NURS 247 - CH 22 - Nursing Management of the Postpartum Woman at Risk Questions and Answers
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What is the leading cause of maternal death in both developed and developing countries., accounting for about 25% of all maternal deaths worldwide? Postpartum Hemorrhage
PPH is defined as: Cumulative blood loss greater than 1,000 mL with signs and symptoms of hypovolemia within 24 hours of the bir...
what is the leading cause of maternal death in bot
pph is defined as cumulative blood loss greater
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NURS 247 - CH 22 - Nursing Management of the Postpartum Woman at Risk Questions and Answers What is the leading cause of maternal death in both developed and developing countries., accounting for about 25% of all maternal deaths worldwide? ✅Postpartum Hemorrhage PPH is defined as: ✅Cumulative blood loss greater than 1,000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process. Morbidity from PPH can be severe when paired with: ✅-Organ Failure -Shock -Edema -Thrombosis -Acute respiratory distress -Sepsis -Anemia -Intensive care admissions -Prolonged Hospitalization. What is the most common reason postpartum women are admitted to intensive care units? ✅Hemorrhage Define Primary Postpartum Hemorrhage: ✅-Immediate or Early -Blood loss that occurs within 24 hours of birth Define Delayed Postpartum Hemorrhage: ✅-Late -Blood loss that occurs 24 hours to 12 weeks. The most common cause of PPH is: ✅Uterine Atony Define Uterine Atony: ✅Failure of the uterus to contract and retract after birth. What is responsible for the majority of primary PPH? ✅Uterine Atony What is responsible for the majority of delayed PPH? ✅-Obstetric Lacerations -Uterine Inversion -Subinvolution -Rupture Can a full bladder that displaces the uterus cause bleeding? ✅Yes. any factor that causes the uterus to relax after birth will cause bleeding. What medication (not specific) promote uterine contraction to prevent atony and speed delivery of the placenta? ✅Uterotonic Medications Clinical Manifestation of Shock due to blood loss: ✅Mild: 20%. Diaphoresis, increased cap refill, cool extremities, maternal anxiety Moderate: 20 -40%. Tachycardia, postural hypotension, oliguria Severe: >40%. Hypotension, agitation/confusion, hemodynamic instability When do the typical signs of hemorrhage appear? ✅Typical signs don't appear until as much as 1,800 - 2,100 mL of blood has been lost. Less common causes of PPH include: ✅-Lacerations of the geintal tract -Episiotomy -Retained placental fragments -Uterine Inversion -Coagulation disorders -Large -for-gestational age newborn -Failure to progress during the second stage of labor -Placenta accreta -Induction or augmentation of labor with oxytocin -Surgical Birth -Hematomas of the vulva, vagina or subperitoneal areas A helpful way to remember the cause of PPH is by using the five T's: ✅1) Tone: Uterine atony, distended bleadder 2) Tissue: Retained placenta and clots; uterine subinvolution 3) Trauma: Lacerations, hematoma, inversion, rupture 4) Thrombin: Coagulopathy (preexisting or acquired) 5) Traction: Too much pulling on umbilical cord The causes of PPH - Tone: ✅-Refers to Uterine Atony -Uterus with sufficient tone clamps to constrict blood vessels -Altered uterine muscle tone most commonly results from overdistention of the uterus. Why is overdistention important to know with PPH? ✅-Its the main reason for Uterine Atony -Caused by: Multiple gestation, fetal macrosomia, hydramnios, fetal abnormality, placenta previa, precipitous birth, or retained placental fragments. -Other causes might include: prolonged or rapid, forceful labor, bacterial toxins, use of anesthesia, halothane, and magnesium sulfate for preeclampsia. -Can cause displacement of the uterus from midline to either side, which impedes its ability to contract to reduce bleeding. The causes of PPH - Tissue: ✅-Refers to placental fragments, membranes, or clots left inside the uterus. -Uterine contracts and retracts lead to detachment and expulsion of the placenta after birth -S/S: small gush of blood with lengthening of the umbilical cord & slight rise of the uterus. -Failure of complete separation and expulsion lead to retained fragments, preventing full clamping. Subinvolution refers to: ✅Incomplete involution of the uterus or failure to return to its normal size and condition after birth. Typically, Subinvolution occurs when: ✅The myometrial fibers of the uterus do not contract effectively causing relaxation. Complications of subinvolution include: ✅-Hemorrhage -Pelvic Peritonitis -Salpingitis -Abscess formation Causes of Subinvolution include: ✅-Retained Placental Fragments -Distended Bladder -Excessive maternal activity prohibiting proper recovery -Uterine Myoma -Infection What is the clinical picture of subinvolution: ✅-Fundal heigh highter than expected with boggy uterus -Lochia fails to change color from red to serosa to alba within a few weeks The causes of PPH - Trauma: ✅-Damage to the genital tract -Lacerations -Hematomas -Uterine Inversion -Uterine Rupture: cause damage to the genital tract Treatment for Uterine Inversion includes: ✅-Giving Uterine Relaxants -Immediate Manual Replacement by the health care provider. Define Uterine Rupture & how to handle it: ✅-Causes damage to the genital tract -Most common in women with previous c/s -S/S: combine pain, FHR abnormalities, and vaginal bleeding
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