Chapter 33 Postpartum Complications Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Postpartum Hemorrhage (PPH)  Definition and incidence  Traditionally defined as: Loss of 500 ml of blood after vaginal birth Loss of 500 ml of blood after vaginal birth Loss of 1000 ml after cesarean birth Loss of 1000 ml after cesarean birth A 10% change in Hct between labor and postpartum A 10% change in Hct between labor and postpartum  Leading cause of maternal morbidity and mortality  Often unrecognized until mother has profound symptoms

3 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Postpartum Hemorrhage (PPH) (cont.)  Uterine atony  Marked hypotonia of uterus  Leading cause of PPH  Associated with High parity High parity Hydramnios Hydramnios Macrosomic fetus Macrosomic fetus Multifetal gestation Multifetal gestation

4 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Postpartum Hemorrhage (PPH) (cont.)  Lacerations of genital tract  Retained placenta  Nonadherent retained placenta  Adherent retained placenta

5 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Postpartum Hemorrhage (PPH) (cont.)  Early recognition of PPH  Hypotonic uterus  Bleeding with a contracted uterus  Inversion of the uterus Potentially life-threatening Potentially life-threatening Occurs in 1 in 2500 births Occurs in 1 in 2500 births  Subinvolution of the uterus Late postpartum bleeding Late postpartum bleeding

6 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

7 Hemorrhagic (Hypovolemic) Shock  Results from hemorrhage  Emergency situation in which perfusion of organs may become severely compromised, death may occur  Medical management  Restore circulating blood volume  Nursing interventions  Monitor pulse and blood pressure  Fluid or blood replacement therapy

8 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Coagulopathies  Idiopathic thrombocytopenic purpura (ITP)  Autoimmune disorder  Antiplatelet antibodies decrease the life span of platelets  von Willebrand disease (vWD)  A type of hemophilia  Deficiency or defect in blood clotting protein

9 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Thromboembolic Disease  Results from formation of blood clot or clots inside a blood vessel, caused by inflammation or partial obstruction of vessel  Incidence and etiology  1 per 1000 to 2000 women  Major causes: venous stasis and hypercoagulation  Clinical manifestations  Medical management  Nursing interventions

10 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Postpartum Infections  Endometritis  Wound infections  Urinary tract infections  Mastitis

12 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

13

14 Key Points  Postpartum hemorrhage is most common and most serious type of excessive obstetric blood loss  Hemorrhagic (hypovolemic) shock is an emergency situation in which perfusion of body organs may become severely compromised, leading to significant morbidity or mortality rates for mothers

15 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Key Points (cont.)  Potential hazards of therapeutic interventions may further compromise woman with a hemorrhagic disorder  Clotting disorders are associated with many obstetric complications

16 Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Key Points (cont.)  First symptom of postpartum infection is usually fever greater than 38°C on 2 consecutive days in first 10 postpartum days (after first 24 hours)  Prevention is most effective and inexpensive treatment of postpartum infection