Post partal hemorrhage and complication

CASE #1

Nena had given birth to a preterm baby boy.She had episiorrhaphy.Suddenly her uterus relaxes.The obstetrician ordered oxytocin to be incorporated at D5LR 1 liter.Several days after her wound had dehiscence and her body temperature rises.Explain what is happening to Nena.What are your nursing interventions regarding her case.formulate your plan of care

Preterm Episiorrhaphy Atony(uterus relaxes) Dehiscence

Disseminated intravascular coagulation

A deficiency in clotting ability caused by vascular injury Usually associated with premature separation of placenta,missed early miscarriage,fetal death in utero. Symptoms: easy bruising,bleeding an intravenous site

Subinvolution
Incomplete return of the uterus to its prepregnant size and shape Lochial discharge is still present May result from a small retained placental fragment 4- or 6- week postpartal visit, uterus is still enlarged and soft.

Therapeutic management oral administration of methylergonovine, 0.2 mg, four times daily prescribed to improve uterine tone and complete involution.

Perineal hematoma
A collection of blood in the subcutaneous layer of tissue of the perineum. Most likely to occur after rapid,spontaneous births and in women who have perineal varicosities May occur at the site of episiotomy or laceration repair if a vein was punctured during repair.

assessment

Discomfort Reports severe pain in perineal area A feeling of pressure between legs If present, appears as an area of purplish discoloration with swelling Area is tender to palpation

Therapeutic management
Administer a mild analgesic as ordered for pain relief Apply ice pack covered with towel to prevent further bleeding Hematoma is absorbed over the net 34days If hematoma continuous to increase in size, the woman may have to be returned to the delivery room to have the site incised.

Puerperal infection

Infection of the reproductive tract is another leading cause of maternal mortality.

Conditions that increase a womans risk for post partal infection

ROM more than 24 hours before birth Placental fragments retained Post partal hemorrhage Pre-existing anemia Prolonged and difficult anemia Internal fetal heart monitoring Local vaginal infection Uterus was explored after birth for a retained placenta or abnormal bleeding site

Management use of an appropriate antibiotic after culture and sensitivity testing of the isolated organism.

Endometritis
An infection of the endometrium,the lining of the uterus.bacteria gain access to the uterus through the vagina Associated with chorioamnionitis(infection of fetal membranes and fluid and cesarean birth.

assessment

Temperature elevation may occur on the third or fourth post partal day WBC is increased Breast filling occurs Chills,loss of appetite,general malaise Uterus is not well contracted and painful to the touch May feel strong afterpains Lochia is dark brown and has a foul odor

Therapeutic management
Administration of appropriate antibiotic such as clindamycin(Cleocin), determined by culture of lochia Oxytoxic agent such as methylergonovine, may be prescribed to encourage uterine contraction. Requires additional fluid Analgesic for pain relief.