NUR2633 Exam 2
Risk factors for postpartum hemorrhage
- An early (primary) postpartal hemorrhage occurs within the first 24 hours after childbirth.
- A late (secondary) postpartal hemorrhage occurs from 24 hours to 12 weeks after childbirth.
Late postpartum hemorrhage occurs in only 1% to 2% of all childbearing women, usually within the first 2 weeks
after birth. Retained placental fragments are the most common cause of late PPH. Other causes include
subinvolution (failure of the uterus to return to its prepregnant size), uterine infection, and less commonly,
inherited coagulation defects such as von Willebrand (vW) disease.
• Risks factors for postpartum hemorrhage (pg 606)
- Multiple births
- A history of postpartum hemorrhage
- Uterine infection
- Any kind of manipulation to the uterus
- Some birthing multiple babies (twins etc)
- Polyhydramnios
- Drug use
- Prolonged labor
- Precipitous (rapid delivery)
• Four T’s of postpartum hemorrhage
- (uterine atony [Tone]) leading cause of early hemorrhages
- laceration, hematoma, inversion, rupture [Trauma] - During the second stage of labor, soft tissue trauma
from a number of causes (e.g., rapid labor, operative delivery, and episiotomy) can result in genital tract
lacerations
- retained tissue or invasive placenta [Tissue]
- coagulopathy [Thrombin]) - Thrombin refers to problems with maternal coagulation. Disorders of the
coagulation system and platelets do not usually result in excessive bleeding during the immediate
postpartum period. Preexistent maternal factors such as low fibrinogen levels and idiopathic
thrombocytopenia (ITP) and acquired pathology such as HELLP syndrome (condition characterized by
Hemolysis, Elevated Liver enzymes, and Low Platelet count), disseminated intravascular coagulation (DIC),
sepsis, and abruptio placentae require vigilant care and anticipation of possible hemorrhage after birth.
Management for postpartum hemorrhage—priority assessment and intervention; uterotonics
- Methylergonovine - Uterotonic and analgesic, It can treat severe bleeding from the uterus after childbirth.
(can not be given if the patient has hypertension)
- Carboprost-Hemabate - Causes uterine contractions by directly stimulating the myometrium. Therapeutic
Effects: Expulsion of fetus. Control of postpartum bleeding (can not be given to ashmatics)
- Misoprostol(cytotek)
- Pitocin/oxytocin
- Fundal massage – to stop bleeding (initial intervention)
- Check for bladder distention
- Vital signs should return to normal
Nursing Assessment for postpartum hemorrhage
- Assess the amount of bleeding.
This study source was downloaded by 100000823822032 from CourseHero.com on 11-23-2021 11:58:13 GMT -06:00
- Assess maternal vital signs to establish baseline data.
, - Assess for signs of shock.
- Assess the condition of the uterus.
Breastfeeding/formula feeding—care of breasts, complications, education pg 576
• Contraindications for breast feeding
- Infants with galactosemia (because of an inability to digest the lactose in the milk)
- Mothers with active tuberculosis or HIV infection
- Mothers with active herpes lesions on the nipples
- Mothers who are receiving certain medications, such as lithium or methotrexate
- Mothers who are exposed to radioactive isotopes (e.g., during diagnostic testing)
- Know about thrush on the tongue of the baby
• Benefits of breast feeding
Mother
- Decreased risk of breast, ovarian, and uterine cancer
- Decreased risk of type 2 diabetes mellitus
- Lactational amenorrhea (LAM) (although breastfeeding is not considered an effective form of contraception)
- Enhanced involution (caused by uterine contractions triggered by the release of oxytocin) and decreased risk
of postpartum hemorrhage
- Enhanced postpartum weight loss
- Increased bone density
- Enhanced bonding with infant
Infant
- Enhanced immunity through the transfer of maternal antibodies; decreased incidence of infections including
otitis media, pneumonia, urinary tract infections, bacteremia, and bacterial meningitis
- Enhanced maturation of the gastrointestinal tract
- Decreased risk of sudden infant death syndrome (SIDS)
- Decreased likelihood of developing insulin-dependent (type 1) diabetes
- Decreased risk of childhood obesity
- Enhanced jaw development
- Protective effects against certain childhood cancers
- Very good for preterm babies
• Care of breasts
-
Medications used postpartum
- Pitocin
- Metergine
- Hemabate
- Cytotec
- Opioids
- NSAIDS
- Rubella – if vaccine needed if non-immune, most stay protected from getting pregnant for 3 months
after administration
- Rhogam – given to RH negative mothers if the baby is RH positive
- Magnesium sulfate - Magnesium sulfate injection is also used for pediatric acute nephritis and to
prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy.
