chapter 25 - maternal semi-final

• Puerperium


  The period of about six weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition
• Perineum


  The area of the body between the anus and the vulva
• Episiotomy


  A cut (incision) through the area between your vaginal opening and your anus (perineum)
• Dyspareunia


  Painful intercourse
• Endometritis


  Infection of endometrium
• Common Postpartum Complications


  • Postpartum Hemorrhages
  • Puerperal Infections
  • Thrombophlebitis
  • Pulmonary Embolism
  • Mastitis
  • Urinary System Disorders
  • Cardiovascular System Disorders
  • Reproductive System Disorders
  • Emotional and Psychological Complications

  
• Postpartum Hemorrhage


  Any blood loss from the uterus greater than 1,000ml following Normal Delivery /CS, or a change in hematocrit by 10%, occurs early or late

  
• Uterine Atony


  Relaxation of the uterus, when your uterine muscles do not contract enough to clamp the placental blood vessels shut, leading to a steady loss of blood after delivery
• Therapeutic Management of Uterine Atony

  1. Catheterization (to drain the bladder) uterus deviate to the right

  2. Fundal massage

  3. Drugs (Ohh My HeMorrhage!)

  4. Elevate lower extremeties

  5. Administer O2 inhalation (10-12L/min)

  6. V/S monitoring

  7. Bimanual Compression

  8. Blood Transfusion

  9. Hysterectomy / Suturing
• Bimanual Compression


  Inserting one hand into the vagina while other hand is pushing against the fundus through the abdominal wall
• Lacerations


  Due to precipitate birth, primigravida, large infant, instrument assisted delivery

  
• 3 Sites of Laceration

  • Cervical Laceration
  • Vaginal Laceration
  • Perineal Laceration
• Cervical Laceration


  Usually found on the sides of the cervix, near the branches of uterine artery, usually bright red, ordinarily occurs immediately after detachment of the placenta, repair (SUTURING) usually in the OR (regional anesthesia)

  
• Vaginal Laceration


  Easier view, easy to locate, vaginal repair, indwelling catheter (foley cath) may be placed after repair, if packing is indicated make sure to document in charting/documentation (removed 24-48 hrs)

  
• Perineal Laceration


  Commonly occurs when in lithotomy position, sutired the same with episiotomy repair, document degree of laceration
• Vulvar Hematomas


  Collection of blood below the epidermis of vulva, purplish discoloration with swelling, report presence of hematoma (note size & degree), administer analgesic as prescribed, apply ice pack (covered with towel to prevent thermal injury to the skin), (if large) incision of hematoma (under anesthesia) – suture care by keeping it clean and dry, sitz bath

  
• Retained Placental Fragments


  Retained fragments keep uterus from contracting – bleeding occurs, every placental should be inspected carefully after birth to be certain it is complete, ultrasound – to check for retained placenta, blood serum sample – to detect hCG, therapeutic management: D&C, observe color of LOCHIA (Rubra, Serosa, Alba), Methotrexate – to destroy retained placental tissue, balloon occlusion and embolization of internal iliac arteries, if deeply attached (Accreta)-Hysterectomy

  
• Subinvolution


  A medical condition in which after childbirth, the uterus does not return to its normal size/shape, resulted from a small retained placental fragments, a mild endometritis, or uterine myoma that is interfering complete contraction
• Therapeutic Management of Subinvolution

  Oral administration of methylergonovine, 0.2mg 4x daily, oral antibiotic
• Uterine Inversion


  Occurs when the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out
• Puerperal Infections


  Infection of the reproductive tract, another major cause of maternal death, risk for infection is greater if tissue edema and trauma are present, prognosis for recovery depends on woman's general health, virulence of the invading microorganism, portal of entry, degree of uterine involvement
• Endometritis


  Infection of the endometrium (lining of the uterus), usually associated with chorioamnionitis and CS birth

  
• Therapeutic Management of Endometritis

  Antibiotic (Clindamycin), Oxytocic agent (Methergine), Increase Fluid, Analgesic – for pain relief, Sitting in Semi-fowler's position or walking – encourages lochia drainage by gravity, Wear gloves when changing perineal pad, Good handwashing techniques
• Infection of the Perineum

  From suture line in her perineum from an episiotomy or a laceration repair
• Therapeutic Management of Perineal Infection


  Open site for drainage and apply packaging such as iodoform gauze, Application of systemic or local antibiotic, Analgesic to alleviate discomfort, Sitz bath, moist warm compress or Hubbard tank treatments – to hasten drainage and cleanse the area, Change perineal pads daily and wipe from front to back
• Peritonitis


  Infection of the peritoneal cavity, gravest complication of childbearing and major cause of puerperal infection
• Therapeutic Management of Peritonitis

  Insertion of nasogastric tube (NGT) – to prevent vomiting and rest the bowel, IVF or Total Parenteral Nutrition (TPN) is necessary, Analgesic – for pain relief, Antibiotics
• Thrombophlebitis

  Phlebitis – inflammation of the lining of the blood vessels, Thrombophlebitis – inflammation with the formation of blood clots, Classification: Superficial Vein Disease (SVD) or Deep Vein Thrombosis (DVT)

  
• Femoral Thrombophlebitis


  Femoral, saphenous or popliteal veins are involved, Formerly called, milk leg or phlegmasia alba dolens (white inflammation), The decreased circulation and edema – impairs the venous return
• Insertion of nasogastric tube (NGT)

  To prevent vomiting and rest the bowel
• Analgesic


  For pain relief
• Thrombophlebitis


  Inflammation with the formation of blood clots
• Thrombophlebitis


  • Can be classified as Superficial Vein Disease (SVD) or Deep Vein Thrombosis (DVT)
• Prevention of thrombophlebitis


  1. Good aseptic technique during childbirth

  2. Ambulation

  3. Limiting time in obstetric stirrup

  4. Wearing support stockings for 2 weeks after birth

  5. Having an exercise program
• Femoral Thrombophlebitis


  • Involves the femoral, saphenous or popliteal veins
  • Formerly called milk leg or phlegmasia alba dolens (white inflammation)
  • Accompanying arterial spasm often occurs, diminishing arterial circulation to the leg
• Pelvic Thrombophlebitis


  • Involves the ovarian, uterine, or hypogastric vein
  • Usually follows a mild endometritis and occurs later than femoral thrombophlebitis often around 14th – 15th day puerperium

  
• Pulmonary Embolus


  Obstruction of the pulmonary artery by a blood clot; usually occurs as a complication of thrombophlebitis
• Mastitis


  Infection of the breast
• Measures to Prevent Mastitis

  1. Making certain the baby is positioned correctly and grasps the nipple and areola properly

  2. Helping a baby release a grasp on the nipple before removing the baby from the breast

  3. Handwashing between touching the breasts and handling perineal pads

  4. Exposing nipples to air

  5. Using Vitamin E ointment to soften nipples

  
• Urinary Retention


  • Occurs as a result of inadequate bladder emptying
  • Output less than 100 ml