Postpartal Complications

(Laceration, Hematoma and its types,

Edema)

Submitted by:
Casquejo, Isabella
Resma, Jhaniel
Ybanez, Maria Allysah
Villegas, Amiel
Laceration & Types

I. Definition
● A jagged cut that may involve only the skin layer or may penetrate to deeper
subcutaneous tissue or tendons.

II. Etiology / Cause

They often occur in:
● Difficult or precipitate births
● Primigravida mothers
● Birth of a large infant (>9 lbs)
● Use of a lithotomy position and instruments

III. Types of Laceration

● Cervical lacerations
-Usually found on the sides of the cervix, near the branches of the uterine artery.
-If the artery is torn, the blood loss may be so great that blood gushes from the
vaginal opening
-Since it is arterial bleeding, it is brighter red than venous blood
-occurs after delivery of the placenta

● Vaginal lacerations
- Although rare, lacerations can occur in the vagina
- Easier to assess than cervical lacerations, because they are easier to view

● Perineal lacerations
- usually occurs when a woman is placed in a lithotomy position for birth,
because this position increases tension on the perineum
-it is classified to four categories, depending on the extent and depth of the tissue
involved
 ● Classification of Perineal Lacerations
1. First Degree
○ Involves the vaginal mucous membrane and skin of
the perineum to the fourchette
2. Second Degree
○ Involves the vagina, perineal skin, fascia, levator
ani muscle, and perineal body
3. Third Degree
○ Entire perineum, extending to reach the external
sphincter of the rectum
4. Fourth Degree
○ Entire perineum, rectal sphincter, and some of the
mucous membrane of the rectum

IV. Signs and Symptoms

● Pain
● Redness
● Swelling
● Bleeding
● Site is warm to touch
● Presence of laceration

V. Nursing Diagnosis
○ Impaired skin integrity : presence of a third degree perineal laceration r/t
episiotomy of the perineum
○ Altered comfort : pain r/t third degree perineal laceration
○ Acute pain: facial grimace r/t third degree perineal laceration
○ Risk for infection r/t third degree perineal laceration
○ Risk for fluid volume deficit r/t third degree perineal laceration
VI. Management
● Medical & Pharmacologic
○ Emergency treatment relies on prompt, adequate blood and fluid
replacement to restore intravascular volume and to raise blood pressure
○ I.M administration of prostaglandins may be ordered to promote strong,
sustained uterine contractions. Be alert for possible adverse reactions
such as nausea, diarrhea, tachycardia, and hypertension.
○ For Cervical Laceration:
■ Regional anesthetic may be necessary to relax the uterine muscle
and to prevent pain.
○ For Vaginal Laceration:
■ Unfortunately, vaginal tissue is friable, making vaginal laceration
lacerations difficult to suture.
■ A balloon tapenade similar to the type used with uterine
hemorrhage may be effective if suturing does not achieve
hemostasis.
○ For Perineal Laceration:
■ Any woman who has a third or fourth degree laceration should not
have an enema or rectal suppository or have her temperature
taken rectally because the hard tips of equipment could open
sutures near to or including those of the rectal sphincter
■ A Diet high in fluid and a stool softener may be prescribed for the
first week after birth to prevent constipation and hard stools.
● Surgical
○ Cervical suturing and packing
○ Episiorrhaphy ( Perineal Lacerations)
● Nursing
○ Cervical Lacerations
■ Be certain the physician or nurse- midwife has adequate space to
work, adequate sponges and suture supplies and a good light
source
 ■ Try to maintain an air of calm and, if possible, stand beside the
woman at the head of the table
■ Reassure her about the baby’s condition and inform her about the
need to stay in the birthing room a little longer than expected while
the nurse- midwife places additional sutures/ packing
■ If the cervical laceration appears to be extensive or difficult to
repair, it may be necessary for the woman to be given a regional
anesthetic to relax the uterine muscle and to prevent pain. Explain
the need for an anesthetic and the procedures being carried out.
○ Vaginal Lacerations
■ Be certain to document in the woman’s record when and where
packing was placed so you can be certain it is removed after 24.
To 48 hours or before hospital discharge to prevent infection.
■ An indwelling catheter may be placed following the repair so that
there will not be too much pressure on the urethra.
○ Perineal Laceration
■ Make certain the degree of laceration is documented

