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Postpartum complications II

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Postpartum complications II Lectures 12 Prepared by MD, PhD Kuziv I. Thank you for attention Postpartum complications Postpartum hemorrhage Hemorrhagic shock ... – PowerPoint PPT presentation

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Title: Postpartum complications II


1
Postpartum complications II
  • Lectures 12
  • Prepared by MD, PhD Kuziv I.

2
Postpartum complications
  • Postpartum hemorrhage
  • Hemorrhagic shock
  • Coagulopathies
  • Thromboembolic disease

3
Main Causes of Early Hemorrhage are
1. Uterine Atony 2.    Lacerations 3.   
Retained Placental fragments 4.    Inversion of
the Uterus 5.    Placenta Accreta
4
The Two Principles that Govern PPH Treatment
  1. The bleeding must be arrested
  2. The maternal volume must be restored

5
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6
Uterine Atony
  • Etiology and Pathophysiology
  • The most frequent cause of postpartal hemorrhage
    is UTERINE ATONY. The myometrium fails to
    contract and the uterus fills with blood because
    of the lack of pressure on the open vessels of
    the placental site.

7
Signs and Symptoms
  • 1. Excessive or bright red bleeding
  • 2. A boggy uterus that does not respond to
    massage
  • 3. Abnormal clots
  • 4. Any unusual pelvic discomfort or backache

8
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11
Management of Postpartum Hemorrhage
  • Close observation of fundal height and bleeding
    after delivery for at least 1 hour
  • Common protocol for fundal height massage Q15min
    X 1 hr, Q30min X1 hr, Q1hr X 4hrs, Qshift PRN)
  • Make sure bladder is drained
  • If uterine massage is ineffective, pharmacologic
    agents are indicated

12
LACERATIONS
  •  
  • ETIOLOGY AND PATHOPHYSIOLOGY
  • Lacerations of the birth canal are second only to
    uterine atony as a major cause of postdelivery
    hemorrhage.
  • Predisposing Factors
  • 1. Spontaneous or Precipitous delivery
  • 2. Size, Presentation, and Position of baby
  • 3. Contracted Pelvis
  • 4. Vulvar, perineal, and vaginal varices

13
LACERATIONS
  •  
  • ETIOLOGY AND PATHOPHYSIOLOGY
  • Lacerations of the birth canal are second only to
    uterine atony as a major cause of postdelivery
    hemorrhage.
  • Predisposing Factors
  • 1. Spontaneous or Precipitous delivery
  • 2. Size, Presentation, and Position of baby
  • 3. Contracted Pelvis
  • 4. Vulvar, perineal, and vaginal varices

14
RETAINED PLACENTAL FRAGMENTS
  • Etiology and Pathophysiology
  • This occurs when there is incomplete separation
    of the placenta and fragments of placental tissue
    retained.
  •  Signs and Symptoms
  •   Boggy , relaxed uterus
  •   Dark red bleeding

Treatment and Nursing Care   D C - clean out
any fragments that may be left   Administration
of Oxytocins to contract the uterus  
Administration of Prophylactic antibiotics
15
INVERSION OF THE UTERUS
  • Etiology and Pathophysiology
  • The uterus inverts or turns inside out after
    delivery.
  • Complete inversion - a large red rounded mass
    protrudes from the vagina
  • Incomplete inversion - uterus can not be seen,
    but felt

16
INVERSION OF THE UTERUS
  • Etiology and Pathophysiology
  • The uterus inverts or turns inside out after
    delivery.
  • Complete inversion - a large red rounded mass
    protrudes from the vagina
  • Incomplete inversion - uterus can not be seen,
    but felt

17
PLACENTA ACCRETA
  Etiology and Pathophysiology Placenta accreta
is a condition that occurs when all or part of
the decidua basalis is absent and the placenta
grows directly onto the uterine muscle. This may
be partial where only a portion abnormally
adhered or it may be complete where all adhered.
18
PLACENTA ACCRETA
  Etiology and Pathophysiology Placenta accreta
is a condition that occurs when all or part of
the decidua basalis is absent and the placenta
grows directly onto the uterine muscle. This may
be partial where only a portion abnormally
adhered or it may be complete where all adhered.
19
Signs and Symptoms During the third stage of
labor, the placenta does not want to separate.
Attempts to remove the placenta in the usual
manner are unsuccessful, and lacerations or
perforation of the uterus may occur
Treatment 1.    If it is only small portions
that are attached, then these may be removed
manually 2.    If large portion is attached--a
Hysterectomy is necessary!
20
LATE POSTPARTUM HEMORRHAGE
  • Etiology and Pathophysiology
  • Occasionally, late postpartal hemorrhage occurs
    around the fifth to the fifteenth day after
    delivery when the woman is home and recovering.
    The most frequent causes are
  • 1. Retained placental fragments
  • 2. Subinvolution the uterus fails to follow the
    normal pattern of involution and remains
    enlarged.

