•Learning how to deals with women which at post partum phase
•Identify Nursing role of each complications of abnormal purperium.
Identify risk factor of Early and late and complications.
•Providing information on postnatal care and danger signs in the new mother and baby
1 _introduction
●What Is the Postpartum Period?
It is the period which starts with the birth of your baby and extends until about six weeks after childbirth.
The postpartum period can be divided into three distinct stages; the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months.
2-Normal physiological changes during post partum
1.Breast :
•Secretion of colostrums begins at the 1st 3 days
•Breast engorgement occur at the 3rd day when milk secretion starts.
•Colostrum is a thick, sticky and light yellowish in colour produced during the first few days after delivery, which although secreted in small quantities (30-90ml), it is sufficient to meet the çaloric needs of a normal newborn in the first few days of life
Breast changes after pregnancy
After giving birth, breast changes continue to occur. The most common are: 1- Leaking
At around 3–5 days after delivery, the milk comes in. A good indicator of this is that the colostrum — the thick, yellow fluid that may be the baby’s first food — becomes lighter in color and thinner in consistency.
Some women experience leaking from their nipples within the first few days of their milk appearing. It can happen:
a)when the baby cries
b)when their breasts are very full
c)when they experience strong emotions
d)for no obvious reason
2- Breast engorgement
Full breasts are a regular part of the postdelivery experience. The medical name for breast fullness is engorgement, and it happens when the milk comes in. A woman may also experience:
heavy, hard breasts skin that is warm to the touch lumps in the breast tissue discomfort
3- Tingling sensations
Breastfeeding women may notice a tingling sensation in their breasts when the babies begin to nurse. This can indicate the ―let-down‖ of milk — the milk releasing into the ducts so that the baby can drink it. Over time, these sensations may become less noticeable.
4- Increased cup size
Typically, the breasts remain enlarged for at least the first few months of nursing. They tend to feel softer and emptier immediately after feedings and may shrink slightly after the baby starts eating solids.
5- Sore or cracked nipples
In the initial stages of breastfeeding, some women experience nipple pain. This occurs while the woman and baby adjust to the process of nursing.
When babies do not latch on to the nipple correctly or suck very strongly, it can cause the nipples to crack, bleed, or blister.
2. Uterus
Involution : return of the uterus to its pre- pregnant condition.
Size: Immediately after (abor the leyel of fundal height should be above level of the umbilicus with 1 finger why?
because of accumulation of lochia in the fundus.
After 6:12 hours the fundus back to umblical level
After 24 hours, fundus begins to descend by approximately 1cm, or one fingerbreadth, per day, so that by the 10th day it is in the pelvic cavity and cannot be palpated abdominally.
Within a week,;
•The uterus should be firm and well contracted in the midline. It decreases in size daily
•By the end of Ist week : the fundus is midway between umbilicus and symphysis pubis. the weight of the uterus decreases to about 500g
•By the 2nd week: the fundus is just behind the symphsis pubis, and thereafter, it becomes a pelvic organ that can no longer be felt abdominally
•at 6 weeks, the uterus weight 60g. This is roughly the pre- pregnancy weight
3.Bladder:
Thére is usually physiological diuresis (polyuria)
Painful, difficult micturition due to tears, lacerations or episjotomy may result in, refiex retention of urine.
Causes of retention of urine in the first few days:
The parturient may experience some retention of urine in the first few days
After labor due to:
Laxity of the abdominal muscles.
bladder Inability to micturate in the recumbent position
Reflex-inhibition due to stitched perineum Atony of the bladder.
Lactosuria is common with milk engorgemen on the 4th day at the start of lactation
4.Bowel:
Gastrointestinal System Thirst is present due to the marked fluid loss through sweat and urine.Tendency to atony of the gastrointestinal tract, with flatulence and constipation.
5.lochia
It is the uterine discharge coming through the vagina during the first 3-4 weeks or the postpartum.
It is alkaline in reaction; the amount is more than the menstrual flow, with fleshy odor..
