Postpartum Complications

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Postpartum Complications

• By
• Christine Hicks

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Complications

• Infections
• Genital Tract
• Perineum Vulva
• Endometritis
• Pelvic Cellulitis Peritonitis
• Incisional
• C Section
• Episiotomy

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• Infections (continued)
• Mastitis
• Urinary Tract Infection
• Hemorrhage
• Thrombophlebitis

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Infection

• Prevention is the Goal
• Careful Assessment
• Practice of Universal Precautions
• Health Teaching
• Risk Factors (p. 1029)
• General Infection Risks
• Related to Labor Event
• Related to Operative Procedure

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• Fever is Principle Sign of Infection
• Elevated Temperature of 102.2 F any time or 101.4
  F on 2 successive occasions
• C Section delivered patient is at higher risk
• Assessment (Refer to previous lecture)

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Infections of the Genital Tract

• Result of bacteria ascending from the genital
  tract
• Often remain localized
• Most common organisms
• Gram positive cocci (Streptococcus)
• Gram negative bacilli (Bacteroides)

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Infections of the Perineum Vulva

• Localized
• Involves repaired perineal lacerations or
  episiotomy
• Assess for elevated temperature, pain, sensation
  of heat of the affected area site is red and
  edematous seropurulent discharge

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• Treatment
• Physician removes sutures opens wound
• Wound must be kept clean
• Sitz Baths/Heat Lamp
• Antibiotics/Analgesics
• Teaching

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Endometritis

• Localized infection of inner uterine wall
• 2-3 of vaginally delivered patients develop
• Risk factors include prolonged labor ruptured
  membranes
• Develops 48-72 hours post delivery

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• Assessment includes
• Fever
• Lower Abdominal Pain
• Uterine Tenderness
• Foul-smelling Discharge
• Tachycardia
• Leukocytosis

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• Treatment
• IV Antibiotics
• Fowlers Position
• Oxytocic Medications
• Monitors Involution Process (Fundus)
• Fluids Well-balanced Diet
• Vital Signs
• Isolation may be necessary
• Emotional Support

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Pelvic Cellulitis Peritonitis

• Infection that extends along the blood vessels
  lymphatics to the pelvic structures
• Peritonitis--major life-threatening infection

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Infection of Incision

• Types of Incision
• Episiotomy
• C-Section

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Mastitis

• Acute infection of glandular tissue of the breast
• Breast-feeding Mothers
• Staphylococcus aureus
• Assessmentfissures erosions of the nipples
  pain temperature firmness red
• Unilateral condition

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• Treatment
• Abscesses will need to be drained
• Cold Heat Therapy
• Antibiotics
• May need to discontinue Breastfeeding
• Wear firm, supportive bra

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Urinary Tract Infection

• Risk
• Indwelling catheter
• C-Section
• Epidural Anesthesia
• Assessment
• Burning on urination
• Urgency
• Frequency
• Low-grade fever

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• Treatment
• Urine Specimen
• Antibiotics, Antispasmodics, Analgesics
• Nutrition Hydration
• Rest
• Repeat Urine Cultures

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Hemorrhage

• Leading cause of Maternal Mortality
• Types
• ImmediateWithin 24 Hours
• DelayedAfter 48 Hours
• LateAfter PP Day 5

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• Causes
• ImmediateUterine Atony
• Delayed/Late Subinvolution, Retained placental
  tissue, Infection
• Assessment includes Profuse bleeding from the
  vagina, Boggy uterus, Vasoconstriction, Changes
  in pulse Bp, Changes in orientation, Changes in
  urinary output

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• Treatment
• IV Therapy
• Oxytocic Medications
• Oxygen
• Trendelenburg Position
• Vital Signs
• Palpation of Fundus

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Thrombophlebitis

• Clot formation attached to the vessel wall
• Sites include ovarian, uterine, femoral
• Femoral Assessment includes Pain, Swelling,
  Paleness, Redness, Warmth
• Prevention of Pulmonary Embolism is the Goal

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• Treatment
• Rest
• Elevation of the Leg
• Analgesics Anticoagulants
• Heat or Cold Therapy
• Surgical Treatment in some cases