ch. 14 from notes

• early: 1st 24 hrs > 500 ml
• late: usually occurs 24-6w

• causes: uterine atony (early)
• lacerations of vagina/cervix (early)
• hematomas (early and late)
• retained placental fragments (early and late)
• uterine inversion (early) when uterus comes out with baby
• subinvolution (late) failure to return to normal

• -due to lack of uterine muscle tone
• -symptoms
• -gross amt bright red bleeding in the presence of a boggy uterus with lots of bright, red vag. bleeding
• -factors: conditions that overdistend uterus, conditions that affect uterine contractility, medication use
• -treatment-uterine massage, oxytocin, methergine, hemabate, blood products if needed, surgical intervention if severe

• types: perineal (3rd or 4th degree), vaginal, cervical
• symptoms: increased vaginal bleeding with firm uterus
• predisposing factors: primipara, instrument assisted birth, precipitous childbirth, macrosomia, epidural anesthesia

a collection of blood, often vulvar or vaginal that occurs as a result of injury to a blood vessel during delivery

symptom: client complains of severe perineal pain and rectal pressure

predisposing factors: prolonged second stage of labor, operative delivery, precipitous labor, macrosomia, pudendal anesthesia.

treatment: ice packs, analgesia

• -most common cause for late PPH
• -small portion of the placenta remains attached
• -cotyledons
• -manual removal of placenta

• prolapse of the uterus or turned inside out after birth
• -not always preventable
• -management: immediate repositioning of uterus by physician

a syndrome that occurs when the body is breaking down blood clots faster than it can form a clot, thus the body quickly depletes itself of clotting factors, leading to hemorrhage

• rare fetal complication, can occur during pregnancy, l&d, pp
• -amniotic fluid enters the maternal vascular system and initiates a cascading process which lease to cardio-respiratory collapse and DIC

• inflammation of the endometrium portion of the uterine lining
• -aerobic and anaerobic organisms
• -temp
• -tachycardia
• -chills
• -lower abdominal pain

bladder infection, low grade fever, burning on urination, suprapubic pain, urgency, small frequent voids

moderate to severe symptoms of depression, may occur anytime in first postpartum year-most in 4th week, has effect on woman, partner and children

• 1-2 per 1000 women
• -usually evident within first 3 months pp
• -however as early as day 3 pp

symptoms: agitation, hyperactivity, insomnia, mood lability, confusion and irrationality, poor judgement, difficulty remembering or concentrating, delusions and hallucinations

treatment: hospitalization and antipsychotics

three categories:

• 1) adjustment reaction with depressed mood (postpartum blues)
• 2) postpartum major mood disorder
• 3) postpartum psychosis