•There are three types of Lochia:-
•1-Lochia rubra:-
Red in color due to the presence of a fair amount of blood, shreds of the deciduas, large amount of chorion, aminiotic fluid, lanugo hair, and Lasts from the 1st postpartum days, to the 4th day (and sometimes to 7th day).
•2-Lochia serosa:-
Pinkish yellow discharge due to relative decrease in RBCs and predominance of leukocytes.Exends for another 3 to 4 days.
•3-Lochia Alba:-
Creamy or white colored discharge containing leucocytes and mucus. It remains to the ten day
6.Epiosotomy:
•Observe any laceration or epiosotomy .
• If noted epiosotomy, observe (Reeda) Reeda are:
▪Redness
▪edematous
▪echemosis ▪discharge
▪approximation of suture line (observe any discharge from sutures).
2- Early complication of peurperium
Primary post partum hemorrhage
It is the loss of >500 ml of blood per-vagina within 24 hours of delivery.
■It can be classified into two main types:-
•Minor PPH – 500-1000ml of blood loss
•Major PPH – >1000ml of blood loos
■Etiology:-
●Primary causes of postpartum hemorrhage include:- o uterine atony. o Trauma. o coagulation disorders. o genital tract lacerations.
o uterine atony is the most common cause of postpartum hemorrhage o Retained placenta
■Risk Factors of primary post partum hemorrage:-
▶obesity
▶ fever during pregnancy
▶bleeding before delivery
▶ heart diseases
▶Age >40
▶Previous postpartum haemorrhage
▶Vaginal bleeding during the pregnancy or labour
▶Previous retained placenta
▶Anaemia
▶The use of certain drugs during pregnancy
▶Epidural anaesthesia
■Clinical Features:-
•Dizziness.
•Palpitations.
•Shortness of breathing.
•Prolonged capillary refill time.
•Increase sweating, Fatige.
■Complications:-
•Hypovolaemic shock.
•Acute kidney failure.
•Liver failure.
•Hypertention.
•Death.
•Acute (adult) respiratory distress syndrome.
•Disseminated intravascular coagulation.
■Diagnoses:-
Postpartum haemorrhage is diagnosed clinically when significant blood loss (>500mL) is observed.
■Investigations:-
The initial laboratory tests in primary post-partum haemorrhage include:
•Full blood count.
•Cross match 4-6 units of blood.
•Coagulation profile.
•Urea and Electrolytes.
•Liver function tets.
■Management:-
Immediate Management
1.Teamwork:- Involve appropriate colleagues for minor and major PPH,
including the midwife in charge and midwives, obstetricians, anaesthetists, blood bank, clinical haematologist and porters. Communication between the team, and diligent documentation is vital.
2.Investigations and Monitoring:-
Investigations as above. Monitoring should include RR, O2 sats, HR, BP, temperature every 15 mins. Consider catheterisation and insertion of a central venous line.
Definitive management
The definitive treatment for primary post-partum dependent on the underlying Cause. ]■Uterine Atony:-
Bimanual compression to stimulate uterine contraction, Performing a uterine Massage
● Atony of the Uterus?
Causes of uterine atony :
General causes (MADE):
•Metabolic disease : as anemia,DM, hypertension
•Anexiety and stress
•Drugs as symathomymitics (action: relaxant to muscle) as:Anti prostaglandin drugs
•Electrolyte imbalance Local causes (4M):
Mechanic: unability uterus to contract
internal uteus: blood clot
External uterus: full blader and full rectum
Mal presentation and mal position
Multi para
Marked distension uterus
Treatment for Atony of the Uterus:-
*Active tt: Correct general condition (restorative ttt = Anti shock measure.
B-ttt according fo cause: 1-Atonic PPH In steps step(1)uterine massage: slow firm, rotatory, 4 fingers behind fundus.
Step(2)uterotonics
1-Oxytocin (syntocinon)
2-Ergometrine (methergine)
3-Prostaglandin
Step(3) EUA(exploration under anesthesia: for a-Exploration of birth canal to exclude mixed type PPH i.e atonic + traumatic
b- Rempval of any retained parts of placenta or blood clots Inside uterine cavity (retained blood clots leads to atony).
