This document summarizes postpartum hemorrhage, its risk factors, etiologies, pathophysiology, nursing interventions, and other potential postpartum complications including infection, emotional disorders, thrombophlebitis, and domestic violence. It discusses postpartum hemorrhage definitions and causes such as uterine atony, retained tissues, and genital tract trauma. It also outlines nursing assessments and treatments for various postpartum complications.

2. Post Partum HemorrhageBlood loss greater than 500mL after a vaginal birth and 1000mL after a cesareanEarly postpartum hemorrhageLate postpartum hemorrhage

3. Risk FactorsMultiple gestationPrevious historyUterine infectionPrecipitous birthManuel removal of placentaPitocin induction

4. EtiologyToneTissueTraumaThrombosis

5. TONERelated to over distention multifetal macrosomia hydramnios retained placental fragmentsOther causes bladder distention anesthesia tocolytics

7. Bimanuel massage

8. TISSUEFailure of complete separation and expulsion of the placenta does not allow the uterus to fully contractUterine subinvolution

9. TRAUMAAny damage to the genital tract that occurs during birth either spontaneously or through manipulation cesarean uterine rupture vigorous labor, pitocin induction manipulation lacerations

11. THROMBOSISBlood clots help to prevent postpartum hemorrhageCoagulation problems: Idiopathic Thrombocytopenia Purpura von Willebrand Disease DIC

12. Pathophysiology of Hemorrhage

13. Nursing Interventions for Postpartum HemorrhageUterine massageDownward pressure to expel clotsPitocin, methergineIV line, blood transfusionPad countVitals, LOCEmpty bladderPatient teaching

14. ThrombophlebitisClot within a blood vessel Superficialsaphenous Deep Vein Thrombosisfemoral and pelvic

15. Nursing Interventions for ThrombophlebitisPreventionEducationLeg exercises, compression devices, elevation, restAnticoagulants (heparin and coumadin),NSAIDAntiembolic stockingsPrevent traumaMonitor for complications-Pulmonary Embolism

16. POSTPARTUM INFECTIONOccurs in 8 % of all birthsHigher incidence in cesarean birthsDefined as: fever of 38 C or 100.4 F or higher after the first 24 hours after birth occurring on at least two of the first ten days postpartum

17. ETIOLOGYStaphylococcus aureusEscherichia coliGroup A or B hemolytic streptococciChlamydia trachomatis

18. Metritis or EndometritisInvolves endometriumExtension can result in parametritis which involves the broad ligaments, ovaries and fallopian tubesORSeptic pelvic thrombophlebitis which results when infection spreads along venous routes into the pelvis

19. WOUND INFECTIONSCesareanEpisiotomyLacerations

20. URINARY TRACT INFECTIONS

21. Nursing Care for UTI’sPreventionHydrationAntibioticsGantrisin

22. MASTITIS

23. Nursing Interventions for MastitisAdminister NSAID, antibioticsWarm compressesEncourage her to increase feedingsIncrease fluidsReview proper breastfeeding techniques

24. Nursing Diagnosis for Post Partum InfectionsIneffective thermoregulation R/T bacterial invasionAcute Pain R/T infectious processR/F impaired parental/infant attachment R/T the effects of postpartum infection

25. Postpartum Emotional DisordersBluesDepressionPsychosis

26. Postpartum DepressionAffects entire familyEarly identification improves outcomesGradual onset evident by 6 weeks of birthAntidepressants, antianxiety medications, psychotherapy

27. POSTPARTUM PSYCHOSIS1:1000 birthsSeen within 3 weeks of birthSymptoms escalate to delirium, hallucinations, anger toward herself and or infant, bizarre behavior, mania, thoughts of hurting herself and baby, suicide, infanticideHospitalized psychotrophic drugs and psychotherapy

28. A postpartum mom is pale and states that she is bleeding heavily. The nurse should first:Call the doctor STATAssess fundus and voiding pattern Set up IV for fluid replacementReassure her that his is a normal finding

29. Hallucinations and expressions of suicide are indicative of:Postpartum psychosisPostpartum anxiety disordersPostpartum bluesPostpartum depression

30. Critical Thinking ExerciseMrsGriffen labored 12 hours in the hospital before a cesarean birth. Her membranes ruptured 6 hours before she came to the hospital. Her fetal monitor showed late decelerations so an internal monitor was inserted. Her most recent blood tests indicate that she is anemic. What postpartum complications is this patient at risk for? Why?What assessments need to be done to detect potential complications?What nursing measures will the nurse use to prevent complications?

31. Child Abuse and NeglectNurses are legally obligated to report ALL suspected cases of abuse and neglectAbuse physical, mental, emotional, sexualNeglect failure to meet the child’s needsMunchausen Syndrome by Proxy

32. Fetal DemiseDiagnosis: no fetal heart on sonogram falling estriol levels Spalding signNursing Interventions listen, encourage grieving, support give opportunity to see, feel ,hold the baby offer photo, lock of hair, footprints assist with religious ceremonies

33. Maceration

34. Anacephalic

35. HydropsFetalis

36. Domestic Violence

37. Cycle of Violence

38. The primary goal of intervention in working with abused women is to:Set up an appt with a mental health counselor for the victimConvince them to leave this unsafe situation before they really get hurtHelp them to develop courage and financial support to leave their abuserEmpower them and improve their self esteem to regain control of their lives