post partal hemorrhage and complication

7/31/2019 Post Partal Hemorrhage and Complication

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Post partal hemorrhage

and complication


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CASE #1

Nena had given birth to a preterm babyboy.She had episiorrhaphy.Suddenly heruterus relaxes.The obstetrician ordered

oxytocin to be incorporated at D5LR 1liter.Several days after her wound haddehiscence and her body temperaturerises.Explain what is happening to

Nena.What are your nursing interventionsregarding her case.formulate your plan ofcare


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Preterm-

Episiorrhaphy Atony(uterus relaxes)-

Dehiscence-


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Disseminated intravascularcoagulation

A deficiency in clotting ability caused byvascular injury

Usually associated with prematureseparation of placenta,missed earlymiscarriage,fetal death in utero.

Symptoms:

easy bruising,bleeding an intravenoussite


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Subinvolution

Incomplete return of the uterus to itsprepregnant size and shape

Lochial discharge is still present

May result from a small retained placentalfragment

4- or 6- week postpartal visit, uterus isstill enlarged and soft.


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Therapeutic management

oral administration of methylergonovine,0.2 mg, four times daily prescribed toimprove uterine tone and completeinvolution.


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Perineal hematoma

A collection of blood in the subcutaneouslayer of tissue of the perineum.

Most likely to occur after

rapid,spontaneous births and in womenwho have perineal varicosities

May occur at the site of episiotomy or

laceration repair if a vein was puncturedduring repair.


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assessment

Discomfort

Reports severe pain in perineal area

A feeling of pressure between legs

If present, appears as an area of purplishdiscoloration with swelling

Area is tender to palpation


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Administer a mild analgesic as ordered forpain relief

Apply ice pack covered with towel to

prevent further bleeding Hematoma is absorbed over the net 3-

4days

If hematoma continuous to increase insize, the woman may have to be returnedto the delivery room to have the siteincised.


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Puerperal infection

Infection of the reproductive tract isanother leading cause of maternalmortality.


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Conditions that increase a womans

risk for post partal infection ROM more than 24 hours before birth

Placental fragments retained

Post partal hemorrhage

Pre-existing anemia Prolonged and difficult anemia

Internal fetal heart monitoring

Local vaginal infection

Uterus was explored after birth for aretained placenta or abnormal bleedingsite


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Management

use of an appropriate antibiotic after

culture and sensitivity testing of theisolated organism.


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Endometritis

An infection of the endometrium,the liningof the uterus.bacteria gain access to theuterus through the vagina

Associated with chorioamnionitis(infectionof fetal membranes and fluid andcesarean birth.


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assessment

Temperature elevation may occur on thethird or fourth post partal day

WBC is increased

Breast filling occurs

Chills,loss of appetite,general malaise

Uterus is not well contracted and painfulto the touch

May feel strong afterpains Lochia is dark brown and has a foul odor


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Administration of appropriate antibioticsuch as clindamycin(Cleocin), determinedby culture of lochia

Oxytoxic agent such as methylergonovine,may be prescribed to encourage uterinecontraction.

Requires additional fluid

Analgesic for pain relief.

post partal hemorrhage and complication

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