21
  • TREATMENT AND NURSING CARE
  • Oral administration of Methergine for 24-48
    hours.
  • D C
  • SIGNS AND SYMPTOMS
  • Lochia fails to progress from rubra to serosa to
    alba.
  • The uterus is higher in the abdomen.
  • Irregular or excessive bleeding.
  •  

22
Thromboembolic Conditions
  • Thrombophlebitisthe formation of a clot in an
    inflamed vein.
  • Risk factors include maternal age over 35,
    cesarean birth, prolonged time in stirrups,
    obesity, smoking, and history of varicosities or
    venous thromboses.
  • Prevention client needs to ambulate early after
    delivery.

23
Thromboembolic Conditions
  • Thrombophlebitisthe formation of a clot in an
    inflamed vein.
  • Risk factors include maternal age over 35,
    cesarean birth, prolonged time in stirrups,
    obesity, smoking, and history of varicosities or
    venous thromboses.
  • Prevention client needs to ambulate early after
    delivery.

24
Thromboembolic Conditions
  • Thrombophlebitisthe formation of a clot in an
    inflamed vein.
  • Risk factors include maternal age over 35,
    cesarean birth, prolonged time in stirrups,
    obesity, smoking, and history of varicosities or
    venous thromboses.
  • Prevention client needs to ambulate early after
    delivery.

25
THROMBOEMBOLIC DISEASE
Superficial thrombophlebitis is limited to the
superficial saphenous veins, whereas deep
thrombophlebitis generally involves most of deep
venous system.  
  • PREDISPOSING FACTORS
  • Slowing of blood flow in legs usually in Moms
    who have a Cesarean delivery.
  • Trauma to the vessels during delivery.

26
THROMBOEMBOLIC DISEASE
Superficial thrombophlebitis is limited to the
superficial saphenous veins, whereas deep
thrombophlebitis generally involves most of deep
venous system.  
  • PREDISPOSING FACTORS
  • Slowing of blood flow in legs usually in Moms
    who have a Cesarean delivery.
  • Trauma to the vessels during delivery.

27
Assessment of Edema Homans Sign
  • Assess legs for presence and degree of edema may
    have dependent edema in feet and legs.
  • Assess for Homans sign- thromboembolism should
    be negative
  • Press down gently on the patients knee (legs
    extended flat on bed) ask her to flex her foot
    (dorsiflex)

28
  • Signs and Symptoms
  • Sudden onset of pain, tenderness of calf, redness
    and an increase in skin temp.
  • Positive Homans Sign.
  •  

Treatment and Nursing Care Heparin it does
not cross into breast milk.
29
  • Signs and Symptoms
  • Sudden onset of pain, tenderness of calf, redness
    and an increase in skin temp.
  • Positive Homans Sign.
  •  

Treatment and Nursing Care Heparin it does
not cross into breast milk.
30
  • Signs and Symptoms
  • Sudden onset of pain, tenderness of calf, redness
    and an increase in skin temp.
  • Positive Homans Sign.
  •  

Treatment and Nursing Care Heparin it does
not cross into breast milk.
31
  • Signs and Symptoms
  • Sudden onset of pain, tenderness of calf, redness
    and an increase in skin temp.
  • Positive Homans Sign.
  •  

Treatment and Nursing Care Heparin it does
not cross into breast milk.
32
COMPLICATION
  • PULMONARY EMBOLI substernal chest pain, sudden
    and intense dyspnea pallor and cyanosis
    increased jugular pressure confusion
    hypotension sudden apprehension hemoptysis.

33
COMPLICATION
  • PULMONARY EMBOLI substernal chest pain, sudden
    and intense dyspnea pallor and cyanosis
    increased jugular pressure confusion
    hypotension sudden apprehension hemoptysis.

34
Thank you for attention
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