POST-PARTAL COMPLICATIONS TONE: UTERINE ATONY CLASSIFICATIONS OF PERINEAL

LACERATION
- Failure of contraction
- Most common cause First Degree
Post-partum Hemorrhage
Secondary to: - Fourchette
 Blood loss of more than 500ml after
- Vaginal Mucus Membrane
completion of the 3rd stage of labor 1. Overdistention of uterus
- Perineal Skin
 For abdominal/ twin delivery- 1000ml 2. Uterine exhaustion
 10 % fall in hct level 3. Intra amniotic infection Second Degree
4. Functional/ anatomic distortion of
Types - First Degree+ Muscles of perineal
uterus subinvolution of uterus
body
PRIMARY POST PARTAL TISSUE: RETAINED PRODUCTS OF
HAEMORRHAGE Third Degree
CONCEPTION
 Bleeding during the 3rd stage of labor - 2nd degree+ Anal sphincter
Secondary to:
 Uterine atony as most common cause Fourth Degree
1. Retained products
SECONDARY POST-PARTAL 2. Blood clots - 3rd Degree + Mucus membrane of the
HEMORRHAGE (LATE) 3. Cotyledons or succenturiate lobe rectum
4. Abnormal placenta
 Bleeding after 24 hours until the 6th
week post-partum TRAUMA:
Lacerations
CAUSES: (4T’S) - May occur spontaneously/
manipulation
1. Tone (Uterine atony)
2. Tissue (retained products of - Lacerations maybe present in vagina,
conception) cervix or perineum
3. Trauma (Lacerations/ hematoma)
4. Thrombin (Coagulopathy)
 3. Discoloration of skin around the area
4. Feeling of pressure around the vagina
Thrombin: coagulopathy
- Secondary to preexisting disorders
- Thrombocytopenia
Coagulopathy
- Leukemia
Secondary to conditions acquired during
pregnancy
- HELLP (Hemolysis Elevated Liver
enzyme and Low Platelet)
- DIC
MANAGEMENT
 Oxytocin
 Misoprostol
 Oxygenation
 Fluid resuscitation/Blood transfusion ENDOMETRITIS
Hematomas causes:  Vasoactive agent
Causes:
1. Vulvar varicosities *Management based on cause
2. Precipitate labor - Most common cause
PUERPERAL INFECTION - 2nd or 3rd PP Day
3. Forceps delivery
4. Inadequate suturing of episiotomy site •Temperature of 100.4 °F (38°C) Risk Factors
Signs and symptoms: • Occurring in any two of the first 10 days PP
 Emergency CS
1. Perineal pain • Taken at least 4x daily  Prolonged ROM
2. Swelling  Prolonged labor
  Multiple intrapartum vaginal
examinations
 Intrauterine manipulative procedures
URINARY TRACT INFECTION
- 2nd most common
-1st or 2nd PP Day
Risk Factors:
- Indwelling FC
- Multiple catheterization
- Multiple vaginal exams
- Untreated asymptomatic bacteriuria
 Staphylococcus aureus
Signs and Symptoms:
- Engorgement or swelling
- Fever and chills
- Hard and reddened breast
- Reduced milk supply
- Breast abscess
Prevention
 Prevent nipple cracks and fissures
Pneumonia  Express milk to prevent stasis Isolate
infants with cord or skin infection
- Noted within the 1st 24 hours PP  Proper handwashing techniques
Wound Infection  Comfort Measures
- Identified in 4th -5th Post-Partum Day Diagnostic Tests for puerperal infection
Risk Factors: - Gram stain, culture and sensitivity
- Urinalysis
- Emergency CS
- Prolonged ROM - Chest x-ray
- Prolonged Labor Pharmacologic Intervention
- Multiple intrapartum vaginal exams
- Broad spectrum
- Obesity
- Clindamycin and gentamycin-
Mastitis standard first line
 Infection of the breast tissue - 3-drug regimen including Ampicillin
- IV antibiotics until patient is afebrile
 Most common among breastfeeding
for 24-48 hours
mothers
 Usually during 2nd and 3rd week PP
Non-Pharmacologic: 3. Anticoagulant meds 5. Social factors: poor support system,
4. Antibiotic therapy, analgesic for low socio-economic status,
- Determine source of fear and anxiety
pain dysfunctional family
- Explain treatment and need for
5. Never massage 6. Self-concept
hospitalization
6. Warm wet compress
- Promote proper hygiene Assessment findings:
- Increase oral fluid Postpartal Psychosis – (Psychologic
1. Withdrawal, depression, blues that
Maladaptation)
persist
Thrombophlebitis
1. Acute postpartum psychosis 2. Delusion, hallucinations, paranoia
- Formed when there is stasis of - Low incidence 3. May have suicidal tendencies; may
circulation or repair of damaged - Divided into depressed and harm infant
tissue. Tend to occlude circulation manic 4. Clouding of consciousness
and become the site of infection - Common to develop within the 5. Fear, hostility
Potentially dangerous= pulmonary first month after delivery (Stuart 6. Feeling of inadequacy, poor bonding
embolism &Sundeen, 1995) 7. Refusal to eat.
2. Postpartum depression
Predisposing factors Nursing Intervention
- gradual; may onset 2 weeks
- Varicosities after delivery; may last 3-6 1. Early recognition/detection of the
- Obesity months problem
- Over 30 y./o. - Low incidence; at least 10-15% 2. Support parenting behavior; Positive
- Multiparity of adult women yearly feedbacking to the mother; Support
- Use of estrogen supplement bonding moment
Risk factors:
- Hx of thromboembolic disease 3. Assist patient in developing parenting
1. Pre-existing psychiatric skills
Homan’s sign condition/problems 4. Administer prescribed meds
2. Stresses of pregnancy 5. Refer to other health team members/
- calf pain when foot is dorsiflexed
3. Separation caused by maternal and agencies/ family
Management
neonatal problems
1. Prevention - early ambulation -
4. Sudden change in role/ parenthood
use of support stockings
2. Bedrest until s/s disappear