postpartal complication

7/27/2019 Postpartal Complication

1/15

PostPartalcompl ication

B y : I mavike


2/15

Postpartal hemorrhage

As any blood loss from the uterus greater

than 500ml within a 24-hour period

Main causes: Uterine atony

Lacerations

Retained placental fragments

Disseminated intravascular coagulation


3/15

Uterine atony

Factors that predispose to poor uterine tone andan inability to maintain a contracted state are

Deep anesthesia or analgesia Labor initiated or assisted with an oxytocin agent Maternal age greater than 30 years High parity Previous uterine surgery

Prolonged and difficult labor Possible chorioamnionitis Prior history of postpartal hemorrhage Endometritis


4/15

Uterine atony

Treatment

Fundal massage IV infusion of oxytocin / IM methergine

Bimanual massage (explore uterine cavitymanually)

Prostaglandin administration Blood replacement

Hysterectomy


5/15

#

Lacer at ions

Large lacerations are complication

Due to:1. With difficult births

2. In primigravidas

3. With the birth of a large infants4. With the use of a lithotomy position

and instruments


6/15

#

Cer viCa l l aCer a t ions

Found on the sides of the cervix near

the branches of the uterine artery

Arterial bleeding so it is brighter red

Occur immediately after delivery of the

placenta

Treatment: repair


7/15

#

Vagina l l acer a t ions

Rare

Easier to assess Treatment : repair


8/15

#

Per inea l l acer a t ions

Lithotomy position for birth

Classified by 4 categories Treatment : treated as episiotomy

repair, a diet high in fluid, a stool

softener


9/15

Classification of perineal

lacerationsclassification Description of involvement

1st degree Vaginal mucous membrane and skin of

the perineum

2nd degree Vagina, perineal skin, fascia, levator ani

muscle, and perineal body

3rd degree Entire perineum, and reaches the external

sphincter of the rectum

4th degree Entire perineum, rectal sphincter, and

some of the mucous membrane of the

rectum


10/15

Retained placental fragments

Assessment :

Large fragment ---- bleeding in the

immediate postpartal periodSmall fragment ---- bleeding detected until

postpartal day 6-10

Uterus not fully contracted

USG

Treatment : a dilation & curettage


11/15

Disseminated intravascular

coagulation (DIC) Is a deficiency in clotting ability caused by

vascular injury

The fibrinogen level falls to below effectivelimits


12/15

PUERPERAL INFECTION

Risk factors including:

Rupture of the membrane > 24 hrs before birth

Retained placental fragment and its exploration

Postparpal hemorrhage

Preexisting anemia

Prolonged and difficult labor, particularly instrumentbirths

Local vaginal infection was present

Treatment : specific antibiotic therapy


13/15

Psychologicaldisorders


14/15

Comparing postpartal blues,

depression and psychosisPostpartal blues Postpartal

depression

Postpartal

psychosis

Onset 1-10 days after

birth

1-12 months after

birth

Within first month

after birth

Symptoms Sadness, tears Anxiety, feeling of loss, sadness

Delusions orhallucinations of

harming infants or

self

Incidence 70% of all births 10% of all births 1-2% of all births

Etiology (possible) Probable hormonal

changes, stress oflife changes

History of previous

depression,hormonal response,

lack of social

support

Possible activation

of previous mentalillness, hormonal

changes

Therapy Support, empathy Counseling, drug

therapy

Psychotherapy,

drug therapy


15/15

postpartal complication

Documents