POST PARTUM COMPLICATIONS

④
 Tone- uterine atony; MASSAGE, ICEPACK, OXYTOCIN
 Tissue- retained placental fragments (excreta); D&C or CURETTAGE ONLY
 Trauma- lacerations; REPAIR
 Thrombosis- blood clot; PREVENTION, AMBULATION

POST PARTUM HEMORRHAGE

 Blood loss from the uterus of more than 500 mL of blood after vaginal delivery
 1000 mL in caesarian birth
 The GREATEST DANGER in HEMORRHAGE is the first 24 HOURS

TYPES:

Early (acute primary)

 Occurs within 24 hours of the birth

 COMMON CAUSE
 Retained placental fragments
 Subinvolution- delayed return of the uterus in its non-pregnant state: 3-4 days

CAUSES:

 Tone
 Tissue
 Trauma
 Thrombosis

TONE

Uterine Atony- lacks unresisting uterus char. By soft, boggy fundus

 Overdistended
 Anesthesia & analgesia
 Infection
 Uncontracted uterus

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Subinvolution

 Delayed return of the reproductive organ into its non- pregnant state
 Usually 3-4 days

CAUSES:

 Retained placental fragments

 Pelvic infection

MANAGEMENT:

 Massage
 If un remained contracted, oxytocin 10 IU as ordered

TISSUE

Non adherent (unattached) retained placenta

CAUSES:

 Pre term gestation

 Mismanagements of the 3rd stage
 Partial separation of a normal placenta

Adherent (attached) retained placenta

CAUSES:

 Deeply attached placenta (placenta accrete)

MANAGEMENT:

 Manual exploration of uterus

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 TRAUMA

CAUSES:

 Uterine inversion
 Fundal implantation
 Vigorous fundal pressure
 Excessive traction

 Laceration
- overstretching of the uterus precipitate delivery
- tears of the birth canal
 cervical
 vaginal
 perineal

 Hematomas
- Extreme vascularity
- To assess: change in v/s

o cervical
 artery- blood loss will be brighter than red
 extensive or difficult to repair- general anesthesia

o vaginal laceration
 rare
 easier to assess
 hard to repair
 pack if there are oozing blood; icepack with gauze
 removed after 24- 48 hours

o perineal repair
 in a lithotomy position
 perineal laceration if there is no episiotomy
 can be treated as episiotomy repair
 episiorraphy

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CLASSIFICATIONS of LACERATIONS AFFECTATIONS

1ST DEGREE vaginal mucous membrane, skin of the perineum to fourchette

2ND DEGREE vagina, perineal skin, fascia, levitor ani muscles, perineal body

3rd DEGREE entire perineum, external sphincter of the rectum

4th DEGREE entire perineum, rectal sphincter, mucus membrane of the rectum

3rd & 4th degree lacerations should be done by the physician

MANAGEMENT:

PROBLEM PROCEDURE

Laceration Repair

Retained fragment D&C or C only

Subinvolution Methergine, Oxytocin, Massage

Perineal Hematomas Report, administer pain analgesics as ordered

THROMBOPHLEBITIS

 Common during pregnancy because:

- Bed rest
- Lithotomy position- ↓venous return
- ↑clotting factor during pregnancy

CAUSES:

 Pre-existing coagulation disorder

 Acquired disorders- DIC- no blood clotting, if mismanaged, may cause thrombosis during or after delivery

TEST:

 Homan’s Sign
-dorsiflex the foot; there is pain at the calf area

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PREVENTION:

 Early ambulation
 If there is pain, COMPLETE BED REST

NURSING INTERVENTION

 Instruct the mother not to massage because it can go to the lungs causing PULMONARY EMBOLISM

SIGNS & SYMPTOMS OF PULMONARY EMBOLISM:

 Sudden chest pain

 Sudden DOB
 Hypotension
 Diaphoresis

TREATMENT:

 Warm compress
 Bed rest

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 POST PARTUM INFECTION

 Any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion or
child birth
 Presence of fever of 38°c (100.4 °F) or more on 2 consecutive days

PREDISPOSING FACTORS:

Antepartal Factors:

 History of UTI
 DM
 Alcoholism and drug abuse
 Immunosuppression
 Anemia
 Malnutrition

Intrapartal Factors

 CS
 Prolonged ROM
 Catheterization
 Retained placental fragments
 Lacerations
 Internal monitor

SIGNS & SYMPTOMS

 Fever
 Foul smelling lochia or vaginal discharge
 Abdominal pain
 Body malaise
 Lack of apetite
 Perineal discomfort

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COMMON INFECTIONS

Endometritis

 Infection of the lining of the uterus

 Begins at the placenta
 Rigid abdomen

CAUSATIVE AGENT

 Day 1 or 2 group A streptococci

 Day 3 or 4 E. coli
 More than 7 days chlamydia trachomatis

MANAGEMENT:

 Administration of anti-biotic (CLINDAMYCIN)

 Sitting in semi- fowler’s or walking encourages lochia drainage
 Increase fluid to combat fever

UTI

 Inflammation of the bladder or the urethra

CAUSATIVE AGENT: E. Coli

RISK FACTORS:

 Catheterization
 Frequent pelvic exam
 Trauma
 CS
 History of UTI
 Genital tract infection

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MANAGEMENT:

 Broad spectrum antibiotic (amoxicillin or ampicillin)

 Encourage to increase fluid intake
 Analgesic to relieve pain during urination

PERITONITIS

CAUSE:

 Extension of endometritis

SIGNS & SYMPTOMS

 Rapid pulse
 Vomiting
 Rigid abdomen

MANAGEMENT:

 Insertion of NGT for vomiting

 Analgesics and antibiotics

THROMBOPHLEBITIS

 Elevated temp, chills, redness on affected leg 10 days after birth

MANAGEMENT:

 Bed rest with affected leg

 If with pain: COLD COMPRESS
 If no pain and taking antibiotics: WARM COMPRESS

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 MASTITIS

 Infection enters through cracked nipples

- Air drying promotes healing

ASSESSMENT:

 Pain, swelling, redness in the affected breast

 Fever
 Breast milk may become scant

MANAGEMENT:

 Broad spectrum antibiotics

 Continue breast milk emptying
- To avoid growth of microorganisms
 Cold compress (pain relief)
 Wear supportive Bra
 Hot compress (relieve/reduce inflammation & edema)

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