https://studylib.net/doc/9484185/postpartum-complications

 A postpartum period is the period beginning immediately after the birth of a child
and extending for about six weeks.
 It is the time after birth, a time in which the mother's body, including hormone
levels and uterus size, returns to a non-pregnant state.
 The World Health Organization (WHO) describes the postnatal period as the
most critical and yet the most neglected phase in the lives of mothers and
babies.
 The average hospital stay for a vaginal birth is one to two days.
 The average caesarean section postnatal stay is three to four days. 
 During this time the mother is typically monitored by nurses or midwives as
complications can arise.
 Postpartum complications are always potentially serious especially during the
first 6-12 hours after delivery, acute complications may happen.
 Most common: Hemorrhage and Infection.

Postpartal Hemorrhage

Defined as loss of more than 500 mls of blood in the 24 hours period following the third
stage of labor or
1000 mls following surgical delivery and does not include
blood loss during the delivery.
Slow and subtle
-
more dangerous because may not notice
Sudden and profuse
Pad count
-
each additional gm of weight of pad= 1 mL of blood lost
Concealed bleeding with hematomas
Defined as loss of more than 500 mls of blood in the 24 hours period following the third
stage of labor or
1000 mls following surgical delivery and does not include
blood loss during the delivery.
Slow and subtle
-
more dangerous because may not notice
Sudden and profuse
Pad count
-
each additional gm of weight of pad= 1 mL of blood lost
Concealed bleeding with hematomas
Defined as loss of more than 500 mls of blood in the 24 hours period following the third
stage of labor or
1000 mls following surgical delivery and does not include

Pitocin Reminder
Given at any time can cause
water intoxication
Stimulates contraction
Promotes fluid retention
Monitor I&O
Peurperal Infection
Report temp > 100.4F 24 hours after delivery and/or 2 of the first 10 postpartum days
Normal elevated temp for first 24 hours due to blood loss, dehydration,
etc.
Chills, anorexia, vomiting, lower abdominal tenderness, purulent or malodorous Lochia
Treatment
Fowler’s position for drainage
Assess Lochia
Cultures/sensitivities
IV antibiotics
Isolation
Suppress milk and discard
Amniotic Fluid Embolism
Occurs
when amniotic fluid, with its particles such as vernix, fetal hair, and sometimes meconium,
enter
the woman’s circulation and typically obstructs small blood vessels in her lungs
Characterized by abrupt onset of hypotension, respiratory distress, and coagu
lation abnormalities
Thrombophlebitis
Treatment
Measure calf
Bed rest with elevation of affected leg
Application of heat
Heparin or Lovenox
Oral anticoagulants for 6 weeks
Avoid crossing legs, constriction, etc.
Postpartum Depression
Hormonal changes in t
he postpartum period contribute to the mood swings and depression
Postpartum blues
-
appears within 3
-
10 days and disappears within 2 weeks
Crying, sadness, irritability
20% of new mothers
True Depression
Sadness doesn’t go away in 2 weeks
Anger 1 month af
ter delivery
Changes in appetite or sleep
Panic attacks
Lack of interest in surroundings or baby
Appears 2 weeks after delivery to 1 year postpartum
More intense symptoms
Alterations in family
Ineffective coping
Babies may fail to thrive
Postpartum
Psychosis
Delusions
Hallucinations
Confusion
Desire to harm baby
Immediate care by obstetrician and psychiatris

Cervical Lacerations
If fundus is firm and can’t get Mom to stop bleeding suspect cervical tear/laceration
Suspect with bright red bleeding in spite of tightly contracted uterus
Cause: Mom pushes before she
is dilated complete 10 cm.
Other causes: Forceps delivery, macrosomia, precipitous delivery
Perineal Lacerations
First degree: tear of skin and MM of the posterior connection of the labia minora and outer
vagina
Second degree: Plus muscles and fascia up t
o the anal sphincter
Third degree: Plus anal sphincter
Fourth degree: Plus extension through the rectal wall
Hematomas
Trauma during delivery
Excessive pain and pressure in the perineal or rectal area
-
feels warm and may bulge out of vaginal wall
Cold
packs to perineum after delivery
Restless
If epidural is working may go straight into shock
Small or size of baseball containing 250
-
500 mL of bloo
Occurs
when amniotic fluid, with its particles such as vernix, fetal hair, and sometimes meconium,
enter
the woman’s circulation and typically obstructs small blood vessels in her lungs
Characterized by abrupt onset of hypotension, respiratory distress, and coagu
lation abnormalities

Delusions
Hallucinations
Confusion
Desire to harm baby
Immediate care by obstetrician and psychiatrist