POSTPARTUM Complications.ppt

This PPT discusses each postpartum complication with the predisposing factors. All the complications are given with their causes. Hope this will help you.

1. Complications of the
Postpartum Period

2. Puerperal Infection
Definition:
Temp of 101
o
or more in the first 24 hrs
following delivery
Temp of 100
4
or higher on any 2 of the
first10 pp days (with the exception of the
first 24 hrs)

3. Types of Infections
•Endometritis
•Parametritis
•Peritonitis
•Pyelonephritis
•Cystitis
•Thrombophlebitis
•Mastitis, abcess

4. Predisposing Factors
Antenatal factors
•poor nutrition
•low SES
•Hx of Infections
•Anemia
•Immunodeficiency

5. Intrapartum predisposing
factors
•Prolonged labor
•PROM
•Poor aseptic technique
•Birth trauma
•Multiple exams
•Internal monitoring
•Episiotomy
•C section

6. Postpartum Predisposing
Factors
•Manual removal of placenta
•Hemorrhage
•Retained secundines

7. Causative Organisms
Aerobic 30%
•B hemolitc strep
•E.coli
•Klebsiella
•Proteus
•Pseudomonas
•Staph
Anerobic 70%
•Bacteriodes
•Peptococcus
•C. perfringes

8. Localized
•Episiotomy
•Lacerations
•C section incision

9. Endometritis
Infection of the endometrium
•placental site
•decidua
•cervix
Symptoms--discharge (scant to profuse),
bloody, foul smelling
uterine tenderness
jagged, irregular temp elevations
tachycardia, chills, subinvolution

10. Salpingitis, Oopheritis
May be caused by gonorrhea, chlamidia
•unilateral or bilateral abd pain
•chills, fever
•mass
•tachycardia
•may lead to sterility

11. Pelvic Cellulitis, (parametritis)
Infection of the connective tissue of pelvis
•frequently infecting the broad ligament
and causing severe pain.
•May ascend from cervical lacerations

12. Parametritis symptoms
•Spiking temp to 104
•chills, flushing, sweating
•tachycardia, tachypnea
•uterine tenderness, cramping
•change in LOC/agitation,delerium,
disorientation
•change in lochia
•cervical or uterine tenderness on vag
exam
•WBC elevation

13. Peritonitis
Life threatening infection of the
peritoneum
•Abcesses on the uterine ligaments, in the
cul de sac, and/or in the
subdiaphragmatic space
•May result from pelvic thrombophlebitis

14. Symptoms of Peritonitis
•High temp
•chills
•malaise
•lethargy
•pain
•subinvolution
•Tachycardia
•local or referred
pain
•rebound tenderness
•thirst
•distension
•nausea and
vomiting

15. Cystitis
Bladder infection
•urgency
•frequency
•burning
•dysuria
•suprapubic pain
•hematuria

16. Pyelonephritis
Kidney infection, usually of the R.
kidney.Ascends from bladder.
•Spiking temp
•Shaking chills
•Flank pain, CVA pain
•Nausea and vomiting
•Hx of asymptomatic bacteruria or
pyelonephritis
•Urgency, frequency, dysuria
•Back pain

17. Prevention and treatment
•Force fluids
•Insure complete emptying of bladder
•Sterile technique for cath
•Good perineal care
•Antibiotics

18. Thrombophlebitis Blood clot
associated with bacterial infection
Etiologies
•blood clotting factors
•postpartal thrombocytosis (platelets)
•thromboplastin release (placenta, amnion)
•fibrinolysin and fibrinogen inhibitors

19. Superficial
•Tenderness
•heat
•redness
•low grade fever
•+ homans sign
•tachycardia
Treatment
•elevation
•heat
•TEDs
•analgesic
•bedrest?
•Antibiotics?

20. Deep Vein Thrombosis
Symptoms
•edema
•low grade fever
•chills
•pain in limb below
affected area
•“milk leg”
•decreased peripheral
pulses
Dx--doppler
Tx:
•heparin to coumadin
•antibiotics
•TEDs
•bedrest
•elevation
•analgesics

21. Pulmonary Embolism
an Obstetrical emergency
Symptoms--sudden onset
•dyspnea
•sweating
•pallor
•cyanosis
•confusion
•hypertension
•cough/hemoptysis
•Tachycardia
•SOB
•Temp
•jugular pressur
•chest pain
•sense of impending
death
•pressure in
bowel/rectum

22. Treatment
•Call MD
•O
2
•Demerol
•Papaverine or other “clot busters”
•Aminophylline
•heparin
•Streptokinase

23. Disseminated Intravascular
Coagulation (DIC)
•prothrombin and platelets
•widespread formation of intravascular
clots
•clotting factor expended
•severe generalized hemorrhaging
Life threatening!

24. Etiologies
•Septic shock
•placental/uterine hemmorhage
•IUFD
•Amniotic fluid embolism
•thrombi secondary to preeclampsia
•thrombi secondary to thrombophlebitis

25. Early signs of DIC
•protime
•fibrinogen
•thrombocytopenia
•bleeding from gums
•bleeding from puncture sites
•ecchymosis
Treatment complex, packed cells,
fibrinogen, whole blood, plasma