Presentation is loading. Please wait.

Presentation is loading. Please wait.

Chapter 17 Postpartum Complications Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1.

Similar presentations


Presentation on theme: "Chapter 17 Postpartum Complications Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1."— Presentation transcript:

1 Chapter 17 Postpartum Complications Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1

2 Effects of Hemorrhage Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 2

3 Objectives  Define key terms listed.  List three major causes of postpartum hemorrhage.  Identify nursing interventions in the care of the woman with postpartum hemorrhage.  Describe the dangers that deep vein thrombosis presents.  Explain the nursing care of a woman who has a thromboembolism. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 3

4 Common Postpartum Complications  Hemorrhage  Thromboembolic disorders  Subinvolution of uterus  Infections  Depression Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 4

5 Postpartum Hemorrhage  Blood loss of  More than 500 mL after uncomplicated vaginal birth  1000 mL after a cesarean birth  Can occur  Early (first 24 hours after delivery)  Late (between 24 hours and 6 weeks after birth) Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 5

6 Causes of Postpartum Hemorrhage  Early: uterine atony and laceration  Late: retained placental fragment or subinvolution Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 6

7 Management of Hypovolemic Shock  Recognize specific cause  Stop blood loss  Start IV fluids  Monitor vital signs  Provide supplemental oxygen  Insert indwelling Foley catheter Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 7

8 Early Postpartum Hemorrhage Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 8

9 Uterine Atony and Causes  Inability of myometrium muscle to contract and stay contracted around open blood vessels  Mechanical factors include Retained placental fragments Large blood clots Extreme uterine distention (multifetal) Full urinary bladder  Metabolic factors Muscle exhaustion due to lactic acid buildup Hypocalcemia  Drugs Magnesium sulfate Calcium channel blockers Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 9

10 Trauma and Lacerations  Includes vaginal, cervical, and perineal  Suspect when excessive bleeding occurs and uterus is firm  Vaginal bleeding typically bright red  Lochia is dark red, not profuse or continuous  Monitor for signs of shock Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 10

11 Retained Placenta  Prevents uterus from contracting effectively  Oxytocics given to expel fragments of placenta  May require D&E to remove remaining fragments  Placenta accreta may result in profuse bleeding and may require hysterectomy Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 11

12 Hematoma  May result from injury to blood vessels in perineum or vagina  If in soft tissue, will typically see bulging, bluish mass  Can contain between 250 and 500 mL of blood  Perineal pain is a distinguishing characteristic  May not be able to void or defecate Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 12

13 Late Postpartum Hemorrhage  Typically a result of subinvolution  Could be caused by a vascular area, retained placental fragments, infection  Fundus may appear higher than expected with persistent lochia rubra  Infection may manifested by a foul odor Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 13

14 Subinvolution of the Uterus  Occurs when uterus fails to return to its nonpregnant size  May result from  Small retained placental fragment  Mild endometritis  Excessively vigorous massage Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 14

15 Disseminated Intravascular Coagulation (DIC)  Clotting and anticoagulation stimulation occur at the same time  Release of thromboplastin uses up available fibrinogen and platelets  Results in profuse bleeding and intravascular clotting  Often secondary condition associated with  Abruptio placentae  Gestational hypertension  Missed abortion  Fetal demise Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 15

16 Signs of DIC  Oozing from IV insertion site  Petechiae  Ecchymosis  Oliguria  Restlessness  In pregnancy and early postpartum, shock is considered late sign of DIC Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 16

17 Von Willebrand’s Disease  Inherited disorder  Decrease in plasma factor VIII (essential for proper platelet function)  History of easy bruising, frequent nosebleeds, heavy menses  Symptoms may be masked during pregnancy  Hemorrhage from this disease is treated with cryoprecipitate to raise factor VIII levels in the blood Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 17

18 Anaphylactoid Syndrome of Pregnancy  Known as amniotic fluid embolism  Caused by unanticipated entrance of amniotic fluid into maternal circulation  Triggers release of mediators that cause pulmonary artery vasospasm and hypoxia  Can lead to myocardial damage, especially in the left side of the mother’s heart Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 18

19 Prevention of Hemorrhage  Prophylactic administration of uterotonic drugs (oxytocin) after placenta delivered  Early clamping of cord and assisted delivery of placenta  Massage of uterine fundus  Observation for and prevention of bladder distention Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 19

20 Assessment and Management of Postpartum Hemorrhage  Monitor vital signs, I&O, level of consciousness  Weigh peripads (1 g = 1 mL of blood)  Massage fundus until firm; express clots  Medications may be required to stop the bleeding Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 20

21 Thrombophlebitis and Thromboembolism  Thrombophlebitis: inflammation of inner blood vessel wall with a blood clot attached to it  When clot tears away from vessel wall and moves into blood circulation, it is called a thrombus  If ends up in lungs, it is a pulmonary embolus, a common postpartum complication Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 21

22 Assessment and Nursing Care  Subjective signs of pain on palpation of calves and when foot is passively dorsiflexed  May be indicative of Homans’ sign  Can have a deep vein thrombosis (DVT) in absence of Homans’ sign  Compare pulses and size in both lower extremities  May note increased diameter of 1 leg from edema due to venous inflammation  If pain extends above knee, it is indicative of DVT Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 22