Assessment Diagnosis Planning Implementation Evaluation

Physiologic
Overload Acute pain: pain After 2 days of Measures to The patient was
score of 6/10 r/t student alleviate pain able to report a
Objective: 2nd degree nurse-patient relief of pain as
● Presence episiotomy interaction, the 1. Promote evidenced by a
of 2nd sustained during patient will: ambulati pain score of
degree vaginal delivery on 3/10
episioto ● Be able
my to report 2. Teach
● 2 days that pain patient
post-part is relieve how to
um nsvd or perform
● Lochia controlle breathing
Rubra d as exercises
present evidence
● Facial d by a 3. Position
 grimace pain the
● Red & score patient
edemato from 7/10 comforta
us to a pain bly
perineum score of
● Guarded 4/10 4. Perform
moveme hot sitz
nt bath and
perlite
Subjective: exposure
● Pain 24 hours
score of after the
7/10 delivery
to
promote
healing
as
ordered
by the
doctor

5. Administ
er
analgesic
s for the
pain as
ordered
by the
doctor
Hematoma & Types

I. Definition
○ Localized collections of blood in loose connective tissue beneath the skin
covering external genitalia., beneath the vaginal mucosa or in the broad
ligaments.
○ Usually occurs without laceration of the overlying tissue.

II. Cause
○ Trauma
○ Grand Multiparity
○ Difficult or prolonged second stage of labor
○ After rapid, spontaneous births
○ Women who have perineal varicosities
 ○ May occur at the site of an episiotomy or laceration repair if a vein was punctured
during suturing

III. Types
○ Subdural Hematoma
■ Venous bleeding into the space between the dura and the arachnoid
membrane. It occurs when head trauma lacerates minute veins in this
area.
■ The collection of blood is usually bilateral
○ Epidural Hematoma
■ Bleeding into the space between the dura and the skull. This happens
wen head trauma is severe. It is usually a result of rupture of the middle
meningeal artery and is therefore, arterial bleeding
○ Perineal Hematoma
■ A collection of blood in the subcutaneous layer of tissue of the perineum.
■ The overlying skin is intact with no noticeable trauma
■ Blood accumulates underneath from injury to blood vessels in the
perineum during birth.
■ They usually represent minor bleeding

IV. Signs and Symptoms

○ Severe pain in the perineal area or a feeling of pressure between her legs
○ Area of purplish discoloration with obvious swelling
○ Can be as small as 2cm or as large as 8 cm in diameter
○ Swelling is tender to touch and palpates as a firm globe
○ Might have a difficulty in passing urine if the swelling presses on the urethra
○ Possible decrease in BP
○ Tachycardia
○ Decrease or absence of lochia flow if vagina is impeded

V. Nursing Diagnosis
○ Altered comfort : pain score 9/10 r/t 7 cm diameter hematoma
○ Impaired skin integrity : hematoma r/t trauma upon surgical manipulation
 ○ Ineffective tissue perfusion: bleeding r/t perineal hematoma
○ Pain : Pain score of 6/10 r/t 7 cm hematoma

