1. postpartum complication
Dr. Miada Mahmoud Rady

2. Uterine Inversion
Definition : turning of uterus inside out due to failure of the placenta to detach properly from the uterine wall when it is expelled.
Severity graded by how much the uterus has reversed itself.
Very painful and may rapidly cause shock.

3. Management Keep the patient recumbent.
Administer 100% supplemental oxygen.
Start two IV lines with normal saline.
Do not attempt to remove placenta if still attached to the uterus.
Carefully monitor vital signs.
Consider Oxytocin to control hemorrhage.
Make one attempt to replace the uterus.

4. Postpartum Hemorrhage
Definition : Blood loss exceeds 500 mL during first 24 hours after birth
Can be either early or late hemorrhage
Early: bleeding within 24 hours of delivery
Late: bleeding occurring from 24 hours to 6 weeks after delivery

5. Postpartum Hemorrhage
Causes of postpartum hemorrhage include:
Prolonged labor or multiple baby deliver
Retained products of conception
Placenta previa
Full bladder

6. Postpartum Hemorrhage management
Continue uterine massage.
Encourage the woman to breastfeed.
Notify the receiving facility of status.
Transport immediately.
Add a large-bore IV line en route.

7. Pulmonary Embolism
Frequently caused by a clot arising in pelvic circulation from:
Amniotic embolism
Pregnancy induced venous thromboembolism
Water embolism

8. Pulmonary Embolism clinical presentation
Suspect if a woman in the postpartum state experiences:
Sudden dyspnea
Tachycardia
Atrial fibrillation
Hypotension and syncope.
Sharp, sudden chest or abdominal pain

9. Postpartum Depression
May appear up to 1 year after birth
Signs and symptoms include:
Signs similar to others with depression
Anger directed toward the infant
Little or no interest in the infant
Thoughts of harming themselves or their infant

10. Trauma and Pregnancy Trauma is a complicating factor in pregnancy.
Leading cause of maternal death in United States

11. Pathophysiology and Assessment Considerations
Anatomic changes are important in trauma.
Abdominal contents compress into upper abdomen.
Diaphragm elevates by about 1.5 inches.
Peritoneum maximally stretches.

12. Pathophysiology and Assessment Considerations
Pregnant patients will have different signs or responses to trauma.
May be more difficult to interpret tachycardia
Signs of hypovolemia may be hidden.
Higher chance of bleeding to death in case of pelvic fractures
Respiratory rate less than 20 breaths/min is not adequate.

13. Considerations for the Fetus and Trauma
Fetal injury can occur from:
Rapid deceleration
Impaired fetal circulation
If a pregnant woman has massive bleeding, maternal circulation will reroute blood from the fetus.

14. Considerations for the Fetus and Trauma
Fetal heart rate is the best indication of fetal status after trauma.
Normal fetal heart rate is between 120 and 160 beats/min.
Rate slower than 120 beats/min means fetal distress and a dire emergency.

15. Management of the Pregnant Trauma Patient
Can only treat the woman directly
Determine gestational age of fetus if possible.
Transport a pregnant woman on left side if no spinal injury is suspected.

17. Management of the Pregnant Trauma Patient
Ensure adequate airway.
Administer oxygen.
Assist ventilations when needed and provide a higher-than-usual minute volume.
Control external bleeding and splint fractures.

18. Management of the Pregnant Trauma Patient
Start one or two IV lines of normal saline.
Inform the receiving facility of the patient’s status and estimated time of arrival.
Transport the patient in the lateral recumbent position.

19. Postpartum Complications
Maternal cardiac arrest
Provide CPR and ALS like any other trauma patient.
CPR and ventilator support may keep the fetus viable, even if the mother is already dead.