POSTPARTAL

COMPLICATIONS
Classified according to

THROMBOSIS TONE TISSUE TRAUMA

THROMBOPHLEBITI UTERINE ATONY edema
S
- extension of an
- Poor uterine POSTPARTUM INFECTION
endometrial
tone
infection
- Relaxation
- inflammation of
of the Infection of the
the lining of a
uterus reproductive tract
blood clots

POSTPARTUM HEMORRHAGE - Blood loss from the uterus

of 1000 ml
POSTPARTUM DEPRESSION (PPD)
- Unprotected uterine area
- Hormonal shifts as level PRIMARY POSTPARTUM SECONDARY left after detachment of
of estrogen, HEMORRHAGE POSTPARTUM placenta
progesterone, and - Blood loss occurs in
gonadotorpin-releasing - Vaginal bleeding
the first 24 hours ff
hormone in her body between 24 hours
delivery
decline or rise and 6 weeks ff
- A response to the
anticlimactic feeling after
birth. HEMORRHAGIC SHOCK

- Losing lots of blood quickly

- Can cause drop in bp leading to
shock and death if untreated
Pathophysiology

1. Postpartum Hemorrhage
a. Uterine Atony - Failure of the uterus to contract may be associated with retained placenta or placental fragments,
either as disrupted portions. The retained material acts as a physical block against strong uterine contraction which
is needed to constrict placental bed vessels.
b. Placenta Previa- the placental site is located in an abnormally low position. Atonic PPH is a recognized complication
and, even if cesarean section is performed, severe intraoperative bleeding is a significant risk.
2. Hemorrhagic Shock
a. Due to the depletion of intravascular volume through blood loss to the point of being unable to match the tissues
demand for oxygen.
3. Thrombophlebitis
a. variety of hypercoagulopathy syndromes
b. formation of a blood clot in the presence of venous inflammation or injury. 
4. Postpartum Infection
a. Local spread of colonized bacteria is the most common etiology for postpartum infection following vaginal
delivery. Endometritis is the most common infection in the postpartum period.
5. Postpartum Depression
a. Changes in hormone levels—Levels of estrogen and progesterone decrease sharply in the hours after childbirth.
b. History of depression—Women who have had depression at any time—before, during, or after pregnancy—or who
currently are being treated for depression have an increased risk of developing postpartum depression.
c. Emotional factors—Feelings of doubt about pregnancy are common. If the pregnancy is not planned or is not
wanted, this can affect the way a woman feels about her pregnancy and her fetus.
d. Fatigue—Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength
and energy.
 e. Lifestyle factors—Lack of support from others and stressful life events, such as a recent death of a loved one, a
family illness, or moving to a new city, can greatly increase the risk of postpartum depression.
6. Primary Postpartum Hemorrhage
a. Atonic Uterus
b. Trauma
c. Retained product of conception
d. Uterine Rupture
e. Uterine inversion
f. Blood coagulopathy
7. Secondary Postpartum Hemorrhage
a. Infection
b. Cervico-vaginal Lacerations
c. Endometritis
d. Retained bits of membranes
e. Subinvolution of placental site
8. Atony
a. Contraction of the myometrium that mechanically compresses the blood vessels supplying the placental bed
provides the principal mechanism uterine hemostasis after delivery of the fetus, and the placenta is concluded.
Interventions:

1. Postpartum Hemorrhage
a. Medicine or uterine massage to stimulate uterine contractions
b. Removing pieces of the placenta that remain in the uterus
c. Exam of the uterus and other pelvic tissues, the vagina, and the vulva to look for areas that may need repair
d. Laparotomy. This is surgery to open the abdomen to find the cause of bleeding.
e. Hysterectomy. This is surgery to remove the uterus. In most cases, this is a last resort.
2. Hemorrhagic Shock
a.  control the source of bleeding as soon as possible and to replace fluid .
b. Fluid resuscitation
3. Thrombophlebitis
a. Blood-thinning medications
b. Clot-dissolving medications
c. Varicose vein stripping
4. Postpartum Infection
a. antimicrobial treatment
b. parenteral broad-spectrum antimicrobials.
5. Postpartum Depression
a. Participation in a support group
b. combination of medication and psychotherapy
c. electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations 
6. Atony
a. uterine massage
b. uterotonic drugs including oxytocin, methylergonovine (Methergine), and prostaglandins.
c. blood transfusions
d. surgery to tie off the blood vessels
e. uterine artery embolization, which involves injecting small particles into the uterine artery to block blood flow to the
uterus
f. hysterectomy if all other treatments fail
REFERENCES :

1. Cunningham GF, Levano KJ, Gilstrap LC, et al. Puerperal Infection. Cunningham GF, Levano KJ, Bloom
SL, et al, eds. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2005. 711-24.
2. Pillittire A. Nursing care of a family experiencing a Postpartal Complication. Maternal and child nursing 6 th
ed 2010.
3. Haas DM, Morgan S, Contreras K, Enders S. Vaginal preparation with antiseptic solution before cesarean
section for preventing postoperative infections. Cochrane Database Syst Rev. 2018 Jul 17. 7:CD007892.
4. World Health Organization. World Health Report 2005: Make Every Mother and Child Count. Available
at http://www.who.int/whr/2005/whr2005_en.pdf.
5. USAID (United States Agency for International Development). Postpartum Hemorrhage Prevention.
USAID Postpartum Hemorrhage Prevention Initiative (POPPHI). Available
at http://www.pphprevention.org/briefs_newsletters.php. 
6. Tintinalli JE, Kelen GD, Stapczynski JS. Gynecology and Obstetrics: Post Partum
Hemorrhage. Emergency Medicine: A Comprehensive Study Guide. 6th. New York: McGraw Hill; 2004.
682.