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1. POSTPARTUM HEMORRHAGE
2. THROMBOPHLEBITIS
3. SUBINVOLUTION
4. POSTPARTUM INFECTION
5. MASTITIS
6. EMOTIONAL COMPLICATIONS

MAJOR CAUSES — MAJOR CAUSES

1. UTERINE ATONY
- loss of muscle tone in uterus
1. UTERINE ATONY - may be the result of:
2. LACERATION OF BIRTH CANAL a. overdistension (large baby, multiple pregnancy,
polyhydramnios)
3. RETAINED PLACENTAL FRAGMENTS
b. overmassage
4. PLACENTA ACCRETA c. maternal exhaustion
d. inhalation anesthesia

— MAJOR CAUSES — MAJOR CAUSES

1. UTERINE ATONY 2. LACERATION OF BIRTH CANAL

Grading of Perineal Lacerations:

a. First Degree Laceration
b. Second Degree
c. Third Degree
d. Fourth Degree

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— MAJOR CAUSES — MAJOR CAUSES

2. LACERATION OF BIRTH CANAL 2. LACERATION OF BIRTH CANAL

Grading of Perineal Lacerations: Grading of Perineal Lacerations:

a. First Degree Laceration a. First Degree Laceration
- vaginal laceration
- perineal skin torn

— MAJOR CAUSES — MAJOR CAUSES

2. LACERATION OF BIRTH CANAL 2. LACERATION OF BIRTH CANAL

Grading of Perineal Lacerations: Grading of Perineal Lacerations:

b. Second Degree Laceration b. Second Degree Laceration
- first degree laceration
- perineal muscles torn

— MAJOR CAUSES — MAJOR CAUSES

2. LACERATION OF BIRTH CANAL 2. LACERATION OF BIRTH CANAL

Grading of Perineal Lacerations Grading of Perineal Lacerations

c. Third Degree Laceration c. Third Degree Laceration
- second degree laceration
- external anal sphincter torn

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— MAJOR CAUSES — MAJOR CAUSES

2. LACERATION OF BIRTH CANAL 2. LACERATION OF BIRTH CANAL

Grading of Perineal Lacerations Grading of Perineal Lacerations

d. Fourth Degree Laceration d. Fourth Degree Laceration
- third degree laceration
- complete anal sphincter tear
- torn rectal mucosa

— MAJOR CAUSES — MAJOR CAUSES

3. RETAINED PLACENTAL FRAGMENTS 3. RETAINED PLACENTAL FRAGMENTS

- incomplete expulsion of
placenta
- usual cause of late
postpartum hemorrhage

— MAJOR CAUSES — MAJOR CAUSES

4. PLACENTA ACCRETA 4. PLACENTA ACCRETA

- penetration of the myometrium by

the trophoblast resulting in
abnormal adherence of the
placenta to the uterine wall
- requires manual removal of placenta

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OTHER POSSIBLE CAUSES:
1. disseminated intravascular
coagulation
2. hematoma
3. postpartal anterior
pituitary necrosis
—MAY BE THE RESULT OF:
1. injury
2. infection
3. normal increase in
circulating clotting
factors during pregnancy
and delivery
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— ASSESSMENT FINDINGS:
1. “boggy” uterus, relaxed state indicating atony
2. if uterus is firm with excessive bleeding, may indicate
lacerations
3. dark, red blood with clots
- large amounts with atony
- steady trickle with lacerations
4. hemorrhage immediately after delivery with atony or
lacerations
5. with retained placental fragments, delay of up to 2 weeks
6. with severe blood loss, signs and symptoms of shock
7. full bladder may displace uterus and prevent it from
contracting firmly
— ASSESSMENT FINDINGS
1. Pain/discomfort in area of thrombus (legs,
pelvis, abdomen)
2. If in the leg: pain, edema, redness over the
affected area
3. Elevated temperature and chills
4. Peripheral pulses may be decreased
5. Positive homan’s sign
6. If in a deep vein, leg may be cool and pale
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— NURSING INTERVENTIONS
1. Maintain bed rest with leg elevated on pillow. Never raise
knee gatch on bed. — Failure of the uterus to revert to pre-
2. Apply moist heat as ordered. pregnant state through gradual
3. Administer analgesics as ordered.
4. Provide bed cradle to keep sheets off leg.
reduction in size and placement.
5. Administer anticoagulant therapy as ordered (usually — May be caused by:
heparin), and observe client for signs of bleeding.
6. Apply elastic support hose if ordered, with daily a. infection,
inspection of legs with hose removed.
7. Teach client not to massage legs. b. retained placental fragments, or
8. Allow client to express fears and reactions to condition.
9. Observe client for signs of pulmonary embolism.
c. tumors in the uterus
10. Continue to bring baby to mother for feeding and
interaction.

— ASSESSMENT — NURSING INTERVENTIONS

1. Uterus remained enlarged 1. Teach client to recognize unusual
2. Fundus higher in the abdomen than bleeding patterns.
anticipated 2. Teach client usual pattern of uterine
3. Lochia does not progress from rubra to involution.
serosa to alba 3. Instruct client to report abnormal
4. If caused by infection, possible bleeding.
leukorrhea and backache 4. Administer oxytocicsas ordered.

— Any infection of the reproductive tract, associated

with giving birth, usually occurring within 10 days
POSSIBLE INFECTIONS
of the birth. Infection may be localized or INCLUDE:
systemic.
— Predisposing factors include: a. endometritis
a. prolonged ruptured of membranes
b. cesarean birth
b. perineal infection
c. trauma during birth process c. urinary tract infection
d. maternal anemia
e. retained placental fragments

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— ASSESSMENT FINDINGS
1. Temperature of 37.8 C or more for 2
consecutive days, excluding the first 24 hours.
2. Abdominal, perineal, or pelvic pain.
3. Foul-smelling vaginal discharge.
4. Burning sensation with urination.
5. Chills, malaise
6. Rapid pulse and respirations
7. Elevated WBC count (may be normal for
postpartum initially), positive
culture/sensitivity report for causative
organism
— Infection of the breast, usually
unilateral.
— Frequently caused by cracked
nipples in the nursing mother.
— Causative organism is usually
staphylococcus aureus.
— If untreated, may result in breast
abscess.
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— NURSING INTERVENTIONS
1. Force fluids, client may need more than 3 liters per
day.
2. Administer antibiotics and other medications as
ordered.
3. Treat symptoms as they arise (warm sitz bath for
infection in episiotomy).
4. Encourage high-calorie, high-protein diet to promote
tissue healing.
5. Position client in semi or high fowler’s to promote
drainage and prevent reflux higher into reproductive
tract.
6. Support mother if isolated from baby.
— NURSING INTERVENTIONS
1. Teach/ stress importance of hand washing
to nursing mother, and wash own hands
before touching client’s breast.
2. Administer antibiotics as ordered.
3. Apply ice if ordered between feedings.
4. Empty breast regularly, baby may continue
to nurse or have mother use hospital-grade
pump.
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postpartum postpartum postpartum

blues depression psychosis

onset 1-10 days

1-12 months after birth within one month
decreased mood, delusions or
symptom sadness, tears diminished hallucinations, harm
concentration to self or baby

incidence 70% of all births

10 % of all births 1%-2% of all births
hormonal changes, lack lack of social
probable hormonal of social support support, previous
etiology changes, stress of life mental illness,
changes hormones, hx of
bipolar disorder

therapy support empathy counseling, drug therapy psychotherapy, drug

therapy
counseling,
offering compassion
nursing role refer to counseling safeguarding
and understanding mother from injury

BUBBLESHE