VI. Management
● Medical & Pharmacologic
○ Administer a mild analgesic as prescribed for pain relief
○ Usually, a hematoma is absorbed over the next 3 or 4 days. Local
anesthesia may be used if one is large when discovered or continues to
increase in size, the woman may have to be returned to the birthing room
to have the site incised.
● Surgical
○ If one is large when discovered or continues to increase in size, the
woman may have to be returned to the birthing rom o have the site
incised and the bleeding vessel ligated under local anesthesia.
● Nursing
○ Report the presence of a hematoma, its estimated size, and the degree of
the woman’s discomfort to her primary care provider.
○ Administer a mild analgesic as prescribed for pain relief.
○ Applying an ice pack may prevent further bleeding
○ Assure the woman that, even though the hematoma is causing her
considerable discomfort, it is not a serious complication and will slowly
reabsorb over the next 6 weeks, causing no further difficulty.
○ If an episiotomy incision line was opened to drain a hematoma, it may be
left open and packed with gauze rather than resutured. Be certain to
record this pacing was placed so it can be removed in 24 to 48 hours
○ Be certain that the woman has clear instructions before discharge
regarding necessary suture line care she will need to do at home, such as
keeping it clean and dry and perhaps using a sitz bath once or twice a
day.
○ Insert a foley catheter if patient is unable to void
○ Position for comfort to decrease pressure on the affected area.
Assessment Diagnosis Planning Implementation Evaluation

Physiologic
Deficit Altered Comfort: After 8 hours of Measures to: The patient was
Pain score of student alleviate pain able to report a
Objective: 9/10 r/t 7 cm nurse-patient pain score of
● G8P7 diameter interaction, the 1. Position 6/10
woman perineal patient will: the
● Hemato hematoma mother in
ma ● Report a dorsal
present = and recumbe
7 cm in alleviatio nt
diameter n of pain position.
● Purplish from a 2. Apply an
discolora pain ice pack
tion of score of covered
the 9/10 to in a
perineum 5/10 towel.
● Prolonge 3. Anticipat
d second e and
stage of assist in
labor the
● Pain incision
score of of the
9/10 site and
● Improper draining
episioto of the
my repair blood.
4. Teach
Subjective: mother
● “ Sakit necessar
kaayo y suture
dapit sa line care
akong before
tahi naay discharg
murag ga e
duot sad 5. Administ
sa er
samad” analgesic
s as
ordered.
Edema
I. Definition

II. Cause

III. Types

IV. Signs and Symptoms

V. Nursing Diagnosis

VI. Management
● Medical & Pharmacologic
 ○ Administer diuretics as prescribed by physician- Diuretics helps
expel excess fluid through urine.
● Nursing
○ Restrict fluid intake as indicated
○ Provide for sodium restrictions if needed
○ Record input and output accurately
○ Weigh daily or on a regular schedule as indicated
○ Elevate dermatitis extremities and change position frequently
○ Advise the client to avoid salty or spicy foods since they increase thirst
and fluid retention
○ Suggest interventions to reduce discomfort of dry mouth such as frequent
oral care, chewing gum/hard candy, or use of lip balm

Assessment Diagnosis Planning Intervention Evaluation

Excess Fluid excess fluid After 8 hours 1. For dry After 8 hours of
Volume volume: of nursing mouth, nursing
swelling of interventions, suggest interventions,
Objective: lower The client will chewing the client was
● Postpartum extremities r/t be able to gum/hard able to attain a
● Edema postpartum attain a candy and stabilised fluid
● Swelling in edema stabilised fluid use of lip volume as
the lower volume as balm, as well evidenced by
extremities evidenced by as frequent balanced input
● Weight gain balanced input oral care and output, vital
of 1.8 kg (4 and output, 2. Provide for signs within
lbs) in a short vital signs sodium client’s normal
period of time within client’s restrictions, limits, stable
● Increase of normal limits, and weight, and free
blood stable weight, avoidance of of signs of
pressure and free of spicy and edema.
from 110/80 signs of salty foods
to 130/90 edema. 3. Record input
● Decrease in and output
hemoglobin accurately
of 11.7 g/dL and monitor
(normal the client's
range: 12.3 - weight
15.3 g/dL) 4. Elevate the
affected
Subjective: leg(s) and
● “My legs feel change
 sore and positions
swollen, I’m frequently
anxious 5. Administer
about the diuretics as
condition of ordered by
my legs,” as physician
verbalised by
client
● Restlessness
● Anxiety
● Discomfort
from dry
mouth