Nursing 209

N209: Reproductive Health Study Guide • Some cultural beliefs include a delay in hygiene or bathing; this may be a conflict for staff 5.3 Postpartum Complications Lacerations These are classified according to depth: • First degree: Skin and subcutaneous tissue of the vagina and perineum; muscles intact; may not require repair • Second degree: Vaginal mucosa and perineal muscle involvement; usually extends midline towards anus • Third degree: Second degree extending into anal sphincter • Fourth degree: Most severe; extends into rectum • Third and fourth degree lacerations: Associated with increased pain, infection, bleeding, and anal incontinence • Periurethral laceration: Tear into the area around the urethra o Must be carefully repaired to avoid urethral damage; often catheter is inserted for repair Cervical Tear • May cause significant bleeding • Risk factors include precipitous labor, operative vaginal delivery, manual dilation of cervix, or previous cerclage placement • Often diagnosed with postpartum hemorrhage despite well-contracted uterus Vaginal Wall Tear • Usually seen with a forcep delivery • Can have significant blood loss if undiagnosed or untreated Hematomas • Most common are vulvar • Can be vulvovaginal, paravaginal, or retroperitoneal • Can occur spontaneously or as a result of an operative vaginal delivery • Can always be visualized • Usually diagnosed after pain persists despite medication, especially in rectal area if vaginal hematoma is present • Most dangerous: Retroperitoneal, which occurs with laceration of hypogastric artery; may have no signs and symptoms until hypotension and shock occur • Treatment: Can be a combination of surgical drainage, antibiotics, and pain medication

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