Ch.33 PostPartum Complications

• PPH:

  • Blood loss of > or = _
  • S/S of H_ within _ hrs of birth
  • Maternal M_ and M_
  • Early, acute, or primary - W_ _hrs
  • Late or secondary PPH - more than _hrs but up to _wks after birth?

  1000, hypovolemia, 24, morbidity, mortality, within 24, 24, 12
• PPH:

  • Make sure P_ is F_ O_
  • Note A_ of B_ on P_
  • S_ and beyond _ pad is bad?

  placenta, fully out, amount, blood, pad, saturation, 1
• PPH Causes:

  • U_ A_
  • P_ C_
  • L_ of the G_ T_
  • H_
  • I_ of the U_
  • S_ of the U_?

  uterine atony, placental complications, lacerations, genital tract, hematomas, inversion, uterus, subinvolution uterus
• PPH (Unusual Adherent Placenta)

  • A_ - S_ penetration
  • I_ - D_ penetration
  • P _ - P_ of myometrium?

  accreta, slight, increta, deep, percreta, perforation
• PPH (Uterine Atony)

  • M_ F_
  • B_ E_
  • U_
  • M_
  • H_
  • C_
  • P_?
  • massage fundus, empty bladder, uterotonics, methergine, hemabate, cytotec, pitocin
• PPH (Lacerations of Genital Tract)

  • C_
  • S_ but F_ U_?

  cervical, spotting, firm uterus
• PPH (Inversion of Uterus):

  • I_ O_
  • C_ out of U_
  • T_ and P_ B_ U_ then U_ med?

  inside out, coming, uterus, terbutaline, push back up, uterotonic
• PPH (Subinvolution of Uterus):

  • L_ P_ bleeding
  • P_ L_ D_ longer than _ days
  • I_ or E_ bleeding?

  late pp, prolonged lochial discharge, 3, irregular, excessive
• PPH Risks:

  • O_ of the uterus
  • A_ or A_
  • L_ L_ of _ to _ hrs
  • O_
  • T_ during birth
  • P_ complications
  • U_ complications
  • M_ S_
  • C_
  • L_ U_
  • F_ to progress _ stage
  • F_ D_ in U_
  • High B_?

  overdistention, anesthesia, analgesia, long labor, 24, 36, obesity, trauma, placenta, uterus, mag sulfate, chorioitis, lacerations unrepaired, failure, 2, fetal death, utero, bp
• PPH Screening:

  • O_ A_
  • _ to _ min before D_
  • P_ B_?

  on admission, 30, 60, delivery, post birth
• PPH Management:

  • M_ F_
  • E_ B_
  • I_ of _ to _ units of O_ added to _ ml IV fluid
  • U_ meds such as M_, C_, H_, and T A_
  • L_ B_ IV
  • B_ or H_ if needed?

  massage fundus, empty bladder, iv, 10, 40, oxytocin, 1000, uterotonic, methergine, cytotec, hemabate, t acid, large bore, balloon, hysterectomy
• PPH Interventions:

  • Positioning
  • S_ or T_
  • Bad VS
  • P_ with H_
  • _ bp, _hr, _ output
  • Avoid H_ with A_?

  supine, trendelenberg, pale, hem, low, high, low, hemabate, asthma
• Hemorrhagic (Hypovolemic) Shock:

  • Results from H_ and is an E_
  • Problematic when N_ R_ or D_ L_ and A_
  • Monitor P_ and B_
  • F_ and B_ R_
  • Careful _ and _
  • Restore _ delivery and maintain C_ O_?

  hemorrhage, emergency, no response, decrease loc, activity, pulse, bp, fluid, blood replacement, i, o, oxygen, cardiac output
• Hemorrhagic (Hypovolemic) Shock:

  • Early parameters of Shock:
  • R_ - R_ and S_
  • H_ - R_, W_, I_
  • B_ - L_
  • C_ and C_ skin
  • L_ U_ output
  • L_ to C_
  • A_ to C_?
  • rr, rapid, shallow, hr, rapid, weak, irregular, bp, low, cold, clammy, low urine, lethargic, coma, anxiety, coma
• Care of Women with PPH:

  • V_
  • A_ F_
  • A_ and P_ D_
  • D_ L_
  • L_ of S_ with H_
  • Watch for D_?

