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Postpartal Family at Risk. Chapter 32. Early Postpartal Hemorrhage. Occurs within first 24 hrs Uterine atony Lacerations Retained placental fragments- inspect Hematomas- trauma, excise over 5 cm Report feeling pressure. Late Postpartal Hemorrhage. 1-2 weeks after childbirth

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Early postpartal hemorrhage
Early Postpartal Hemorrhage

  • Occurs within first 24 hrs

  • Uterine atony

  • Lacerations

  • Retained placental fragments- inspect

  • Hematomas- trauma, excise over 5 cm

  • Report feeling pressure

Late postpartal hemorrhage
Late Postpartal Hemorrhage

  • 1-2 weeks after childbirth

  • Increase fundal height- lochia remains rubra

  • Leukorrhea, backache, foul smelling lochia

  • Methergine and ABX as indicated

  • Take all c/o pain seriously

  • Assess v/s,fundus, bleeding

Reproductive tract infections
Reproductive Tract Infections

  • Puerperal infection-up to 6 wks. PP

  • Endometritis most common, 38C. or above after 24 hrs

  • Often at site of placenta- medium for growth

  • Saw tooth temp, chills, foul smelling lochia

  • Pelvic cellulitis- ascending infection, lymph

  • Peritonitis-pelvis abcess

  • High temp, acutely ill, tachy, sever pain

Wound infection
Wound Infection

  • Episiotomy infection R/S/T, discharge, wound gaping

  • Tx ABX, heal by secondary closure

  • Cesarean wound infection- warm, drainage, edema, tenderness, fever, pain

Treatment of wound infection
Treatment of Wound Infection

  • Cultures, r/o UTI

  • Tx with ABX, sitz bath, analgesics

  • May need to remove sutures and pack

  • Endometritis- ABX

  • Peritonitis-ABX may require incision and drainage

  • REEDA- redness, edema, ecchymosis, discharge, approximation

Health promotion
Health Promotion

  • Teach self care

  • Good hygiene

  • Change peripads

  • Diet

  • Fluid intake

  • No tampons or douching

Urinary tract infection
Urinary Tract Infection

  • At risk due to diuresis, bladder capacity, distention, trauma

  • Need to void frequently

  • Warm water over perineum

  • If need catheterization be gentle

  • Use aseptic technique


  • Will ascend from bladder - kidney - renal pelvis

  • Get midstream sample

  • Give ABX

  • S/S dysuria, urgency, frequency, nocturia

  • Pylonephritis- chills, fever, flank pain

  • Prevention- voiding after intercourse, good hygiene, drink fluids, cotton underwear

  • Drink acidic fruit juice


  • Infection in connective tissue 2-4 wks pp

  • Fatigue, trauma, milk stasis, organisms in babies mouth and nose

  • Shooting pain, pink, flaking, prutitic

  • C&S breast milk

  • Rest, supportive bra, ABX, NSAIDS, pumping, aspiration

Prevention of mastitis
Prevention of Mastitis

  • Wear supportive bra, prevent stasis, express milk, massage breast, pump

  • Empty effected side completely, point baby chin towards effected side

  • Teach breast care, positioning, latch on

  • Develops after discharge

  • Flu like symptoms consider mastitis

Thromboembolitic disease
Thromboembolitic Disease

  • Clot formation- danger if breaks off

  • Inflammatory response = thrombophlebitis

  • Non inflammatory thrombis at risk for embolism

  • Contributing factors increase coags, obesity ,immobility, varicosities

Types of thrombis
Types of Thrombis

  • Superficial- common pp, saphenous vein.

  • S/S heat, tenderness, temp

  • Tx- heat, rest, analgesics, stockings

  • DVT- hx of thrombosis

  • S/S ankle-leg edema, low to high temp, chills, pain, Homan’s + or- , pale, cool limb

  • Septic pelvic thrombophlebitis- C/S with reproductive tract infection

  • S/S guarding, ab., flank pain, fever chills

  • Tx- ABX and anticoagulants

Treatment of thromboembolic disease
Treatment of Thromboembolic Disease

  • Difficult to diagnose

  • Bed rest, elevate leg, anticoagulant, analgesic, walk with stockings

  • Prevention- fluid, stirrups, ambulate, exercise

  • After dx- watch for emboli, avoid sitting, standing

  • Tx with Warfarin- s/s of bleeding, no BF

Postpartum depression
Postpartum Depression

  • Baby Blues- mild depression, self limiting

  • More often with primiparas

  • Hormonal

  • Acknowledge as real and normal

  • PP psychosis- first three months

  • Tx- may need hospitalization and meds

  • PP depression- 4th week, return of menses, weaning

Depression assessment
Depression Assessment

  • PP depression can be progressive

  • Assess for stressors

  • Observe for excessive fatigue, anxiety, crying

  • Assess for strange behavior

  • Refer to social worker

  • Father may be overwhelmed by assumption of responsibilities