POSTPARTUM MATERNAL COMPLICATIONS:

Question 1

Postpartum Hemorrhage: Major Causes

Answer 1

• Uterine Atony: Boggy Uterus (uterus remains inadequately contracted
• Subinvolution: uterus not contracting properly
• Retained placental fragments

Question 2

Postpartum Hemorrhage: Predisposing Factors

Answer 2

• Overdistension of uterus
• Multiparity (have had multiple deliveries)
• Prolonged or precipitate (quick) labor
• Use of vacuum or forceps/trauma
• C-Section/general anesthesia
• Uterine inversion
• Tension on placenta, placenta previa (covers opening), placenta accreta (rooted too deep)
• Tocolytics (meds that stop/slow contractions) prostaglandins, Mag Sulfate
• Chorioamniontis (intra amniotic infection)
• Clotting disorder, DIC
• Fibroids or previous uterine surgery

Question 3

Treatment of PP Hemorrhage:

Answer 3

• Control/treat Bleeding
• Empty Bladder
• Massage fundus/Bimanual Compression
• *Pitocin-prophylactically
• *Breastfeeding (releases Pitocin)
• *Methergine (Vasoconstrictor)
• *Misoprostol (prostaglandin)
• *Hemabate (Prostaglandin, oxytocic)
• Manage hypovolemic shock- PRBC, MTP (medical termination), Lactated Ringers, NS
• Possible D&C
• last resort: hysterectomy

Question 4

Thrombolytic Disorders: Etiology (cause):

Answer 4

• Venous stasis
• Hypercoagulability of blood
• Blood vessel injury Types:
  — Superficial venous thrombosis
  — DVT & PE

Question 5

Therapeutic Management:

Answer 5

• Heparin or Enoxaparin
• Pad stirrups and limit time
• Ambulation
• Compression device
• For PE- respiratory assessment, Oxygen, bed rest, elevate HOB

Question 6

Puerperal Infections:

Answer 6

occurs when bacteria infect the uterus and surrounding areas after a female gives birth
- Endometritis

Question 7

Endometritis

Answer 7

inflammation of the endometrium (the inner lining of your uterus) due to infection

Question 8

Endometritis: Risk factors:

Answer 8

• Extended labor
• PROM (premature rupture of membranes)
• UTI
• Wound Infections
• Wound dehiscence
• Mastitis
• CS
• Birth trauma