  vitamins, address fatigue, anxiety, pp depression, delayed lactogenesis, lots, support, hysterectomy, dic
• DIC (Disseminated Intravascular Coagulation):

  • Bleeding from D_ A_ such as E_, N_, I_ S_
  • Triggered by O_ E_ such as A_, P_, I_, S_, and A_ F_ E_?

  different areas, ear, nose, iv site, other event, abruption, preeclampsia, IUFD, sepsis, amnio fluid embolism
• DIC (Disseminated Intravascular Coagulation):

  • Symptoms
  • T_
  • L_ B_
  • B_ and P_
  • O_ at I_ S_
  • P_ C_
  • R_ I_
  • D_ and C_
  • C_
  • G_ B_ and H_?
  • tachycardia, low bp, bruising, petechia, oozing, iv site, peripheral cyanosis, renal impairment, drowsy, confused, coma, GI bleeding, hematuria
• DIC (Disseminated Intravascular Coagulation):

  • Labs
  • Low P_ and F_
  • Prolonged P_ and A_ P_ T_
  • Increased F_ S_ and D_?
  • platelet, fibrinogen, prothrombin, activated partial thromboplastin, fibrin split, d-dimer
• Thromboembolic Disease:

  • Idiopathic Thrombocytopenic Purpura
  • A_ A_ decrease P_ life
  • Von Wildebrand
  • C_ that D_ of blood clotting P_
  • Venous
  • Caused by I_ that is I_ of blood V_
  • Superficial venous thrombosis
  • P_ and T_
  • W_ and R_
  • R_ and E_ L_
  • C_ and N_?
  • antiplatelet antibodies, platelet, congenital, defect, protein, inflammation, inside, blood vessel, pain, tenderness, warm, red, rest, elevate leg, compression, NSAIDs
• DVT:

  • U_ L_ P_
  • C_ T_
  • S_, R_, W_
  • P_ H_
  • C_
  • B_ and E_
  • Avoid R_ A_ and S_ with legs S_ F_?

  unilateral leg pain, calf tenderness, swelling, red, warm, positive homan, coagulation, bed, elevate, rubbing area, siting, slightly flexed
• Pulmonary Embolism:

  • D_ and carried to P_ A_
  • D_ and T_
  • T_ and A_
  • C_ P_, C_, H_
  • E_ T_ and S_
  • C_?

  dislodges, pulmonary artery, dyspnea, tachypnea, tachycardia, apprehension, chest pain, cough, hemoptysis, elevated temp, syncope, coagulation
• Postpartum Infection:

  • Risks
  • P_ R_ and L_
  • C_
  • C_
  • R_ P_
  • P_
  • P_ T_
  • C S_
  • I_ M_
  • V_ E_
  • N_
  • P_
  • D_
  • P_
  • H_
  • A_?
  • prolonged rom, labor, chorio, cath, retained placenta, pph, perineal trauma, section, interval monitoring, vag exams, nutrition, pep, diabetes, pneumonia, hx, anemia
• PP Infection:

  • Occurs with _ days of birth
  • Presence of fever _ C or _ F or more on _ successive days of first _ pp days but no _ _hrs after birth?

  28, 38, 100.4, 2, 10, 1st 24
• PP Infection (Mastitis)

  • B_ I_
  • F_, M_
  • F_ L_ symptoms
  • S_ A_ in the breast?

  breast infection, fever, malaise, flu-like, sore are
• PP infection (Endometritis)

  • I_ of the U_
  • F_, I_ P_
  • C_, A_, N_, F_
  • L_, P_ P_
  • U_ T_, F_ S_?

  infection, uterus, fever, increased pulse, chills, anorexia, nausea, fatigue, lethargy, pelvic pain, uterine tenderness, foul-smelling
• PP Infection (UTI)

  • D_
  • F_ and U_
  • L_ G_ F_
  • U_ R_
  • H_ and P_?

  dysuria, frequency, urgency, low grade fever, urinary retention, hematuria, pyuria
• PP Infection Wound:

  • F_, E_, E_
  • W_, T_, P_
  • S_ P_ D_
  • W_ S_
  • C S_ and P_?

  fever, erythema, edema, warmth, tenderness, pain, sero purulent drainage, wound separation, section, prom
• PP Infection Interventions

  • A_
  • R_
  • A_ P_
  • F_
  • A_ D_?

  antibiotics, rest, anti pyretic, fluids, adequate diet