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Semelhante a POSTPARTUM Complications.ppt
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POSTPARTUM Complications.ppt
- 1. Complications of the Postpartum Period
- 2. Puerperal Infection Definition: Temp of 101o or more in the first 24 hrs following delivery Temp of 1004 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 • O2 • 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