Nursing 209

N209: Reproductive Health Study Guide • Smaller hematomas may be observed and allowed to spontaneously resolve with ice packs and pain relief Postpartum Hemorrhage • Loss of more than 500 ml of blood after delivery • Severe: Loss of more than 1000 ml • Most common life-threatening condition in pregnancy • Causes more direct maternal morbidity than any other condition, about 25% globally • If the patient is severely anemic prior to hemorrhage, she may experience hypovolemic shock and even death prior to 500ml blood loss • Treatment: Uterine massage, manual extraction of retained placenta and clots, and medications (Pitocin, Methergine, and Cytotec) • Risk factors: o Prolonged third stage of labor o Multiple delivery o Fetal macrosomia o History of postpartum hemorrhage o Episiotomy Puerperal Infections • The sixth leading cause of maternal death, according to the WHO • Bacterial infection following delivery; usually within 72 hours PP • More common after C-section • Signs and symptoms: Uterine tenderness, abdominal/pelvic pain, fever, malaise, and foul- smelling drainage/lochia • Treatment: Broad spectrum IV antibiotics until afebrile x 48 hours • Can be prevented with aseptic technique during vaginal delivery; prophylactic antibiotics 30- 60 minutes prior to a C-section with sterile technique maintained during procedure; good handwashing Mastitis • Infection of the breast tissue • Occurs in 5% of breastfeeding women • Most easily recognized PP complication besides hemorrhage • Signs and symptoms: Fever, localized erythema of breast tissue, tenderness, chills, and malaise • Commonly transferred from organisms in the baby’s mouth during breastfeeding • Treatment: Frequent expression of breast milk (may nurse if tolerable, otherwise pumping is encouraged), analgesics, support bra, application of heat (warm compresses), and antibiotics

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