postpartum complication

Dr. Miada Mahmoud Rady

Uterine Inversion

Definition : turning of uterus inside out due to

failure of the placenta to detach properly from the

uterine wall when it is expelled.

Severity graded by how much the uterus has

reversed itself.

Very painful and may rapidly cause shock.

Management

Keep the patient recumbent.

Administer 100% supplemental oxygen.

Start two IV lines with normal saline.

Do not attempt to remove placenta if still attached to

the uterus.

Carefully monitor vital signs.

Consider Oxytocin to control hemorrhage.

Make one attempt to replace the uterus.

Postpartum Hemorrhage

Definition : Blood loss exceeds 500 mL

during first 24 hours after birth

Can be either early or late hemorrhage

1. Early: bleeding within 24 hours of

delivery

2. Late: bleeding occurring from 24 hours

to 6 weeks after delivery

Postpartum Hemorrhage

Causes of postpartum hemorrhage

include:

1. Prolonged labor or multiple baby

deliver

2. Retained products of conception

3. Placenta previa

4. Full bladder

Postpartum Hemorrhage management

Continue uterine massage.

Encourage the woman to breastfeed.

Notify the receiving facility of status.

Transport immediately.

Add a large-bore IV line en route.

Pulmonary Embolism

Frequently caused by a clot arising in pelvic circulation

from:

1. Amniotic embolism

2. Pregnancy induced venous thromboembolism

3. Water embolism

Pulmonary Embolism clinical presentation

Suspect if a woman in the postpartum state

experiences:

1. Sudden dyspnea

2. Tachycardia

3. Atrial fibrillation

4. Hypotension and syncope.

5. Sharp, sudden chest or abdominal pain

Postpartum Depression

May appear up to 1 year after birth

Signs and symptoms include:

1. Signs similar to others with depression

2. Anger directed toward the infant

3. Little or no interest in the infant

4. Thoughts of harming themselves or their infant

Trauma and Pregnancy

Trauma is a complicating factor in

pregnancy.

Leading cause of maternal death in

United States

Pathophysiology and Assessment Considerations

Anatomic changes are important in trauma.

1. Abdominal contents compress into

upper abdomen.

2. Diaphragm elevates by about 1.5

inches.

3. Peritoneum maximally stretches.

Pathophysiology and Assessment Considerations

Pregnant patients will have different signs or

responses to trauma.

1. May be more difficult to interpret tachycardia

2. Signs of hypovolemia may be hidden.

3. Higher chance of bleeding to death in case of

pelvic fractures

4. Respiratory rate less than 20 breaths/min is

not adequate.

Considerations for the Fetus and Trauma

Fetal injury can occur from:

1. Rapid deceleration

2. Impaired fetal circulation

If a pregnant woman has massive

bleeding, maternal circulation will

reroute blood from the fetus.

Considerations for the Fetus and Trauma

Fetal heart rate is the best indication of

fetal status after trauma.

1. Normal fetal heart rate is between 120

and 160 beats/min.

2. Rate slower than 120 beats/min means

fetal distress and a dire emergency.

Management of the Pregnant Trauma Patient

Can only treat the woman directly

Determine gestational age of fetus if

possible.

Transport a pregnant woman on left

side if no spinal injury is suspected.

Management of the Pregnant Trauma Patient

1. Ensure adequate airway.

2. Administer oxygen.

3. Assist ventilations when needed and provide a

higher-than-usual minute volume.

4. Control external bleeding and splint fractures.

Management of the Pregnant Trauma Patient

Start one or two IV lines of normal saline.

Inform the receiving facility of the patient’s

status and estimated time of arrival.

Transport the patient in the lateral

recumbent position.

Postpartum Complications

Maternal cardiac arrest

1. Provide CPR and ALS like any other

trauma patient.

2. CPR and ventilator support may keep

the fetus viable, even if the mother is

already dead.