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Lowdermilk: Maternity Nursing, 8th Edition

Chapter 23: Postpartum Complications


Key Points Print
Postpartum hemorrhage, a life-threatening event, often goes unrecognized until the
mother has profound symptoms.
Causes of postpartum hemorrhage include uterine atony, genital tract lacerations,
retained placenta, inversion of the uterus, and subinvolution of the uterus.
Hemorrhage may lead to hemorrhagic shock, also called hypovolemic shock.
The classic signs of hemorrhagic shock may not appear until the postpartum woman has
lost as much as 40% of her blood volume.
When postpartum bleeding continues and the source cannot be identified, the womans
coagulation status should be assessed.
In the last 20 years, the incidence of postpartum thromboembolic disease has decreased
because early ambulation after childbirth has become standard practice.
The most common postpartum infection is endometritis. Other infections include wound
infections, urinary tract infections, and mastitis.
Uterine displacement and prolapse may result from congenital or acquired weakness of
the pelvic support structures.
The incidence of urinary incontinence is higher among women who have given birth
than among nulliparous women.
Bladder training and pelvic muscle exercises, called Kegel exercises, may reduce or
relieve mild to moderate urinary incontinence.
During the postpartum period, new mothers may experience mood disorders. Nurses
should offer anticipatory guidance, assess the mental health of the mother, offer
therapeutic interventions, and provide referral if necessary.
A mother may experience postpartum depression with or without psychotic features.
Postpartum depression often goes undetected because women are hesitant to report its
symptoms.
Suicidal thoughts require immediate assessment and intervention.
Women who have postpartum depression are usually treated with antidepressant drug
therapy.

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