* Recognize common and potentially life-threatening postpartum complications
* Postpartum Hemorrhage
* Postpartum Endometritis
* Peripartum Cardiomyopathy
* Postpartum Thyroiditis
* Postpartum Depression
* Direct the initial management of the ill postpartum patient
* Know the appropriate threshold for consultation with specialist
* Be defined as a blood loss exceeding 500ml after delivery of the infant
* Excessive bleeding that makes the patient symptomatic (lightheaded, syncope) and/or results in signs of hypovolemia (hypotension, tachycardia, oliguria)
* PPH: occurs in 24 hour of ...view middle of the document...
* 24 hrs. after birth uterus should be a firmly contracted ball resembling a grapefruit located at the level of the umbilicus.
* Lochia is dark red, moderate in amount, saturation of 1 pad/hr. is excessive.
* Uterine fundus that is difficult to locate
* Soft or “ boggy” feel when fundus is located
* Uterus that becomes firm when massaged but loses its tone when massage is stopped.
* Uterine fundus that is located above expected level
* Excessive Lochia
* Uterine massage and expression of clots
* Pharmacologic measures –
20 “u” oxytocin in 1 L D5LRS per doctor’s order
Methylergonovine 0.2mg.IM per doctor’s order
* If postpartum hemorrhage is uncontrollable , do a Hysterectomy.
* can include vaginal, cervical, perineal lacerations and hematoma
* If with lacerations of the birth canal, there’s excessive uterine bleeding when fundus is contracted firmly and on the right location. Bleeding is bright red, oozing, slow trickle or frank hemorrhage.
* Occur when bleeding into a loose connective tissue occurs while overlying tissue remains intact. Blood collects 25-500 ml. in the soft tissue
* Related to vascular injury during spontaneous or assisted delivery involving the vulva or vagina.
* Vulvar hematoma – a discolored bulging mass producing deep ,severe, unrelieved pain with feelings of pressure.
* Severe vulvar pain
* Unilateral purplish discoloration of the perineum or buttocks which are firm and tender.
* Feeling fullness in the vagina
1. Application of small ice packs
2. Surgical evacuation
* Non-adherent Retained Placenta –
* Results from partial separation of a normal placenta, entrapment of the partially or completely separated placenta by an hourglass constriction ring of the uterus, mismanagement of the third stage of labor or abnormal adherence of the entire placenta or a portion of the placenta to the uterine wall.
* Management :
* Manual separation and removal by a primary health care provider under light anesthesia to facilitate exploration and removal
* Adherent Retained Placenta
* Thought to be a result from zygotic implantation in an area of defective myometrium so that there is no zone of separation between the placenta and the decidua.
* Attempts to remove the placenta in the usual manner is unsuccessful, laceration or perforation of the uterine wall may result putting woman in a greater risk of PPH and infection.
* Degrees of attachment:
* Placenta Accreta – slight penetration of...