Step (4):Bimanual compression(under anaesthesia): The uterus ts firmly compressed for(30 min, between the closed fist of RT hand in anterior fornix and LT hand abdominally behind body of uterus.
Step (5): Intrauterine pack.
Step (6): uterine compression suture (B-lunch).
Step (7) Surgical step
1-Bilateral uterine artery mass ligation.
2-Bilateral ovarian artery ligation.
3-Internal iliac artery ligation.
4-Subtotal hystrectomy
●Trauma:-
Primary repair of laceration, if uterine rupture: laparotomy and repair or hysterectomy.
●Tissue:-
Administer IV Oxytocin, manual removal of placenta with regional or general anaesthetic, and prophylactic antibiotics in theatre. Start IV Oxytocin infusion after removal.
●Thrombin:-
Correct any coagulation abnormalities with blood products under the advice of the haematology team.
is typically used right after the delivery of the baby to prevent PPH,Oxytocin helps the uterus to contract quickly and the contractions to last for longer
2.Misoprostol:-
may be used in areas where oxytocin is not available
3.Tranexamic acid (TXA) :-
is a medication used to treat or prevent excessive blood loss from major trauma, postpartum bleeding
• Retained placenta
What is retained placenta?
After you have your baby, the final stage of childbirth is the delivery of the placenta during uterine contractions. Delivering the placenta usually occurs within 5 to 30 minutes of delivery, whether vaginally or by C-section
■Definition:-
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
■Who is at risk for retained placenta?
Women who are at risk for a retained placenta include those who've had:
•A previous C-section
•A premature delivery before 34 weeks
•A stillborn baby
•Uterine abnormalities
•A long first or second stage of labor
•Retained placenta during a previous delivery
■What are the different types of retained placenta?
There are three scenarios in which a retained placenta can occur:
1•Placenta adherens:- which happens because the uterine muscles don’t contract enough to make the placenta separate from the uterine wall and expel it from the womb.
2•Trapped placenta:-
which happens when the placenta separates from the uterus but does not naturally exit the mother’s body. This can occur when the cervix begins to close before the entire placenta is excreted.
3•Placenta accrete:- which happens when the placenta grows into the deeper layer of the uterus and is unable to naturally detach from the organ. This is the most dangerous type of retained placenta and can lead to a hysterectomy and blood transfusions.
■What are the symptoms and signs of retained placenta?
If pieces of the placenta are still inside your body days or weeks after delivery, you may experience symptoms including:-
1.Fever.
2.Persistent heavy bleeding with blood clots.
3.Cramping and pain.
4.A foul-smelling discharge.
■How is retained placenta treated?
●Management:
If the placenta is undelivered after 30 minutes, consider :-
Emptying bladder.
Uterine message
Breastfeeding or nipple stimulation.
Change of position - encourage an upright position.
Controlled cord traction (applying pressure on the lower abdomen while simultaneously pulling on the umbilical cord).
●If bleeding immediately:- Inform doctor.
Insertion of large bore IV ( 18g ) cannula.
Insert urinary catheter.
Continue oxytocin infusion 20 units in 1 litre / rate - 60drops per min.
Measure and accurately record blood loss.
Prepare and transfer patient to theatre for manual removal of placenta ( MROP ) .
Manual removal of placenta:
to be removed manually by a doctor Hysterectomy: o Uterine massage. o Medications such as oxytocin.
CONTRACTION RING :-
•Definition: It's persistent localized annular spasm.of uterine muscles, it occurs at any stage of labour and at any part of uterus.
●Causes:-
Unknown, but predispoding factor of hypertonic inertia.
1-Elderly Primi Gravida(PG).
2-Anxiety and excitation.
3-Irregular use of oxytocin.
4-psychic patient.
5-cephalopelvic disproportion (CPD)
●Complications:-
1 -Prolonged 1st/stage of labour.
2-Prolonged second stage of labour.
3-Retained placenta and PPH, if the ring occurs in 3rd stage of labour (hour-glass contraction).
●Treatment:-
1-Exclude disproportion and malpresentation.
