nutrition, hemorrhage, DM, poor hygiene
• endometritis risks: prolonged labor and subsequent cesarean birth
• endometritis S&S: fever, chills, abdominal pain, uterine tenderness, purulent lochia, tachycardia, elevated WBC
• endometritis goal: prevent systemic spread, IV antibiotics, prevent complications (sterility)
• UTI causes: trauma, catheterization, urinary stasis and retention, frequent vaginal exams
• UTI S&S: dysuria, hematuria, fever, flank pain
• UTI treatment: antibiotics, urinary analgesics, hydration
• mastitis: bacteria enters injured area of nipple; engorgement and stasis of milk precede infection (d/t skipped feedings, sudden stop of breastfeeding, tight bras)
• mastitis S&S: flulike, fatigue, aching muscles, fever, localized lump with redness heat and pain, palpable hard tender area
• mastitis treatment: antibiotics, heat/ice packs, bed rest, fluids, analgesics, continued emptying of breast (**)
• postpartum depression: days or weeks within birth and lasts longer than 2 weeks and up to a year
• postpartum depression risk factors: anxiety, guilt, agitation, irritability, lack of energy, crying, sadness, suicidal ideation, less responsive to infant, loss of pleasure in normal activities
• postpartum depression treatment: encourage skin to skin care, encouraging rooming in, promote breastfeeding, document bonding concerns, provide support and referrals, and encourage co-parent and sibling adaptation
• immunizations given after delivery: rubella, varicella, TDAP, and Rhogam within 72 hours of exposure
• postpartum is a good time for immunizations because you have the family there already and the baby is immunocompromised
• thrombophlebitis: very high risk during pregnancy; superficial vein
• DVT: very high risk during pregnancy; deep vein and causes a pulmonary embolism if it breaks off and ends up in the lungs
• thrombophlebitis/DVT risk factors: venous stasis (immobility), pregnancy (hyper coagulable state), prolonged surgery, operative vaginal birth, obesity, history of smoking, over 35
• thrombophlebitis/DVT expected findings: leg pain, tenderness, unilateral area of swelling warmth and redness
• prevention of thrombophlebitis/DVT: SCDs, passive ROM, early ambulation

  BUT if someone HAS a DVT then do NOT used SCDs
• management of thrombophlebitis/DVT: bed rest and elevation, warm compress, DO NOT use SCD (embolus), DO NOT massage (embolus), measure leg circumference, analgesics, anticoagulants
• heparin: anticoagulant used for initial treatment of DVT and acute PE; monitor aPTT

  risks: bleeding
• warfarin: anticoagulant used for treatment of clots; monitor PT and INR

  risks: teratogenic