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POSTPARTUM COMPLICATIONS

This comprehensive guide discusses major postpartum complications, including cystitis, hematoma, hemorrhage, infection, mastitis, and pulmonary embolism. Each section outlines assessment findings, implementation strategies, and necessary nursing interventions to ensure optimal care for postpartum patients. Recognizing symptoms such as pain during urination, abnormal pain, fever, or dyspnea is crucial for timely intervention. Proper management techniques, including medication administration, monitoring vital signs, and patient education on prevention strategies, enhance recovery and minimize risks.

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POSTPARTUM COMPLICATIONS

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  1. POSTPARTUM COMPLICATIONS Mrs. G.SAVITHA M.Sc (N) Assistant Professor, OBG Department Annammal College of Nursing

  2. CYSTITIS • An infection of the bladder • ASSESSMENT • Burning & pain on urination • Lower abdominal pain • Increased frequency of urination • Costovertebral angle tenderness • Fever • Proteinuria, hematuria, bacteriuria, WBC in the urine.

  3. IMPLEMENTATION • Palpate bladder for distension • Palpate fundus • Obtain urine specimen for culture & sensitivity if prescribed • Institute measures to assist the client to void • Encourage frequent & complete emptying of the bladder • Force fluids to 3000ml per day • Administer antibiotics as prescribed after the urine culture is obtained • Instruct the client in the methods of prevention & treatment of cystitis

  4. HEMATOMA • Localized collection of blood into the tissues of the reproductive sac after the delivery • Predisposing conditions include operative delivery with forceps & injury to a blood vessel • Can be life- threatening condition

  5. Assessment • Abnormal severe pain • Pressure in the perineal area • Sensitive, bulging mass in the perineal area with discolored skin • Inability to void • Decreased hemoglobin & hematocrit levels • Signs of shock, such as pallor, tachycardia, & hypotenion, if significant blood loss has occurred

  6. IMPLEMENTATION • Monitor vital signs • Monitor client for abnormal pain, especially when forceps delivery has occurred • Place ice at the hematoma site • Administer analgesics as prescribed • Monitor I/O • Encourage fluids & voiding • Prepare for urinary catheterization if the client is unable to void • Administer blood products as prescribed • Monitor for signs, such of infection, such as increased temperature, pulse rate, & WBC count • Administer antibiotics as prescribed, as infection is common following hematoma formation • Prepare for incision & evacuation of hematoma if necessary

  7. HEMORRHAGE • Bleeding of 500ml or more following delivery • ASSESSMENT • EARLY • Hemorrhage occurs during the first 24 hrs after delivery • Caused by uterine atony, lacerations, or inversion of the uterus • LATE • Hemorrhage occurs after thr first 24 hrs following delivery • Caused by retained placental fragments

  8. IMPLEMENTATION • Massage fundus, with care not to overmassage • Notify physician if hemorrhage occurs • Monitor vital signs & fundus every 5 to 15 minutes • Remain with the client • Assess & estimate blood loss by pad count • Assess level of consciousness • Administer fluids & monitor I & O • Maintain asepsis, since hemorrhage predisposes to infection • Prepare for the administration of Oxytocin if prescribed • Prepare for blood transfusion if prescribed

  9. INFECTION • Any infection of the reproductive organs that occurs within 28 days of delivery or abortion • ASSESSMENT • Fever • Chills • Anorexia • Pelvic discomfort or pain • Vaginal discharge • Elevated WBC count

  10. IMPLEMENTATION • Monitor vital signs(temperature) • Make her comfortable;position for comfort & to promote drainage • Keep the mother warmed if chilled • Isolate the baby from the mother only if the mother can infect the baby • Provide nutritious, high calorie, protein diet • Force fluids to 3000 to 4000 ml per day, if not contraindicated • Encourage frequent voiding & monitor I &O • Monitor culture results • Administer antibiotics according to organism, as prescribed

  11. MASTITIS • Inflammation of the breast as a result of infection • Primarily seen in breastfeeding mothers 2 to 3 weeks after delivery but may occur at any time during lactation • ASSESSMENT • Localized heat & swelling • Pain • Elevated temperature • complaints of flu like symptoms

  12. IMPLEMENTATION • Instruct the mother in good hand washing & breast hygiene techniques • Promote comfort • Apply heat or cold to site as prescribed • Maintain lactation in breastfeeding mothers • Encourage manual expression of breast milk or use of breast pump every 4 hrs • Encourage mother to support breasts by wearing supportive bra • Administer analgesics & antibiotics as prescribed

  13. PULMONARY EMBOLISM • The passage of thrombus, often originating in one of the uterine or other pelvic veins, into the lungs, where it disrupts the circulation of the blood • ASSESSMENT • Dyspnea, tachypnea, & tachcardia • Cough & rales • Hemoptysis • Pleuritic chest pain • Feeling of impending doom

  14. IMPLEMENTATION • Administer oxygen as prescribed • Position client with the head of the bed elevated to promote comfort • Monitor vital signs frequently • Frequently assess respiratory rate & breadth sounds • Monitor for signs of respiratory distress & for signs of increasing hypoxemia • Administer IV fluids as prescribed • Administer anticoagulants as prescribed • Prepare to assist physician to administer streptokinase to dissolve the clot if prescribed

  15. SUBINVOLUTION • Incomplete involution or failure of the uterus to its normal size & condition • ASSESSMENT • Uterine pain on palpation • Uterus is larger than expected • Greater than normal vaginal bleeding

  16. IMPLEMENTATION • Assess vital signs • Assess uterus & fundus • Monitor for vaginal bleeding • Elevate the legs to promote venous return • Encourage frequent voiding • Monitor Hb & hematocrit • Prepare to administer Methergine as prescribed

  17. THROMBOPHLEBITIS • A condition in which a clot forms in a vessel wall as a result of the inflammation of the vessel wall • A partial obstruction of the vessel can occur • Increased blood clotting factors in the postpartum period place the client at risk • TYPES • Superficial thrombophlebitis • Femoral thrombophlebitis • Pelvic thrombophlebitis

  18. Assessment of the type of Thrombophlebitis

  19. IMPLEMENTATION • Assess lower extremities for edema, tenderness, varices & increased skin temperature • Evaluate the legs for Homan’s sign by extending the legs with the knees slightly flexed & dorsiflexing the foot • Maintain bed rest • Elevate the affected leg • Apply bed cradle & keep bedclothes off affected leg • Never massage the leg • Monitor for manifestations of pulmonary embolism

  20. Superficial thrombophlebitis • Provide bed rest • Apply hot packs to the affected site as prescribed • Apply elastic stockings • Administer analgesics as prescribed • Femoral Thrombophlebitis • Provide bed rest • Elevate affected leg • Apply moist heat continuously to affected area to alleviate discomfort • Administer analgesics & antibiotics as prescribed • Prepare to administer IV heparin sodium to prevent further thrombus formation

  21. Pelvic Thrombophlebitis • Provide bed rest • Administer analgesic & antibiotic as prescribed • Prepare to administer IV heparin sodium

  22. Client Education • Avoid pressure behind the knees • Avoid prolonged sitting • Avoid constrictive clothing • Avoid crossing the legs • Never massage the legs • Understand the importance of anticoagulant therapy as prescribed • Understand the importance of follow-up with the health care provider

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