2- Specific ttt: - Antispasmodic + sedatives if no response -> anesthesia if no response ----> C-section
3-Retained placenta in 3rd stage:-Deep general anaesthesia + manual removal of placenta
• Uterine inversion
Uterine inversion occurs when the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out.
■Signs and symptoms:-
●Mild to severe vaginal bleeding.
●Mild to severe lower abdominal pain.
●A smooth, round mass protruding from the cervix or vagina.
●Urinary retention.
■Risk factors:-
●Long labour (more than 24 hours).
●Use of the muscle relaxant magnesium sulphate during labour.
Short umbilical cord.
●Placenta accreta (the placenta has invaded too deeply into the uterine wall).
●Congenital abnormalities or weaknesses of the uterus.
■Diagnosis methods:-
•The uterus protrudes from the vagina.
•The fundus doesn’t seem to be in its proper position when the doctor palpates (feels) the mother’s abdomen.
•The mother experiences greater than normal blood loss.
•The mother’s blood pressure drops (hypotension).
•The mother shows signs of shock (blood loss).
•Scans (such as ultrasound or MRI) may be used in some cases to confirm the diagnosis.
■Degrees of Uterine Inversion:-
•Incomplete: Fundus inverts but does not herniate through the level of the internal os. •Complete: The internal lining of the fundus crosses through the cervical os with no palpable fundus abdominally.
•Prolapsed: Entire uterus prolapsing through the cervix with the fundus passing out of the introitus.
■Classification:-
•Acute: Twenty-four hours or less after delivery.
•Subacute Longer than 24 hours postpartum.
•Chronic: Longer than 1 month postpartum.
■Nursing Management:-
▪Promptly identify and assist with the resolution of uterine inversion
▪Recognize signs of impending inversion, and immediately notify the physician calling for assistance
▪Immediate manual replacement of the uterus at the time of inversion
▪will prevent cervical entrapment of the uterus, if reinversion is not performed immediately, rapid and extreme blood loss may occur, resulting in hypovolemic shock
▪Take steps in order to prevent or limit hypovolemic shock if occured
▪Insert a large gauge intravenous catheter for fluid replacement
▪Measure and record maternal vital signs every 5 to 15 minutes to
▪establish a baseline and document change
▪Open an established intravenous line for optimal fluid replacement
▪A fibrinogen level should be drawn to determine the risk for formation of a blood clot
▪Prepare for anesthesia as needed
▪Prepare to administer CPR, if required
▪If manual reinversion is not successful, prepare the client and family for
▪possible general anesthesia and surgery
Obestatric shock
●Definition:
Inadequate tissue perfusion
●Types:-
1- Oligemic shock
▪loss of fluid(hyperemesis gravidarum).
▪Loss of plasma(burns) .
▪Loss of blood(A.P.H.,P.P.H)
2- Cardiogenic shock
Heart failure
Pulmonary embolism(amniotic fluid embolism)
3-Septic shock: due to infection in obstetrics
a)Septic abortion
b)Acute pyelonephritis
c)Chorioamnionitis
d)Puerperal sepsis
4- Neurogenic shock
Due to vagal tone in painful conditions.
●Complication of any type of shock:- 1- .Electrolyte imbalance & metabolic acidosis
occurs Secondary when a woman loses more than 500 mL of blood in a normal delivery and more than 1000mL of blood in a cesarean delivery within 24 hours.
■Pathophysiology:-
•There are different main causes of postpartum hemorrhage, and they cause bleeding in different ways.
•In uterine atony, the uterus stops contracting, which leads to bleeding because the placental sites have closed.
•Lacerations also cause bleeding after delivery.If the uterus has retained placental fragments, it can also cause massive bleeding postpartum.
■Risk Factors:-
These are the risk factors that you should watch out for in a postpartum woman.
Conditions that distend the uterus beyond average capacity.
•Multiple gestations.
•hydramnios.
•a large baby.
•cervical or uterine lacerations.
•A woman who underwent operative birth or rapid birth could develop lacerations that would cause bleeding.
•Placenta previa and abruption placenta also cause heavy maternal bleeding. cesarean delivery.
•advanced maternal age.
•Inadequate blood coagulation .
