POSTPARTU

M
INTRODUCTION

Postpartum Haemorrhage
Postpartum Infections
Thromoboembolic Disorders
Psychiatric Disorders
POSTNATAL REVIEW
Ask & assess the woman about her and baby’s health and wellbeing.
Advise women of the signs and symptoms of potentially life
threatening conditions and to seek medical attention if required.
CAUSES OF MATERNAL
DEATH WORLDWIDE
POSTPARTUM
HAEMORRHAGE
Blood loss greater than 500 mL
Early postpartum hemorrhage
 First 24 hours after delivery
Uterine atony
Lacerations of the genital tract
Haematomas
Uterine rupture
Late postpartum hemorrhage
 Usually 1-2 weeks
 Retention of placental tissue
EARLY POSTPARTUM
HEMORRHAGE:
UTERINE ATONY
Causes Assessment
 Over distention  Fundus
 Prolonged labor Soft
 Induction
Difficult to find
 Grand multiparity
 Pre-eclampsia Above expected level
 Retained placental tissue  Lochia
 Placenta praevia Excessive
 Full Bladder Bright red
 Caesarean Section
 GA
Clots
EARLY POSTPARTUM
HEMORRHAGE:
UTERINE ATONY
Interventions
 Assess for bleeding
 Assess fundal height
 Encourage voiding
 Oxytocin
 Fundal massage
 IV fluid and/or transfusion
 Bimanual compression of uterus
 Ligation of uterine vessels or hysterectomy
BIMANUAL MASSAGE
Bimanual uterine compression
massage is performed by placing
one hand in the vagina and
pushing against the body of the
uterus while the other hand
compresses the fundus from
above through the abdominal
wall. The posterior aspect of the
uterus is massaged with the
abdominal hand and the anterior
aspect with the vaginal hand.
EARLY POSTPARTUM
HEMORRHAGE:
LACERATIONS
Perineal, vaginal, cervical
Predisposing factors
 Primiparous
 Precipitous delivery
 Macrosomia
 Forceps or vacuum-assisted birth
 Mediolateral episiotomy

Assessment
 Firm uterus
 Bright red blood
 Stream of unclotted blood
EARLY POSTPARTUM
HEMORRHAGE:
HAEMATOMAS
Blood in soft subcutaneous tissue
Predisposing factors
 Prolonged pressure of fetal head
 Forceps or vacuum extraction
 Prolonged or precipitous labor
 Macrosomia
 Pudendal anesthesia

Subperitoneal haemotoma
 Uterine artery branch or vessels in broad ligament
 Severe pain and hypovolemic shock
 EARLY POSTPARTAL
HEMORRHAGE:
HAEMATOMAS
Vaginal
 Assessment
 Unilateral purplish discoloration
 Pain
 Feeling of fullness in vagina or rectal pressure
 Difficult voiding
 Intervention
 Analgesia
 Ice packs
 Sitz bath
 Surgery
LATE POSTPARTUM
HEMORRHAGE
Assessment
 Subinvolution
 Lochia
 Fails to progress from rubra to alba
 Saturation of more than 1 pad per hour
 Abnormal clots
 Bladder distention
 Increased rectal, back, or pelvic pain
 Increased pulse or decreased blood pressure
 Signs of anaemia
LATE POSTPARTAL
HEMORRHAGE
Intervention
 Teach
 Signs of hemorrhage
 Massage fundus
 Iron administration
 Pitocin or Methergine
 IV fluid or blood transfusion,
 Oxygen
 Dilation and curettage
 PUERPERAL INFECTIONS
Reproductive tract associated with childbirth
 Metritis, perineal or caesarean wound

Causes of metritis
 Caesarean - Prolonged labor
 PROM - Multiple vaginal exams
 Scalp electrodes - Internal uterine monitor
 OB trauma - Instrument assisted birth
 Manual removal of placenta
 Preexisting infection
 Compromised health status
PUERPERAL INFECTIONS:
METRITIS

