Chapter 23 Nursing Care Of The Woman And Family Experiencing Postpartum Complications

3388 words - 14 pages

Chapter 23
Nursing Care of the Woman and Family Experiencing Postpartum Complications

Postpartum Hemorrhage
← Loss of more than 500mL of blood following vaginal childbirth or loss of more than 1000mL following cesarean birth
← Early postpartum hemorrhage
â–ª >500 ml in first 24 hrs (blood loss often underestimated)
← Late or delayed
â–ª >500 cc after first 24 hrs.
← Decrease in hematocrit of 10% or more since admission pr the need for blood transfusion

Etiology:
← Early postpartum hemorrhage:
o Uterine Atony
o Trauma to the birth canal
← Late postpartum hemorrhage
o Retained placental fragments
o Subinvolution or ...view middle of the document...

First degree – vaginal mucous membrane and skin of the perineum to the fourchette
b. Second degree – vagina, perineal skin, fascia, levator ani muscle, and perineal body
c. Third degree – entire perineum, and reaches the external sphincter of the rectum
d. Fourth degree – entire perineum, rectal sphincter, and some of the mucous membrane of the rectum

Management
← Episiotomy repair by physician
← Document degree of laceration
← Laceration heals slowly ( suture line are ragged
← 1st week ( diet high in fluid and stool softener ( prevent constipation
← Be aware of the extent laceration
← Do not give enema or rectal suppository
← Avoid taking rectal thermometer (could open suture
← Avoid sex for 6 months

Retained Placental Fragments
← Placenta does not deliver entirely
← Fragments of it separate and are left behind
← Commonly with:
o Succenturiate placenta - a placenta with an accessory lobe
o Placenta Accreta – placenta that fuses with the myometrium ( abnormal deciduas basalis ( retained placenta

Assessment
← Undetected retained fragment ( large ( bleeding ( uterus cannot contract
← Small fragment ( bleeding ( 6th or 10th day postpartum
← Abrupt discharge of large amount of blood
← On examination( not contracted uterus
← (+) placental tissue (elevated hcG
← Sonogram ( retained placental fragment

Therapeutic Management
← Removal of the fragments ( D&C
← Methotrexate therapy ( destroy retained placental tissue
← At home: observe color of the lochia
← Report changes from lochia serosa or alba to rubra

Disseminated Intravascular Coagulation
← Deficiency in clotting ability caused by vascular injury
← ( prothrombin and platelets

← severe generalized hemorrhaging

Predisposing Factors:
â–ª Missed abortion
â–ª Abruptio placenta
â–ª Preeclampsia or Eclampsia
â–ª Fetal death in utero
â–ª Septic shock

â–ª Amniotic fluid embolism

Signs and Symptoms
← ( protime

← ( fibrinogen

← thrombocytopenia

← bleeding from gums

← bleeding from puncture sites

← ecchymosis ( hemorrhage into the skin and subcutaneous tissue

Management
← Delivery of the fetus and placenta ( stop production of thromboplastin
← Blood transfusion ( whole blood, packed RBC, plasma, cryoprecipitate)
← Monitor vital signs ( hypovolemia
← Document location and severity of bleeding

Late postpartum hemorrhage

Subinvolution
← Incomplete return of the uterus to its normal size and shape
← 4th – 6th week ( uterus ( enlarged and soft

Etiology
← Retained placental fragments
← Pelvic infection

Clinical Signs and Symptoms
← Prolonged lochial discharge
← Irregular or excessive...

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