Postpartum Complications

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Postpartum Complications
2012-02-12 22:59:48
OB Chpt 23

postpartum complications
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  1. ergonovine (Ergotrate)
    methylergonovine (Methergine)
    • Can be given intramuscularly to produce sustained uterine contractions.
    • *Alert*
    • is contraindicated in the presence of hypertnesion or cardiovascular disease.
  2. 0.25 prostaglandin F2-alpha ( carboprost tromethamine)
    • intramuscularly is more common for sustained uterine contractions.
    • *Alert*
    • should be used cautiously in women with cardiovascular disease or asthma.
  3. R E E D A
    • R- redness
    • E- edema
    • E- ecchymosis
    • D- discharge
    • A- approximation
  4. Progesterone
    inhibits uterine contrantions
  5. Estrogen
    promotes uterine contractions
  6. Pituitary
    releases oxytocin

    oxytocin & prostaglandis work together for contraction
  7. Magnesium Sulfate
    Magnesium sulfate is most commonly used for the treatment of preeclampsia during pregnancy. Magnesium sulfate is sometimes used as a tocolytic medicine to slow uterine contractions during preterm labor.
  8. Inversion of the Uterus
    When the uterus comes out of the vagina.
  9. Uterine Atony
    Is when muscle tone is decreased and uterus wont contract, allowing hemorrage to begin.
  10. Postpartum Hemorrage (PPH)
    • 500 ml of blood after vaginal birth
    • 1000 ml after c-sec
    • Dark blood is probably of venous origin
    • Bright blood is arterial amd may indicate deep lacerations of the cervix.
    • Spurts of blood with clots may indicate partia placental separation.
  11. Subinvolution of the Uterus
    retained placental fragments and pelvic infection. A pelvic examination usually reveal a uterus that is larger than normal and that may be boggy.
  12. Hypotonic uterus (excessive bleeding)
    • Oxygen can be given
    • urinary cathether is usually inserted to monitor I&O's
    • Lab tests-PTT, PT, CBC, platelet count, fibrinogen, blood type, antibody screening
  13. Oxitocin (Pitocin)
    for contraction of uterus, to decrease bleeding
  14. Dinoprostone (Prostin E2)
    • Contraction of uterus
    • Avoid with High BP
  15. Misoprostol (Cytotec)
    • Contraction of Uterus
    • *Alert*
    • Contraindicated with Hx of allergy to prostaglandins.
  16. Uterine Inversion
    is considered an emergency situation
  17. Tocolytics (magnesium sulfate, terbutaline) or halogenated anesthetics may be given to relax the uterus for Uterine Inversion.
  18. *Alert*
    to prevent injury to the suture line a woman with third or fourth degree lacerations is not given rectal suppositories or enemas or digital rectal examinations.
  19. Hemorrhagic (Hypovolemic) Shock
    is an emergency situation
  20. Assess v/s q15mins. during the first 2hrs of delivery
  21. Disseminated intravascular coagulation (DIC)
    is a serious disorder in which the proteins that control blood clotting become abnormally active.
  22. Idiopathic thrombocytopenic purpura (ITP)
    Idiopathic thrombocytopenic purpura is a bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. Persons with the disease have too few platelets in the blood. If ITP was diagnosed during pregnancy, the woman likely was treated with corticosteroids or IV immunoglobulin.
  23. Thromboembolic Disease
    • medical management is to elevate affected leg, rest, and elastic stockings. Local application of heat may also be used. Analgesia, and anticoagulants (IV Heparin)
    • IV Heparin is used 3-5days, Warfarin is started is continued for the next 3 months.
  24. *Alert*
    Medication containing aspirin arent given to women taking anticoagulant meds due to aspirin inhibits clotting factors and prolongs clotting time and increases the risk of bleeding.
  25. Puerperal infection (Postpartum infection)
    is any clinical infection of the genital canal that occurs within 28 days after.
  26. Side effects of Rhogam
    Side effects of Rhogam are mild and include soreness tenderness, warmth or a rash at the injection site. Other side effects can include:

    • Fever
    • Chills
    • Headache
    • Fatigue
  27. On what occassions can rhogam be given to the mother?
    RhoGAM is routinely given to mothers at approximately 28th week of pregnancy. The shot lasts approximately 12 weeks, and is repeated within 72 hours of birth to mothers with Rh positive babies in case there is any blood exposure
  28. Narcan (narcotic antagonist/drug blocker)
    Pain Med
    Narcan (naloxone) is an opioid antagonist and is used for the complete or partial reversal of opioid depression, including respiratory depression. It is also used for diagnosis of suspected or known acute opioid overdose and also for blood pressure support in septic shock.
  29. Endometritis
    • the most common infection in Postpartum
    • s/s increased pulse
    • chills
    • anorexia
    • nausea
    • fatigue
    • lethargy
    • pelvic pain
    • uterine tenderness
    • foul smelling profuse lochia
    • FEVER greater than 38o
  30. Hemabate 0.25mg intramuscularly
    expected outcome of this medication is limitation of excessive blood loss that is occurring after birth.
  31. zidovudine (retrovir)
    Zidovudine is a medicine that is prescribed to treat HIV and AIDS. It is also used for preventing the transmission of the HIV virus from a pregnant woman to her unborn child.
  32. Meconium
    the earliest stools of an infant. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus:
  33. erythromycin opthalmic (Ilotycin)
    must be given to newborns within the 1st hour to prevent any bacteria forming in the eyes, or to prevent blindness
  34. APGAR score
    • A- active
    • P- pulse
    • G- grimace
    • A- appearance (color)
    • R- respirations
  35. Coombs Test
    The Coombs' test looks for antibodies that may bind to your red blood cells and cause premature red blood cell destruction (hemolysis).
  36. Kleihauer-Betke Test
    This test detects and measures the number of fetal (unborn baby) cells in the mother's blood. This test is used to predict certain types of pregnancy complications