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POST PARTUM COMPLICATIONS Lecture 9

POST PARTUM COMPLICATIONS Lecture 9. Endometritis. Infection of Uterus: endometrium, myometrium, or parametrium. Caused by: E.Coli, Staph, Group A/B Streptococcus. Occurs within 10 days, abortion or delivery.

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POST PARTUM COMPLICATIONS Lecture 9

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  1. POST PARTUM COMPLICATIONS Lecture 9

  2. Endometritis • Infection of Uterus: endometrium, myometrium, or parametrium. • Caused by: E.Coli, Staph, Group A/B Streptococcus. • Occurs within 10 days, abortion or delivery. • Granulocytes in lochia & endometrial lining - help prevent infection • Risk factors: PROM, C/S, multiple pelvic exams, UTI, +GBS, DM, poor nutrition, poor health, catheterization. • T = 100.4 x 2 ; C/S most common cause of infection followed by UTI.

  3. S/S: • fever, chills, malaise, abd.pain, uterine cramping & tenderness, foul-smelling lochia, tachycardia. • LAB findings: CBC & Blood cx’s. WBC > 20,000 [indicates infection] 20,000 - normal > delivery. • Blood cx may be + for bacteremia. Send UA, urine cx; lochia cx. TX: • ^ po fluids, hypothermia blankets, ice packs to head/groin. • Broad spectrum antibiotics. Ampicillan, cephalosporin, gentamycin, clindamycin for 2-3 days. • Antipyretics [Tylenol] &/or pain meds.as well.

  4. Wound Infection Common Sites: incision, perineum [episiotomy & laceration], vagina. [port of entry] • S/S REEDA: erythema, ecchymosis, edema, purulent drainage, wound edges not approximated, pain, tenderness. Management: Remove some staples/sutures . Allow wound to drain. • Irrigation & packing of wound, broad spectrum AB, wound & blood cx, analgesics, warm compresses. • Perineal care: wipe front to back; warm water .

  5. GI • Paralytic Ileus: hard abdomen with absent bowel sounds, N V, abd.distention & pain. • NG tube to low intermittent suction; NPO; IVF

  6. Subinvolution of Uterus • Major complication > del. involving postpartum bleeding > 500 ml. [caused by uterine atony] • Delayed return of uterus to its normal size and functions. • Normally descends 1 cm/day PP. • S/S: larger than normal uterus, heavy flow, fatigue, back pain. • Methergine 0.2 mg po q 4 x 24 hrs. • Tx with AB as directed. Possible D&C. • Common Causes: retained placenta & pelvic infection. • Teach: self palpation of uterus [@ home]

  7. Postpartum Hemorrhage Caused by overdistention of uterus: • large infant, multiple gestation, retained placenta & pelvic infection; grand multip > 5; Precipitous delivery; prolonged labor, clotting disorders. Uterus “boggy” - soft. Relaxed uterus prevents constriction of blood vessels @ uteroplacetal site. S&S: profuse bleeding, ^ clots. • Massage til firm. Assess for continued bleeding & passage of clots.

  8. PP Hemorrhage Manage: • 20-30 units of Pitocin in liter RL • Massage uterus • Methergine 0.2 mg po q 4h x 24hr. • Monitor BP before giving; may ^ BP or may give Methergine 0.2 mg. IM stat & q4 po x 24hrs. Also used: Hemabate, Prostin [prostaglandins]. • Remove clots &/or retained placenta; may need D&C or hysterectomy. IV RL, transfusion with whole blood,

  9. Late P.P.H • Appears 24 hours to month > delivery. • Caused by retention of small piece of tissue • Tissue necrosis > delivery and sloughs off, causing bleeding at site. Teach mom s/s PP hemorrhage & to contact HCP if ^ bleeding. Remove pieces of retained placenta by dilation & curettage (D&C) • Do bimanual compression for ^ bleeding. • Follow tx for PP hemorrhage.

  10. Uterine Prolapse • Relaxation of uterine muscle; uterus protrudes from vagina. • Ligaments over stretched & don’t return to normal. • Common after vaginal births or large infants. • Manifests @ menopause d/t decreased estrogen. TX: severe prolapse: hysterectomy milder prolapse: pessary [supportive device]

  11. Mastitis • Develops after breast milk is established, 2-4wks.PP • D/t ineffective or infrequent breast feeding or milk stasis from engorgement, skipping breast. • E.Coli or Staph.aureus; carried on hands of mom. Enters nipple thru crack or blister. • S/S: fever, chills, malaise, localized erythema & tenderness of breast tissue. • Tx: Warm soaks to both breasts as needed; pumping; put baby on breast more often. • Analgesics; AB’s - Amoxicillan 250mg.po TID.

  12. UTI • ~ 2-4 % develop UTI postpartum. • Bladder hypotonic > del. & residual urine & reflux results. • Freq. VE’s, catheterizations & birth trauma. • S/S: dysuria, low grade fever, urgency, & frequency. ^ temp. • UA & urine cx. • E.Coli most common pathogen ~ 75% of cases. • Bactrim [sulfanomide], Ampicillan, cephalexin {po Keflex}.

  13. Thrombophlebitis • aka “Superficial thrombophlebitis” • Rate 5x higher in preg.women. • Inflammation of vein wall. • Risk factors: women with extensive varicosities, smoking, inactivity, obesity, C/S, age > 35. • Occurs within few days postop. • Localized swelling, erythemia, tenderness. Unilateral; affects one leg/calf or other. • Tx: warm soaks to affected area; elevation of extremities; analgesics. • No ambulation for 1 wk; then OK to ambulate. No anticoagulants @ this time. Support stockings recommended. Avoid standing too long.

  14. Deep Vein Thrombosis • Caused by inflammatory process • Collection of blood factors, mainly fibrin, accumulates & may be released . • [1 in 2,000 preg] - deep veins of calves, thigh, pelvis. Prevent by early ambulation 6-8 hrs. post op • ROM exercises; changing positions often. • Teds stockings, compression boots post op. {TEDS} stockings are used in pts. with hx of phlebitis, C/S, or varicose veins. Diagnosis: Doppler’s studies [gold standard] diagnosing.

  15. DVT S/S: • frank pain in calf/hip; inability to walk upon rising; + Homan’s ; + tenderness with local calf swelling, heat, redness; measure both calves & compare. Treatment: • Bedrest & leg elevation; Anticoagulants; PT/PTT prior to therapy & during for therapeutic dosing. • Heparin or Lovenox SC . Analgesics. Septic pelvic thrombophebilits: often with C/S; thrombus formation in pelvis. • May proceed to pulmonary embolis = life threatening. • PE: fragments of clot carried to lung; can be fatal.

  16. Pulmonary Embolism • Fragments of blood clot carried to lungs. • S/S: sudden, sharp chest pain, tachycardia, syncope [fainting], tachypnea, rales, cough, hemoptysis. • ABG’s show decreased PO2; chest x-ray > pleural effusion & atelectasis. • Manage: Dissolve clot & maintain pulmonary circulation. Initiate IV heparin therapy asap. O2, bedrest; ICU admission, ABG’s, O2 sat, VS, narcotics to alleviate pain & anxiety.

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