m3&4

• Post partum (or postnatal) period


  Begins immediately after childbirth as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state
• Women experiencing postpartal complications

  • Subject to difficulty in bonding with her child
• Post partum complications


  • Always potentially serious because they can impact so many people
  • A complication may be serious it could cause a personal injury
  • Leave a woman with her future fertility impaired or even lead to death
• Women are very susceptible to hemorrhage and thrombophlebitis in the post partum period
• Nursing Care of a woman and family experiencing a postpartal complications

  1. Postpartal / Post partum Hemorrhages

  2. Infection

  3. Thrombophlebitis

  4. Pulmonary Embolus

  5. Problem of the Psyche / Emotional & Psychological Complications
• Postpartal / Post partum Hemorrhages


  One of the primary causes of mortality associated with childbearing, a major threat during the entire pregnancy and continuing into the postpartum bleeding
• Postpartum Hemorrhage


  Blood loss of 500 ml or more following a vaginal birth, while for cesarean section blood loss of 1000 ml and decreased in hematocrit level
• Four main reasons of Hemorrhage

  • Uterine Atony
  • Trauma (Lacerations, Hematomas, Uterine Inversion or Rupture)
  • Retained Placental Fragments
  • Uterine Inversion
  • Disseminated Intravascular Coagulation (DIC)
• Uterine Atony


  Relaxation of the uterus
• Predisposing factors for Uterine Atony

  • Multiple gestation
  • A large baby
  • Polyhydramnios (excessive amount of amniotic fluid)
  • Placenta previa
  • Placenta accreta
  • Premature separation of placenta
• Therapeutic Management for Uterine Atony

  1. Remain with the woman after massaging her fundus to assess if uterus is not relaxing

  2. Call the physician if uterus does not remain contracted

  3. Administer Pitocin (Oxytocin) intravenously

  4. If Oxytocin is not effective, give Methylergonovine (Methergine)
• Nursing Considerations while giving oxytocin or methergine

  • Elevate woman's lower extremities to improve circulation
  • Offer bedpan or assist woman to the bathroom at least every 4 hours
  • Administer oxygen by facemask if woman is experiencing respiratory distress
  • Position on supine to allow adequate blood flow
• Trauma (Lacerations, Hematomas, Uterine Inversion or Rupture)


  May occur in the cervix, vagina or perineum
• Degrees of Cervical Lacerations

  • 1st degree - length of cervical rupture not over 2cm
  • 2nd degree - length of rupture >2cm but does not extend to vaginal fornices
  • 3rd degree - ruptured area extends to the vaginal fornices
• Retained Placental Fragments


  A placenta does not detach in its entirety; fragments of it separate and are left still attached to the uterus
• Uterine Inversion


  Prolapse of the fundus of the uterus through the cervix so that the uterus turns inside out
• Disseminated Intravascular Coagulation (DIC)


  Deficiency in clotting ability caused by vascular injury; usually associated with premature separation of the placenta, missed early carriage or fetal death in utero
• Subinvolution


  Incomplete return of the uterus to its prepregnant size and shape
• The 4 T's


  • Tone
  • Trauma
  • Tissue
  • Thrombin
• Endometritis


  Infection of the endometrium, the lining of the uterus; infection is usually associated with chorioamnionitis and cesarean birth
• Assessment of Endometritis


  • Fever on the 3rd and 4th day postpartum
  • Chills, loss of appetite, and general body malaise
  • Uterus is not well contracted and is painful to touch
  • Lochia - dark brown and has foul odor
• Therapeutic Management of Endometritis

  1. Administration of antibiotic such as Clindamycin (Cleocin)

  2. Oxytocin agent such as Methylergonovine to encourage uterine contraction

  3. Increase oral fluid intake to combat fever

  4. May give analgesics for pain and abdominal discomfort
• Infection of the Perineum


  Infection usually remains localized
• Assessment of Perineal Infection

  • Pain, heat and feeling of pressure
  • May or may not have elevated temperature
• Therapeutic Management of Perineal Infection

  1. Sutures may be removed to open the area and allow drainage

  2. Sitz baths, moist warm compress or Hubbard tank treatments to hasten drainage and cleanse the area

  3. Remind the woman to change perineal pads frequently

  4. Analgesic may be prescribed to alleviate discomfort
• Disseminated Intravascular Coagulation (DIC)


  Deficiency in clotting ability caused by vascular injury
• Perineal Hematomas


  Collection of blood in the subcutaneous layer of tissue of the perineum
• Puerperal Infections


  • Endometritis
  • Peritonitis
  • Thrombophlebitis
  • Pelvic Embolus
• Signs and Symptoms of Pelvic Embolus


  • Sudden sharp chest pain
  • Tachypnea
  • Tachycardia
  • Orthopnea
  • Cyanosis
• Thrombophlebitis


  Inflammation with the formation of blood clots
• Classifications of Thrombophlebitis


  • Superficial Vein Disease (SVD)
  • Deep Vein Thrombosis (DVT)
• Reasons for Thrombophlebitis in Postpartum Period

  • Woman's fibrinogen level is still elevated from pregnancy
  • Dilatation of lower extremity veins is still present
  • Develop postpartal infection
  • Preexistent obesity and a pregnancy weight gain
  • Smoke cigarettes
• Femoral Thrombophlebitis


  Inflammation of the femoral, saphenous, or popliteal veins
• Assessment of Femoral Thrombophlebitis


  • Unilateral localized symptoms such as redness, swelling, warmth and hard inflamed vessel in the affected leg
  • Symptoms present about 10 days after birth
  • Homans sign - pain in the dorsifexion of the foot is positive
• Therapeutic Management of Femoral Thrombophlebitis

  1. Administration of anticoagulants

  2. Application of moist heat to decrease inflammation

  3. Bed rest with the affected leg elevated

  4. Never massage the skin over clotted area
• Pelvic Thrombophlebitis


  Involves the ovarian, uterine or hypogastric veins
• Assessment of Pelvic Thrombophlebitis


  • Woman suddenly becomes extremely ill, with a high fever, chills, abdominal pain, weakness, and general malaise
• Therapeutic Management of Pelvic Thrombophlebitis

  1. Total bedrest

  2. Administration of analgesics, antibiotics and anticoagulants
• Pulmonary Embolus


  Obstruction of the pulmonary artery by a blood clot; occurs as a complication of thrombophlebitis
• Assessment of Pulmonary Embolus


  • Sudden, sharp chest pain
  • Tachypnea, tachycardia
  • Orthopnea (inability to breathe except in an upright position)
  • Cyanosis