Postpartum Maternal Complications

1
Postpartum Maternal Complications

• Unit 3
• Chapter 28

2
Postpartum Hemorrhage

• gt 500cc NSVD or 1000cc C/S
• Hematocrit decrease of 10 or more
• Early vs Late PP hemorrhage
• Complicates about 5 of deliveries
• Leading cause of maternal morbidity and mortality

3
Postpartum Hemorrhage

• Predisposing factors
• uterine overdistention
• multiparity
• precipitous
• prolonged labor
• forceps/vacuum
• C/S
• manual removal of placenta

• previous PPH
• previa/accreta
• drugs Pit, MgSO4
• general anesthesia
• chorioamnionitis
• clotting disorders
• previous C/S
• DIC

4
Postpartum HemorrhageClinical Signs

• Where is the fundus??
• How does it feel?? boggy
• Does it stay contracted??
• Once located is it too high??
• Excessive bright red lochiasteady trickle??
• Excessive clots expelled
• Traumalacerations/hematoma
• Drugs Methergine/Hemabate/Pit

5
Thromboembolic DisordersDVT/PE

• Venous stasis compression of large vessels of
  legs and pelvis due to enlarging uterus
• Hypercoagulation elevated coagulation factors,
  suppressed fibrinolytic system
• Blood vessel injury endothelium injury,
  thrombosis 9X more likely in C/S birth
• Superficial venous thrombosis associated with
  varicosities limited to calf area

6
Clinical Signs/SymptomsDVT

• Swelling of the leg
• Redness
• Warmth
• Tenderness
• Pedal edema
• Homans sign

• Prophylactic Heparin
• Appropriate positioning _at_ delivery
• Encouraging frequent ambulation
• Antiembolic stockings

7
Pulmonary Embolism

• Complication of DVT and a leading cause of
  maternal mortality.
• Dislodged fragments of blood clot or amniotic
  fluid are carried to the lungs.
• Partial or complete obstruction of blood flow to
  lungs
• Death can occur within minutes

8
Clinical Signs Symptoms

• Depends on amount of obstruction
• Dyspnea
• Sudden sharp chest pain
• Tachycardia
• Syncope
• Tachypnea
• Pulmonary rales, cough, hemoptysis

9
Puerperal Infection

• Bacterial infections after childbirth
• Endometritis
• Wound infections
• UTI
• Mastitis
• Septic pelvic thrombophlebitis

10
Signs Symptoms

• Fever, chills
• Pain /redness of wound
• Wound drainage
• Edges approximated?
• Tachycardia
• Uterine subinvolution

• Abnormal duration of lochia, foul odor
• Elevated WBC
• Dysuria
• Suprapubic pain
• Body aches malaise

11
Preventing Infection

• Promoting hygiene
• Preventing urinary stasis
• Teaching breastfeeding techniques
• Providing Information

12
Postpartum Depression

• Most common affective disorder, occurs in 15-20
  of women
• Usually develops first 3 weeks to 3 months
• Unknown cause
• Strongest predictor is depression during
  pregnancy or previous PPD
• Major depression interferes with the normal
  mother-child relationship and places the infant
  at risk for later cognitive and behavioral
  problems