■Symptoms of secondary postpartum hemorrhage include the following:-
•Fever and uterine tenderness:- if infection is present (typically lower uterine tenderness).
•Hypotension.
•Tachycardia.
• Tachypnea >22/minute.
•Decreased urine output.
•Lightheadedness.
•Paleness.
•Cold and clammy hands and feet.
•Syncope.
•Anemia :-
(severe anemia is common prior to a secondary hemorrhage).
•Pain may or may not be present.
•Occult bleeding.
•Sudden bleeding after lochia:- has tapered off (possibly foul lochia).
■Causes of secondary postpartum hemorrhage:-
1-retained placental or fetal tissue.
2-infection.
3-subinvolution of the placental site (delayed or_ inadequate physiologic closure and sloughing of the superficial modified spiral arteries at the placental attachment site).
• Peur peural sepsis
What is Peur peural sepsis?
A Peur peural sepsisoccurs when bacteria infect the uterus and surrounding areas after a woman gives birth. It’s also known as a postpartum infection.
■types of postpartum infections, including:
•endometritis:-
an infection of the uterine lining
•myometritis:-
an infection of the uterine muscle
•parametritis:-
an infection of the areas around the uterus
●Aetiology:
General P.F:-
1-Disease(B. M or anemia)
2- Drugs (alcohole, Cxtotoxic drugs)
3. under nutrition
4-Physical and mental Stress ●Organisms:
1 -Group A beta hemolytic streptococi
2-Group B beta hemolytic streptococci.) GBS)
3-Non - hemolytic streptococci )strept. faecalis)
4-Anaerobic streptococci
5-Staphylococci: causing suppuration and pus formation
6-Other organisms: e.g: Bacteroid fragilis, E. coli,CL.welchii
●Mode of transmissions :-
1-Endogenous infection:(by brganisms already present in genital tract that flare up if there is a predisposing factor (e.g. anaerobic strept.)
2-Exogenous infection From outside
•Attendants
Staph, which present in nasal opening(nasal carriers)
infection spread from septic focus elsewhere inside body (e. g. tonsils or chronic appendicitis) through blood or lymphatic spread e.g. E. coll from colon to genital tract through lymphatics. ■What are the symptoms of a puerperal infection?
1.fever.
2.pain in the lower abdomen or pelvis caused by a swollen uterus.
3.foul-smelling vaginal discharge.
4.pale skin, which can be a sign of large volume blood loss.
5.chills.
6.feelings of discomfort or illness.
7.headache.
8.loss of appetite.
9.increased heart rate .
Prophylaxis
A)Antental level
(1)- correct general P. F for infections e. g. correct anemia, control D. M nutritional support, no stress.
(2)-ttt of any septic focus e. g. tonsilitis
(3)-No sexual intercourse in last month of pregnancy
B)intrenatal level
(1)-strict asepsis for
Patient: Shave of vulvar hair, sterilization of vulva, lower abdomen and upper thigh during second stage of labour by antiseptic solution.
Instruments: Sterilization by boiling or better autoclaving.
Attendants: -Doctor and nurse must attend Labour with mask, over shoes
-Nasal carriers for staph. must not attend labour until treated.
(2)-Any laceration should be properly repaired.
(3)-Prophylactic antibiotics
C)Post natal level
(1)-Maintenance of antiseptic precautions.
(2)-Minimize visitors.
(3)-Early isolation of suspected cases.
Active:-
(1)-If patient develop septic shock: ttt of septicshock.
(2)-general measures to any feverish patient: hospitalization.
a- isolated semi dark calm room. b-observation: fever chart,general condition and vital signs. c-_restrict visitors. d-_light easly digestable. carbohydrate diet with fluid. e-_antipyretics and analgesics.
(3)-Sepcific ttt:
a_antibiotics: triple regimen antibiotics to cover all the causative organism unless culture and sensitivity result is obtained
we have
•penicillins to cover gram +ve organisms either ampicillin 1gm I.V.I /8hr or crystalline P.
is an inflammatory condition of the breast that may occur in breastfeeding women during the puerperium and is reported in women who continue to breastfeed up to 1-year after delivery and it's common in the first 6 months Causes of mastitis :
(1)A blocked milk duct....Milk ducts carry milk from the breast glands to the nipple. When these ducts are blocked, milk builds up within the breast and causes inflammation and may result in infection.
