Postpartum Complications
Part 1
Module 10.3: Postpartum
Maternal and Reproductive Health
Bleeding Complications
Postpartum
Hemorrhage Presenter video here!
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Postpartum hemorrhage is the major loss of
blood after a vaginal delivery
Can occur immediately after the delivery up until 2
weeks after delivery (delayed postpartum
hemorrhage)
It is one of the major causes of maternal mortality
Almost 3% of women in the US will experience PPH to
some degree
Definitions
2 types of post partum hemorrhage
To qualify as PPH,
EARLY LATE the mother must lose
500ml of blood if she
Occurs in the Occurs after the had an SVD and
first 24 hours first 24 hours
post-delivery 1,000 ml of blood if
post-delivery
she had a cesarean
section
Risk Factors
Twins or triplets Precipitous labor
Macrosomic fetus Use of forceps or vacuum during delivery
Preeclampsia Placenta previa
Prolonged labor Abruptio placenta
Causes
Uterine atony
Inability of the uterus to contract
Retention of the
Typically after birth, the uterus contracts to
placenta
clamp down on all blood vessels and stop
bleeding If the entire placenta is not expelled
If the uterus does not contract, or “clamp within 30 minutes of delivery, the
down”, hemorrhage will occur mother is at risk for PPH
Most common cause of PPH
Injury to birth canal Bleeding disorders
Could be due to malpresentation of the DIC
fetus, use of forceps or vacuum, or a large Mothers on lovenox or warfarin for
fetus pre-existing conditions
Assessment Presenter video here!
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Boggy This is a uterus that is not contracting to clamp down on the blood
vessels
Uterus The fundus will feel soft instead of hard as it should
Pad counts - most PPH clients are saturating pads every 15 minutes
Blood Puddle of blood in the bed
loss If they try to stand up for the first time, there could be a huge gush of
blood
Shock -If there is large amounts of blood loss leading to hypovolemia
Decreased LOC Pale Diaphoretic Hypotensive Tachycardia
Interventions
Fundal massage
Massage the fundus - hard
Medications
Warn the mother this will hurt,
Oxytocin
but you must do it to get the
uterus to contract and stop the Estimated Blood Methylergonovine
bleeding Loss (EBL)
Blood products
Every 15 minutes at a minimum Weigh pads to estimate the
loss
1 g = 1 mL
Monitor hemoglobin and
hematocrit
Deep Vein Thrombosis
(DVT) Presenter video here!
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Thrombus - A clot that remains
attached to the vascular wall
Causes Prevention
Venous stasis Assess at-risk individuals
Immobility Promote venous return
Age SCD’s, ted hose, encourage
LHF mobility
Vein wall damage
Hypercoagulable states
Pregnancy, oral
contraceptives, malignancy Treatment
Anticoagulants
Hypovolemic
Shock Presenter video here!
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Severe blood loss leading to
inadequate tissue perfusion
Pathophysiology
Low blood flow
There is a loss of the circulating volume
Not enough blood to enter the heart (preload), which decreases cardiac output
The body will vasoconstrict to compensate
Hypovolemic
Shock Presenter video here!
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Causes
Hemorrhage
Traumatic injury
Dehydration
Vomiting
Diarrhea
Burns
Assessment
Weak
Pale
Tachycardic
Anxious
Hypotension
Decreased LOC
Pale
Cool
Clammy
Decreased UOP
Treatment
Fix the cause
Stop vomiting/diarrhea
Stop bleeding
Repair in OR
Replace volume
Isotonic IVF Isotonic
NS
LR
Blood products
Support perfusion
Vasopressors
Disseminated Intravascular
Coagulation (DIC) Presenter video here!
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Abnormal clotting cascade leading to
widespread bleeding and clotting
Causes Signs and Symptoms
Placental abruption Infection Bleeding from at least three sites
Severe PPH Preeclampsia, Sites are unrelated
Spontaneous nosebleed
Amniotic fluid embolism eclampsia, HELLP
Bleeding from IV or blood draw sites
Petechiae
DIC Assessment
Treatment
Determine underlying cause and
TREAT
Administer clotting factors
Administer platelets
Bleeding precautions
Idiopathic
Thrombocytopenic Presenter video here!
Purpura (ITP)
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Autoimmune disorder causing low
platelet count Signs & Symptoms
Bruising
Petechiae
Bleeding gums
Management
Fix the underlying problem
Volume expansion
Blood products
Clotting factors