← PN2150 CHAPTER 8 HIGH RISK POSTPARTUM CARE Export Options Alphabetize Word-Def Delimiter Tab Comma Custom Def-Word Delimiter New Line Semicolon Custom Data Copy and paste the text below. It is read-only. Select All UTERINE ATONY Lack of uterine muscle tone and firmness. DISSEMINATED INTRAVASCULAR COAGULATION (DIC) This is an over activation of blood clotting mechanism resulting in depletion of clotting factors & platelets. Hemorrhaging and clotting continuously. Give IV fluids, transfusions, Oxygen & anticoagulants. DIC Post partum patients with Abruptio placentae, missed abortions, eclampsia & hydataform mole are at higher risk for this blood condition, which will cause hemorrhageing MASTITIS Infection or inflammation of the breasts. Most commonly caused by StaphyloccusAaureus, Haemophilus Parinfluenzae, Haemophilus Influenza & Streptococcus MASTITIS This inflammation of the breast is usually unilateral, more likely to occur in 1st time breast feeding moms, 2-4 weeks after delivery (when mature milk shows). Can continue to breast feed unless an abscess forms. MASTITIS S & S of this postpartum infection is: pain, fever, head ache, flue-like symptoms, red, swollen area on breast that is warm to touch, red streaks on breast. Abscess may form. POSTPARTUM (puerperal) INFECTION Rare infection. Begins in vagina & migrates upward into uterus (endometritis), pelvic, lymph nodes, peritoneum (peritonitis) & circulation. Organisms grow in the blood & disease progresses to septicemia. Takes several days for symptoms to begin. ENDOMETRITIS Inflammation of the endometrium, can lead to septicemia. Can be caused from prolonged ROM (Rupture of Membrane). ENDOMETRITIS Infection in genital tract or birth canal that occurs after miscarriage, abortion or child birth. ENDOMETRITIS S & S of this postpartum (puerperal) infection is: Fever 100.4 or higher, chills, pelvic & ab pain, foul smelling lochia, prolonged lochia serosa & alba. ENDOMETRITIS Most common postpartum (puerperal) infection SEPTICEMIA organisms growing in the blood PERITONITIS Infection in the peritoneum CLONUS Spasms or seizures PRE-ECLAMPSIA this (B/P) problem can become worse in 24-48 hours after delivery. Must check B/P, Reflexes, Clonus, Protein in urine. Can cause seizures, stroke, kidney damage & liver damage. May keep mother on Magnesium Sulfate. TACHYCARDIA the FIRST vital sign to change if client is experiencing hemorrhaging will be: HEMORRHAGE the leading cause of post partum maternal morbidity in the US is: >500mL Excessive blood loss for vaginal delivery (indicating hemorrhage) is: >1,000 mL Excessive blood loss for C-section delivery (indicating hemorrhage) is: RETAINED PLACENTA Most common of cause of Postpartum hemorrhage within the first hour after delivery is: RETAINED PLACENTA, UTERINE ATONY & LACERATIONS The 3 most common causes of Postpartum hemorrhage after delivery are, (in order): RETAINED PLACENTA This is when all or part of the placenta remains attached to the decidua. Causes hemorrhaging. Signs: High uterus, Lochia does not change from Rubra to Serosa lochia. Intervention: D &C RETAINED PLACENTA This is when all or part of the placenta or fetal membranes remain attached to endometrium. Occasionally one or more of the cotyledons remain attached. They continue to bleed. Uterus recognizes the intact placenta tissue and fails to contract to stop the bleeding. UTERINE ATONY This is a Hypotonic uterus. Uterus does not fully contract. Causes hemorrhaging. Myometrium fibers flaccid & will not compress bleeding vessels. S & S: Boggy uterus. If left untreated causes hemorrhage & uterine inversion. Intervention: 1) Fundal massage 2) pitocin or methergine 3) Bimanual massage (inside & out) UTERINE ATONY This is when the uterus becomes tired of contracting & no longer responds to hormonal stimulation. Follows long labors, multifetal pregnancy, large fetus or many pregnancies in short period of time. Uterus does not fully contract following delivery of placenta. Fundus can become firm but looses tone quickly, resulting in free flow of bright red blood. May need pitocin or methergine. LACERATIONS This cause of Postpartum hemorrhaging are wounds in perineum, vagina, cervix or periurethral area. Causes are precipitous labor and or pushing too soon or too hard. S & S: Fundus is in correct place but there is a continuous trickle of blood. LACERATIONS Postpartum hemorrhaging signs are: Fundus in correct place but there is a continuous trickle of blood UTERINE ATONY S & S of this Postpartum hemorrhaging is: Boggy uterus RETAINED PLACENTA This Postpartum hemorrhaging signs are: High uterus, lochia does not change colors. COMPLETE RUPTURE This is a hole thru the uterine wall, from abdominal cavity to abdominal wall. The hole is open to the abdominal cavity, Causes can be: C-sections or previous C-sections, pitocin & multiple pregnancies & trauma. DEHISCENCE This can happen at the site of an old uterine scar, usually from a previous C-section. Can also be caused by a wound infection at laceration, episiotomy or cesarean incision site. COMPLETE RUPTURE & DEHISCENCE Two types of Uterine ruptures UTERINE RUPTURE S & S of this are: Shock , Abdominal pain, scapula pain, cessation of Uterine Contractions (UC's) and Abnormal or absent Fetal Heart Tones (FHT's). AMNIOTIC FLUID EMBOLISM This occurs when amniotic fluid enters the woman's circulation & typically obstructs small blood vessels in her lungs. S & S: Abrupt hypotension, resp distress & coagulation abnormalities. POSTPARTUM DEPRESSION This can appear 4 weeks after delivery AND/OR upon weaning from the breast. Will not go away by itself. SS: sadness, crying, insomnia or excessive sleep, appetite change, dif. Concentrating, feel worthless, lack of interest, lack of concern. 10-15% of Moms get it POSTPARTUM PSYCHOSIS This is a major psychiatric disorder evident in the first three months after delivery. Is a break with reality. Considered an emergency because of risk of suicide and infanticide. DIABETES Postpartum Moms with _______ will need more frequent monitoring of blood sugars and adjustments in insulin (or orals) until their condition has stabilized and values remain within normal limits. 24-48 HOURS Woman with pre-eclampsia (usually during pregnancy) can become worse during this time frame after delivery. Check B/P, reflexes & clonus every 2-4 hours. Check protein in urine each void & continue meds & monitor carefully.