Assessment Interventions
 Abd/Uterine pain  CBC
 Foul smelling vaginal  Cultures
discharge  Hygiene
 Fever 101-104 F  Abscess is drained
 Chills  IV antibiotics
 Malaise  Antipyretics
 30% increase in WBC  ICU hospitalization
PUERPERAL INFECTIONS:
PERINEAL AND CAESAREAN
WOUNDS
Perineal wound
 Assessment
Cesarean wound
 Assessment
Intervention
 Sutures removed
 Drain purulent material
 Antibiotics
 Analgesics
 Warm compress or sitz baths
 OVERDISTENTION OF THE
BLADDER
Cause
 Unable to empty bladder due to trauma or anesthesia
Assessment
 Distended bladder
 Displaced uterus, increased vaginal bleeding, boggy uterus,
backache, restless
Intervention
 Encourage voiding
 Perineal ice packs
 Pour water over perineum
 Aseptic straight catheter X 1
URINARY TRACT
INFECTIONS
Cause
 Retention of urine
 Bacteria from catheterisation
Cystitis
 Assessment
 Intervention
 Increase fluids
 Empty bladder- Urine culture and antibiotics
 Prevention
 Hygiene
 Void every 2-4 hrs
 Increase acidity in urine
URINARY TRACT
INFECTIONS
Pyelonephritis
 Assessment
 UTI signs >> High fever
 Chills >> Flank pain
 N&V >> Acutely ill
 Management
 IV antibiotics >> Increase fluids
 Antipyretics >> Analgesic
 Follow-up culture in 2 weeks
 MASTITIS
Infection of breast tissue
Causes
 Bacteria enters through cracks in nipple
 Milk stasis
 Poor hand washing
 Breast not dry or wet breast pad
 Incorrect placement of baby causes sore nipples
Assessment
 Fever and chills, acutely ill
 Flu-like symptoms, malaise, headache
 Painful, warm, red area of breast
MASTITIS
THROMBOEMBOLIC
DISORDERS
Causes
 Hypercoagulability of blood
 Venous stasis
 Injury to epithelium of vessels
Increased risk
Prevention
 Avoid dehydration
 Avoid trauma to legs in stirrups
 Early postpartum ambulation
 Leg exercises to support venous return
 No smoking
 Antiembolism stockings
 THROMBOEMBOLIC
DISORDERS:
SUPERFICIAL
 3THROMBOPHELBITIS
to 4 day after delivery
th

 Assessment
 Tenderness
 Swelling
 No or low fever
 Localised heat/redness
 Intervention
 Elevate leg
 Local moist heat
 Analgesia
 Support hose
 Little risk of pulmonary embolism
THROMBOEMBOLIC
DISORDERS:
DEEP VEIN THROMBOSIS
 10 to 20 days after delivery

 Assessment
 Swelling
 Pain
 Erythema
 Heat
 Pedal edema
 Low to high fever
 Positive Homan’s
 Sometimes decreased perfusion
 Chills
THROMBOEMBOLIC
DISORDERS:
DEEP VEIN THROMBOSIS
Intervention
 Bed rest, elevate legs
 Analgesia
 Anticoagulant therapy
 Dalteparin
 Warfarin
 Monitor for pulmonary embolism
 Antiembolism stockings after symptoms
THROMBOEMBOLIC
DISORDERS:
PULMONARY EMBOLISM
Assessment
 Dyspnea
 Chest pain
 Cough/Haemoptysis
 Cyanosis
 Tachypnoea/Tachycardia
Treatment
 Oxygen
 Anticoagulation with heparin
PSYCHIATRIC DISORDERS:
POSTPARTUM BLUES OR BABY
BLUES
Assessment
 Within a few days after delivery and last a few hours to 10 or
more days
 Mild depression with interspersed happier feelings
 Tearful without reason
 Feel overwhelmed, unable to cope, fatigued, anxious, irritable,
oversensitive
Intervention
 Provide reassurance
 Assist with self and infant care
PSYCHIATRIC DISORDERS:
POSTPARTUM DEPRESSION
Assessment
 During first year - 4th week to 3 months
 Sad/frequent crying
 Poor decision making
 Insomnia or excessive sleeping
 Appetite change
 Feelings of worthlessness
 No interest in activities
 Feel inadequate as a mother
PSYCHIATRIC DISORDERS:
POSTPARTUM DEPRESSION
Risk factors
 Primiparity
 Ambivalence to pregnancy
 History of depression
 Lack of support
Treatment
 Medication
 Risk for suicide
 Group and individual therapy
 Assistance with child care and ADL’s
PSYCHIATRIC DISORDERS:
POSTPARTUM PSYCHOSIS
Risk factors
 Previous psychosis - Poor social support
Assessment
 Seen within 3 months - Agitation
 Insomnia - Hyperactivity
 Labile mood - Confusion
 Irrational thoughts - Poor concentration
 Poor judgment - Delusions/Hallucinations
Intervention
 Hospitalization - Antipsychotic medication
 Social support - Psychotherapy
 Considered an emergency due to suicide/infantcide risk
THANK YOU!