AJ Uy

• Early post partum hemorrhage

  Occurs during the first 24 hours postpartum
• Uterine Atony


  Lack of muscle tone that results in failure of the uterine muscle fibers to contract firmly around blood vessels when the placenta separates
• Uterine Atony


  • A uterine fundus that is difficult to locate
  • A soft, or "boggy," feel when the fundus is located
  • A uterus that becomes firm as it is massaged but loses its tone when massage is stopped
  • A uterine fundus that is located above the expected level
  • Excessive lochia
  • Severe blood loss
• Management of Uterine Atony

  1. Massage the uterus

  2. Express clots that may have accumulated in the uterus

  3. Ice compress

  4. Oxytocin administration

  5. Emptying the bladder

  6. Bimanual compression- to explore retained placental fragments

  7. Hysterectomy- last resort
• Fundal massage


  • One hand is placed just above the symphysis pubis to support the lower uterine segment while the other hand gently but firmly massages the fundus in a circular motion
• Additional measures for Uterine Atony

  1. Elevate the woman's lower extremities to improve circulation to essential organs

  2. Offer a bedpan or assist the woman to the bathroom at least every 4 hours to be certain her bladder is emptying

  3. Administer oxygen by face mask at a rate of about 10 to 12 L/min if the woman is experiencing respiratory distress from decreasing blood volume

  4. Obtain vital signs frequently and assess them for trends such as a continually decreasing blood pressure with a continuously rising pulse rate
• Lacerations


  Types of lacerations: perineum, vagina, cervix, urethral meatus
• Hematomas


  Bleeding into loose connective tissue while overlying tissue remains intact
• Hematomas


  • Visible vulvar hematomas appear as discolored, bulging masses that are sensitive to touch
  • Hematomas may be found in vulvar, vaginal, or retroperitoneal areas
  • Hematomas in the upper vagina or retroperitoneal areas cannot be seen
  • Hematomas produce deep, severe, unrelieved pain and feelings of pressure
• Management of Hematomas


  1. If trauma is present in the birth canal- surgical repair is often necessary

  2. Small hematomas usually reabsorb naturally

  3. Large hematomas may require incision- evacuation of the clots and location of the bleeding vessel so that it can be ligated
• Trauma to the birth canal

  • Types of Trauma: Vaginal, Cervical, Perineal Lacerations, Hematomas
  • Predisposing Factors: Risk for uterine atony, Rapid Delivery, Forcep Delivery, Induction and augmentation of labor, Use of assistive devices, Tissue trauma
• Late Postpartum Hemorrhage


  The most common causes are: Subinvolution (delayed return of the uterus to its nonpregnant size and consistency) and retained placental fragments
• Postpartal Puerperial Infection


  Entry or presence of microorganisms. Sources: Endogenous (primary) sources and Exogenous sources
• Signs and symptoms of Infection

  • Malaise, anorexia, Chills, fever and headache
• Management of Infection


  CBR, proper nutrition, Increased fluid intake, Administer antipyretics, analgesics and antibiotics
• Infection of the perineum

  • Signs: Pain, Heat and feeling of pressure in the perineum, Inflammation of the suture line
• Endometritis


  • Signs and symptoms: Abdominal tenderness, Uterus not contracted and painful to touch, Dark brown, foul smelling lochia
• Management of Endometritis


  Administer oxytocin, Fowlers position – to drain lochia and prevent pooling of infected discharge, Administer antibiotics and analgesics
• Urinary infection


  • Signs and symptoms: Burning sensation on urination, Hematuria, Feeling of frequency, Lower abdominal pain, Low or high fever
• Management of Urinary infection

  Increase oral fluid intake, Perineal hygiene, Administer analgesics and antibiotics
• Thrombophlebitis


  Infection of the lining of a blood vessel with formation of clots, usually an extension of endometritis/endometrial infection
• Thrombophlebitis


  • Signs and symptoms: Pain, stiffness and redness in the affected part of the leg, Positive Homan's sign
• Management of Thrombophlebitis


  Good aseptic technique, Ambulation and limiting the time in the stirrups, Wearing support stockings (2 weeks), Bedrest, Administer anticoagulants (decumarol, heparin), Administer analgesics
• Mastitis


  Manifestations: Initial symptoms may be flu-like, Fatigue and aching muscles, Fever of 38.4° C , chills, malaise, and headache, Characterized by a localized area of redness and inflammation
• Therapeutic Management of Mastitis


  Antibiotic therapy, Continued emptying of the breast by breastfeeding or breast pump, Application of heat or ice packs, breast support, and analgesics
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