Lacerations of genital tract, episiotomy, retained placental fragments, uterine inversion, coagulation disorders, LGA newborn, failure to progress during 2nd stage, placenta accreta, induction with pitocin, surgical birth, and hematomas Show Petechiae, ecchymoses, bleeding gums, fever, hypotension, acidosis, hematomas, tachycardia, proteinuria, uncontrolled bleeding during birth, and acute renal failure b. Acute distress. The immediate reaction to news of a perinatal loss or infant death encompasses a period of acute distress. Disbelief and denial can occur. However, parents also feel very sad and depressed. Intense outbursts of emotion and crying are normal. However, lack of affect, euphoria, and calmness may occur and may reflect numbness, denial, or personal ways of coping with stress. Anticipatory grief applies to the grief related to a potential loss of an infant. The parent grieves in preparation of the infant's possible death, although he or she clings to the hope that the child will survive. Intense grief occurs in the first few months after the death of the infant. This phase encompasses many different emotions, including loneliness, emptiness, yearning, guilt, anger, and fear. Reorganization occurs after a long and intense search for meaning. Parents are better able to function at work and home, experience a return of self-esteem and confidence, can cope with new challenges, and have placed the loss in perspective. Causes- the Four T's of PPH • Tone • Neonatal macrosomia. Birth weight greater than 4000 grams ... • Abnormal placenta implantation: placenta
accreta chorionic villi is directly attached to the myometrium of the uterus placenta previa marginal or complete Uterine inversion A prolapse of the fundus of the uterus to or through the cervix so that the
uterus is turned inside out Associated with: Early post-partum hemorrhage (PPH) occurs within the first 24 hours after childbirth • Most common cause uterine atony - decreased uterine tone. A contracted uterus post-delivery results in constriction of blood vessels at the placental site. When the uterus relaxes there is increased blood loss Late post-partum hemorrhage (PPH) occurs after 24 hours after birth • Most common cause is retained placental tissue Non uterine related PPH causes • Lacerations are the second most common cause of early PPH •
Hematomas occur when blood collects within connective tissue of the vagina and perineal areas related to a vessel that ruptures and continues to bleed Coagulopathies . Medical Management of Uterine Atony (Most common cause of PPH):
Dilation and curettage (D&C) - for retained placental tissue Lab evaluation of: Nursing Interventions: Uterotonic Drugs for Post-Partum Hemorrhage pitocin pitocin 10-40 units per 100mL, rate is titrated to uterine tone IV infusion Usually none (side effects) N&V contraindicated: Presence of hypersensitivity to the drug store at :Room temperature Methergine IM frequency: Every 2-4 hours side effects-Severe hypertension, especially with rapid administration or in patients with existing hypertension or PIH contraindications: Hypertension, PIH, heart disease, hypersensitivity to med, use with caution if ephedrine has been used (compounded effect) store:Refrigerated Hemabate IM or intramyometrial frequency: Every 15-90 minutes side effects: Bronchospasms Use with caution with women who have liver disease Refrigerate Cytotec 800-1000mcg side effects:N&V, diarrhea, shivering, fever (transient) contraindicated: store at room temp bakri balloon uterus isnt contracting due to fibroids blood loss calc. if dry item ways 40 g, wet weight minus dry weight = 100 g = 100ml blood loss What is the most common reason for late postpartum hemorrhage PPH )?Uterine atony.
This is the most common cause of PPH. It happens when the muscles in your uterus don't contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.
What are the 3 main causes of postpartum hemorrhage quizlet?The most common cause of early postpartum hemorrhage is uterine atony, but it can also be caused by trauma, lacerations, and hematomas.
What are risk factors for PPH quizlet?Risk factors for PPH include uterine over distension (polyhydramnios, macrosomia, and multiple gestation), prolonged labor, chorioamnionitis, and grandmultiparity.
What are the 4 most common causes of postpartum hemorrhage?What causes postpartum hemorrhage?. Placental abruption. The early detachment of the placenta from the uterus.. Placenta previa. The placenta covers or is near the cervical opening.. Overdistended uterus. ... . Multiple pregnancy. ... . Gestational hypertension or preeclampsia. ... . Having many previous births.. Prolonged labor.. Infection.. |