Risk factors for postpartum hemorrhage
- An early (primary) postpartal hemorrhage occurs within the first 24 hours after childbirth.
- A late (secondary) postpartal hemorrhage occurs from 24 hours to 12 weeks after childbirth.
Late postpartum hemorrhage occurs in only 1% to 2% of all childbearing women, usually within the first 2 weeks
after birth. Retained placental fragments are the most common cause of late PPH. Other causes include
subinvolution (failure of the uterus to return to its prepregnant size), uterine infection, and less commonly,
inherited coagulation defects such as von Willebrand (vW) disease.
• Risks factors for postpartum hemorrhage (pg 606)
- Multiple births
- A history of postpartum hemorrhage
- Uterine infection
- Any kind of manipulation to the uterus
- Some birthing multiple babies (twins etc)
- Polyhydramnios
- Drug use
- Prolonged labor
- Precipitous (rapid delivery)
• Four T’s of postpartum hemorrhage
- (uterine atony [Tone]) leading cause of early hemorrhages
- laceration, hematoma, inversion, rupture [Trauma] - During the second stage of labor, soft tissue trauma
from a number of causes (e.g., rapid labor, operative delivery, and episiotomy) can result in genital tract
lacerations
- retained tissue or invasive placenta [Tissue]
- coagulopathy [Thrombin]) - Thrombin refers to problems with maternal coagulation. Disorders of the
coagulation system and platelets do not usually result in excessive bleeding during the immediate
postpartum period. Preexistent maternal factors such as low fibrinogen levels and idiopathic
thrombocytopenia (ITP) and acquired pathology such as HELLP syndrome (condition characterized by
Hemolysis, Elevated Liver enzymes, and Low Platelet count), disseminated intravascular coagulation (DIC),
sepsis, and abruptio placentae require vigilant care and anticipation of possible hemorrhage after birth.
Management for postpartum hemorrhage—priority assessment and intervention; uterotonics
- Methylergonovine - Uterotonic and analgesic, It can treat severe bleeding from the uterus after childbirth.
(can not be given if the patient has hypertension)
- Carboprost-Hemabate - Causes uterine contractions by directly stimulating the myometrium. Therapeutic
Effects: Expulsion of fetus. Control of postpartum bleeding (can not be given to ashmatics)
- Misoprostol(cytotek)
- Pitocin/oxytocin
- Fundal massage – to stop bleeding (initial intervention)
- Check for bladder distention
- Vital signs should return to normal
Nursing Assessment for postpartum hemorrhage
- Assess the amount of bleeding.
This study source was downloaded by 100000823822032 from CourseHero.com on 11-23-2021 11:58:13 GMT -06:00
- Assess maternal vital signs to establish baseline data.
, - Assess for signs of shock.
- Assess the condition of the uterus.
Breastfeeding/formula feeding—care of breasts, complications, education pg 576
• Contraindications for breast feeding
- Infants with galactosemia (because of an inability to digest the lactose in the milk)
- Mothers with active tuberculosis or HIV infection
- Mothers with active herpes lesions on the nipples
- Mothers who are receiving certain medications, such as lithium or methotrexate
- Mothers who are exposed to radioactive isotopes (e.g., during diagnostic testing)
- Know about thrush on the tongue of the baby
• Benefits of breast feeding
Mother
- Decreased risk of breast, ovarian, and uterine cancer
- Decreased risk of type 2 diabetes mellitus
- Lactational amenorrhea (LAM) (although breastfeeding is not considered an effective form of contraception)
- Enhanced involution (caused by uterine contractions triggered by the release of oxytocin) and decreased risk
of postpartum hemorrhage
- Enhanced postpartum weight loss
- Increased bone density
- Enhanced bonding with infant
Infant
- Enhanced immunity through the transfer of maternal antibodies; decreased incidence of infections including
otitis media, pneumonia, urinary tract infections, bacteremia, and bacterial meningitis
- Enhanced maturation of the gastrointestinal tract
- Decreased risk of sudden infant death syndrome (SIDS)
- Decreased likelihood of developing insulin-dependent (type 1) diabetes
- Decreased risk of childhood obesity
- Enhanced jaw development
- Protective effects against certain childhood cancers
- Very good for preterm babies
• Care of breasts
-
Medications used postpartum
- Pitocin
- Metergine
- Hemabate
- Cytotec
- Opioids
- NSAIDS
- Rubella – if vaccine needed if non-immune, most stay protected from getting pregnant for 3 months
after administration
- Rhogam – given to RH negative mothers if the baby is RH positive
- Magnesium sulfate - Magnesium sulfate injection is also used for pediatric acute nephritis and to
prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy.
