ch. 14 from notes

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ch. 14 from notes
2013-02-17 19:34:38

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  1. postpartal hemorrhage
    • early: 1st 24 hrs > 500 ml
    • late: usually occurs 24-6w

    • causes: uterine atony (early)
    • lacerations of vagina/cervix (early)
    • hematomas (early and late)
    • retained placental fragments (early and late)
    • uterine inversion (early) when uterus comes out with baby
    • subinvolution (late) failure to return to normal
  2. uterine atony
    • -due to lack of uterine muscle tone
    • -symptoms
    • -gross amt bright red bleeding in the presence of a boggy uterus with lots of bright, red vag. bleeding
    • -factors: conditions that overdistend uterus, conditions that affect uterine contractility, medication use
    • -treatment-uterine massage, oxytocin, methergine, hemabate, blood products if needed, surgical intervention if severe
  3. lacerations
    • types: perineal (3rd or 4th degree), vaginal, cervical
    • symptoms: increased vaginal bleeding with firm uterus
    • predisposing factors: primipara, instrument assisted birth, precipitous childbirth, macrosomia, epidural anesthesia
  4. hematomas
    a collection of blood, often vulvar or vaginal that occurs as a result of injury to a blood vessel during delivery

    symptom: client complains of severe perineal pain and rectal pressure

    predisposing factors: prolonged second stage of labor, operative delivery, precipitous labor, macrosomia, pudendal anesthesia.

    treatment: ice packs, analgesia
  5. retained placental fragments
    • -most common cause for late PPH
    • -small portion of the placenta remains attached
    • -cotyledons
    • -manual removal of placenta
  6. uterine inversion
    • prolapse of the uterus or turned inside out after birth
    • -not always preventable
    • -management: immediate repositioning of uterus by physician
  7. DIC-desseminated intravascular coagulation
    a syndrome that occurs when the body is breaking down blood clots faster than it can form a clot, thus the body quickly depletes itself of clotting factors, leading to hemorrhage
  8. Amniotic fluid embolism
    • rare fetal complication, can occur during pregnancy, l&d, pp
    • -amniotic fluid enters the maternal vascular system and initiates a cascading process which lease to cardio-respiratory collapse and DIC
  9. endometritis
    • inflammation of the endometrium portion of the uterine lining
    • -aerobic and anaerobic organisms
    • -temp
    • -tachycardia
    • -chills
    • -lower abdominal pain
  10. cystitis
    bladder infection, low grade fever, burning on urination, suprapubic pain, urgency, small frequent voids
  11. postpartum depression
    moderate to severe symptoms of depression, may occur anytime in first postpartum year-most in 4th week, has effect on woman, partner and children
  12. postpartum psychosis
    • 1-2 per 1000 women
    • -usually evident within first 3 months pp
    • -however as early as day 3 pp

    symptoms: agitation, hyperactivity, insomnia, mood lability, confusion and irrationality, poor judgement, difficulty remembering or concentrating, delusions and hallucinations

    treatment: hospitalization and antipsychotics
  13. pp psychiatric disorders
    three categories:

    • 1) adjustment reaction with depressed mood (postpartum blues)
    • 2) postpartum major mood disorder
    • 3) postpartum psychosis