Postpartum Complications Lecture Notes

Introduction

• Presenter: Meris from Level Up RN
• Topics: Postpartum complications, including hemorrhage, endometritis, mastitis, mental health concerns
• Resource: Maternity flashcards available at leveluprn.com

Postpartum Hemorrhage

• Definition:
  • Vaginal delivery: >500 mls blood loss
  • C-section: >1,000 mls (1 liter) blood loss
• Risk Factors:
  • Uterine atony (boggy fundus)
  • Birth canal trauma (laceration/hematoma)
  • Precipitous delivery
  • Retained placental fragments
  • Uterus inversion/subinvolution
  • Coagulopathies (e.g., DIC, ITP)
  • Multipolarity, multiple births, fetal macrosomia
• Signs and Symptoms:
  • Saturating a pad in ≤15 minutes
  • Soft or boggy fundus
  • Large blood clots, continuous blood flow
  • Signs of hypovolemic shock (tachycardia, hypotension, tachypnea, cool clammy skin)
• Labs and Treatment:
  • Decreased hemoglobin and hematocrit
  • Treatments include uterine stimulants (oxytocin, methylergonovine, misoprostol, carboprost), bimanual compression, uterine packing, surgical intervention
  • Nursing care: Fundus massage, administering oxygen, IV fluids, blood products, elevate legs

Endometritis

• Definition: Infection/inflammation of the uterine lining
• Risk Factors:
  • C-section, chorioamnionitis
  • Retained placental fragments
  • Premature/prolonged rupture of membranes
  • Prolonged labor, internal fetal monitoring
  • Multiple cervical exams
• Signs and Symptoms:
  • Fever, suprapubic pain, tenderness, malodorous lochia
  • Tachycardia, hypotension
• Treatment:
  • IV/oral antibiotics, analgesics
  • Monitor for complications, expect symptom resolution with treatment

Mastitis

• Definition: Infection and inflammation of the breast
• Risk Factors:
  • Infrequent feeding, clogged milk duct
  • Nipple damage, poor hand hygiene
• Signs and Symptoms:
  • Flu-like symptoms (malaise, fatigue, body aches, fever)
  • Unilateral breast pain, swelling, erythema
• Treatment:
  • Antibiotics and analgesics
  • Patient education on prevention: hand hygiene, proper latch, feed from both breasts, apply heat, ensure breast drainage

Mental Health Concerns

• Types:
  • Baby blues: Mood swings/crying within 1-2 weeks postpartum
  • Postpartum depression (PPD): Persistent sadness within 1 year postpartum
  • Postpartum psychosis: Hallucinations, delusions within 2 weeks postpartum
• Risk Factors and Symptoms:
  • History of bipolar disorder for psychosis
  • Symptoms of PPD: Sadness, mood swings, rejection of infant, anxiety
  • Importance of screening (Edinburgh Depression Scale)
• Treatment:
  • PPD: Screen and support, psychotherapy, medication
  • Psychosis: Antipsychotics, mood stabilizers, ensure safety

Quiz Questions

1. Treatment for postpartum hemorrhage: magnesium or oxytocin?
2. Higher risk for endometritis: vaginal birth or C-section?
3. Treatment for mastitis: which two medication classes?
4. Sadness/mood swings for 12 days postpartum: normal or abnormal?

Conclusion

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