23 Management  Superficial venous thrombosis  Rest  Antiembolism stockings  Analgesics for comfort  Elevation of leg  Frequent ambulation to help prevent clots  DVT  Anticoagulation therapy  Monitoring of serum for clotting factors (i.e., PT, PTT, INR) Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 23

24 Pulmonary Embolism  1 of 3 leading causes of maternal death (others are hemorrhage and gestational hypertension)  Embolism can occlude vessel and obstruct blood flow into lungs  Embolectomy may be required  What are the signs and symptoms? Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 24

25 Risk Factors for Postpartum Hemorrhage  Risk factors for postpartum hemorrhage include:  Hydramnios  Bladder distention  Macrosomia  Uterine atony Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 25

26 Audience Response System Question 1 This type of embolism can cause significant damage to the heart of a postpartum woman. A.Pulmonary fluid B.Cerebral C.Amniotic fluid D.Aortal Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 26

27 Puerperal Infections/Depression Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 27

28 Objectives  List four common sites for puerperal infection.  Describe predisposing factors for infections of the reproductive system.  Discuss the nursing care of a woman who has an infected episiotomy.  Compare postpartum blues with postpartum psychosis. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 28

29 Puerperal Sepsis  Puerperal infection (fever)  Bacterial infections arising in genital tract after delivery  Infections other than genital tract  Mastitis  Urinary tract infection  Symptoms include  Fever of 38° C (100.4° F) or higher after first 24 hours following delivery  Fever persisting for at least 2 days within the first 10 days postpartum Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 29

30 Postpartum (Puerperal) Infection  Associated risk factors  Physiologic changes during pregnancy increase risk  Labor: amniotic fluid, blood, lochia decrease acidity of vagina, thus increasing growth of pathogens; premature rupture of membranes  Most women do not get an infection because of granulocytes in the lochia and endometrium  Prevention  Meticulous adherence to aseptic techniques, hand hygiene, and perineal care  Minimize number of vaginal examinations Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 30

31 Endometritis  Infection of endometrial lining, decidua, and adjacent myometrium of uterus  Symptoms begin 2nd to 5th day postpartum  Uterine tenderness and enlargement  Foul odor or purulent lochia  Malaise, fatigue, tachycardia  Temperature elevation Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 31

32 Wound Infection  Common in women with history of chorioamnionitis, intraamniotic infection, hemorrhage, diabetes mellitus, and obesity  Multiple vaginal examinations  Most common sites  Perineum  Cesarean incision site Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 32

33 Assessment and Management  REEDA  Redness  Edema  Ecchymosis  Discharge  Approximation  Necrotizing fasciitis is serious complication Blue discoloration and numbness of wound edges Aggressive treatment is essential  Patients with chorioamnionitis and endometritis are at risk for septic shock Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 33

34 Urinary Tract Infection and Pyelonephritis  Can occur after birth from hypotonia of bladder, urinary stasis, birth trauma, catheterization, frequent vaginal examinations, or epidural anesthesia  Symptoms: dysuria, frequency, urgency, and low- grade fever  Pyelonephritis: the above symptoms plus  Costovertebral angle tenderness, chills, fever, malaise, hematuria, nausea, and vomiting Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 34

35 Mastitis  Usually occurs around 2 to 3 weeks after birth  Interlobular connective tissue of 1 breast usually involved  Painful or tender localized hard mass; reddened area  Fever, chills, and malaise  Causes  Milk stasis  Nipple trauma  Poor breastfeeding technique  Inadequate handwashing Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 35

36 Care of Mastitis  Antibiotics  In many cases, can continue to breastfeed from both breasts  Ice or warm packs  Moist heat promotes comfort and increases circulation Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 36

37 Postpartum Blues  Transient state; rarely lasts more than 10 to 14 days  May complain of feeling overwhelmed and unable to cope, and may be oversensitive with periods of unexplained tearfulness  Treatment: rest, anticipatory guidance, empathy, reassurance, support, and assistance Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 37

38 Postpartum Depression  Includes general signs of depression such as weight loss, sleeplessness, and ambivalence  Women at high risk  Have unstable or abusive family environment  History of previous depressive episode  History of limited support system  Low self-esteem  Dissatisfaction with education, economics, or partner Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 38

39 Postpartum Psychosis  Similar to other psychoses  Early signs of depression or may start abruptly within 3 weeks following birth  Confusion, restlessness, anxiety, and suicidal thoughts  Delusional thoughts may be expressed  Safety of woman and her newborn are at risk  Psychiatric interventions, including medications Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 39

40 The Nurse’s Role  Provide support and referral  Encourage woman to express feelings, provide validation, address personal conflicts, and reinforce personal power and autonomy  A woman’s culture, experiences, and coping strategies influence her adjustment to becoming a mother  Above all, listen to what the woman is saying, verbally and with her body language Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 40

41 Discussion What type of infection typically begins 2 to 5 days postpartum? A.Endometritis B.Mastitis C.Pyelonephritis D.Chorioamnionitis Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 41

42 Review Key Points Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 42


Download ppt "Chapter 17 Postpartum Complications Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1."

Similar presentations


Ads by Google