Postpartal Complication
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Transcript of Postpartal Complication
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PostPartalcompl ication
B y : I mavike
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Postpartal hemorrhage
As any blood loss from the uterus greater
than 500ml within a 24-hour period
Main causes: Uterine atony
Lacerations
Retained placental fragments
Disseminated intravascular coagulation
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Uterine atony
Factors that predispose to poor uterine tone andan inability to maintain a contracted state are
Deep anesthesia or analgesia Labor initiated or assisted with an oxytocin agent Maternal age greater than 30 years High parity Previous uterine surgery
Prolonged and difficult labor Possible chorioamnionitis Prior history of postpartal hemorrhage Endometritis
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Uterine atony
Treatment
Fundal massage IV infusion of oxytocin / IM methergine
Bimanual massage (explore uterine cavitymanually)
Prostaglandin administration Blood replacement
Hysterectomy
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Lacer at ions
Large lacerations are complication
Due to:1. With difficult births
2. In primigravidas
3. With the birth of a large infants4. With the use of a lithotomy position
and instruments
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Cer viCa l l aCer a t ions
Found on the sides of the cervix near
the branches of the uterine artery
Arterial bleeding so it is brighter red
Occur immediately after delivery of the
placenta
Treatment: repair
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Vagina l l acer a t ions
Rare
Easier to assess Treatment : repair
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Per inea l l acer a t ions
Lithotomy position for birth
Classified by 4 categories Treatment : treated as episiotomy
repair, a diet high in fluid, a stool
softener
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Classification of perineal
lacerationsclassification Description of involvement
1st degree Vaginal mucous membrane and skin of
the perineum
2nd degree Vagina, perineal skin, fascia, levator ani
muscle, and perineal body
3rd degree Entire perineum, and reaches the external
sphincter of the rectum
4th degree Entire perineum, rectal sphincter, and
some of the mucous membrane of the
rectum
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Retained placental fragments
Assessment :
Large fragment ---- bleeding in the
immediate postpartal periodSmall fragment ---- bleeding detected until
postpartal day 6-10
Uterus not fully contracted
USG
Treatment : a dilation & curettage
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Disseminated intravascular
coagulation (DIC) Is a deficiency in clotting ability caused by
vascular injury
The fibrinogen level falls to below effectivelimits
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PUERPERAL INFECTION
Risk factors including:
Rupture of the membrane > 24 hrs before birth
Retained placental fragment and its exploration
Postparpal hemorrhage
Preexisting anemia
Prolonged and difficult labor, particularly instrumentbirths
Local vaginal infection was present
Treatment : specific antibiotic therapy
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Psychologicaldisorders
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Comparing postpartal blues,
depression and psychosisPostpartal blues Postpartal
depression
Postpartal
psychosis
Onset 1-10 days after
birth
1-12 months after
birth
Within first month
after birth
Symptoms Sadness, tears Anxiety, feeling of loss, sadness
Delusions orhallucinations of
harming infants or
self
Incidence 70% of all births 10% of all births 1-2% of all births
Etiology (possible) Probable hormonal
changes, stress oflife changes
History of previous
depression,hormonal response,
lack of social
support
Possible activation
of previous mentalillness, hormonal
changes
Therapy Support, empathy Counseling, drug
therapy
Psychotherapy,
drug therapy
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