Nursing 209

N209: Reproductive Health Study Guide

Cardiac Decompensation • Postpartum cardiomyopathy is most common in the first five months PP • Signs and symptoms: Dyspnea, fatigue, and edema • If signs and symptoms are missed, will progress to rales, audible third heart sound, peripheral edema, and jugular vein distention • Risk factors: o AMA o Black race o Multiple gestation o Preeclampsia • Diagnosis: Usually made by echocardiogram 5.4 Postpartum Medications • Rhogam: Rho (D) immune globulin; given to Rh negative mother if the infant is Rh positive to prevent immune response or development of antibodies o Antibodies can cause hemolytic anemia in the newborn o Sensitization can occur if fetal blood mixes with maternal blood o If the baby is Rh positive with no evidence of maternal-fetal transfusion, a standard dose is 300ug of Rhogam given within 72 hours o If there is a concern that an exchange has taken place (abruption, previa, trauma, or bloody amniotic fluid), then the Kleinhauer-Betke test is performed; dose is then calculated based on the amount of fetal blood noted in maternal circulation • Methergine (Methylergonovine maleate): Ergot alkaloid o Used for PP bleeding; increases tone and contractions of uterine smooth muscle o Dose: 0.2mg IM or PO o Contraindicated in patients with hypertension and toxemia o Not recommended to be given in an IV, as it can lead to hypertensive or cerebrovascular accident o Should not breastfeed for 12 hours after administration • Pitocin (Oxytocin) o Uterotonic agent of choice o Can be given IV or IM o Used routinely postpartum after delivery of placenta o Dose: IV is 10-20 units added to 500-1000ml of IVFs; IM is 10 units

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