(2)Bacteria entering the breast......Bacteria from the skin's surface and baby's mouth can enter the milk ducts through a crack in the skin of the nipple or through a milk duct opening. Stagnant milk in a breast that isn't emptied provides a breeding ground for the bacteria.
Most common symptoms of mastitis :
1....Swelling or breast enlargement
2....Redness, swelling, tenderness, or a sensation of warmth on the breast
3....Itching over the breast tissue
4....Tenderness under the arm
5....A small cut or wound in the nipple or on the skin of the breast 6....fever
Risk factors for mastitis include:
1....Previous bout of mastitis while breast-feeding
2....Sore or cracked nipples — although mastitis can develop without broken skin
3....Wearing a tightfitting bra or putting pressure on the breast when using a seat belt or carrying a heavy bag, which may restrict milk flow
4....Becoming overly tired or stressed
5....Poor nutrition 6....Smoking
Treatment
Mastitis treatment might involve:
Altrnative treatment
Pain relievers. Your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).
It's safe to continue breast-feeding if you have mastitis. Breast-feeding actually helps clear the infection. Weaning your baby abruptly is likely to worsen your signs and symptoms
Prophylactic treatment
Antibiotics. If you have an infection, a 10-day course of antibiotics is usually needed. It's important to take all of the medication to minimize your chance of recurrence. If your mastitis doesn't clear up after taking antibiotics, follow up with your doctor.
Your doctor might refer you to a lactation consultant for help and ongoing support.
Suggestions for adjusting your breast-feeding techniques might include the following:
Avoiding prolonged overfilling of your breast with milk before breast-feeding.
Trying to ensure that your infant latches on correctly — which can be difficult when your breast is engorged. Expressing a small amount of milk by hand before breast-feeding might help.
Massaging the breast while breast-feeding or pumping, from the affected area down toward the nipple.
Making sure your breast drains completely during breast-feeding. If you have trouble emptying a portion of your breast, apply warm and moist heat to the breast before breastfeeding or pumping milk.
Breast-feeding on the affected side first, when your infant is hungrier and sucking more strongly.
Varying your breast-feeding positions Prevention:
1....Taking care to prevent irritation and cracking of the nipple
2....Frequent breast-feeding
3....Using a breast pump
4....Using a proper breast-feeding technique that allows for good latching by the infant
5....Weaning the baby over several weeks, instead of suddenly stopping breast-feeding.
• Uterine sub involution
■Definition:-
Subinvolution is a medical condition in which after childbirth, the uterus does not return To lts normal size.
■Causes:- ●predisposing factors:-
a)-grand multiparity
b)-overdistention of uterus as in twins and hydramnios
c)-caesarean section
d)-uterin prolapse
e)-retroversion after the uterus becomes pelvic organ
f)-uterin fibroid
■Risk factor-:
1.lochia/fresh bleeding
2.Long labor
3.Anesthesia
4.Full bladder
5.Difficult delivery
6.Retained placenta
7.Maternal infection
8.organ Retroversion after the uterus becomes pelvic
9.Uterine fibroid
10.Breast infection
11.Breast infection (breast mastitis)
■symptoms:-
•abnormal lochial discharge.
•excessive uterine bleeding.
•irregular cramp.
■Sign:-
-uterine hight is greater than normal.
■Management:-
-antibiotics in endometritis
-exploration of the uterus in retained products -pessary in prolape or retroversion.
-ergometrine so often prescribed to enhance the involution process by reducing the blood flow of the uterus is of no value in prophylaxis.
■Nursing intervention:-
◦early ambulation postpartum
◦daily evalution of fundal height to document involution
• Post partum blue
Definition of Post partum blue:-
●Postpartum blues:-
also known as baby blues and maternity blues, is a very common but self-limited condition that begins shortly after childbirth and can present with a variety of symptoms such as mood swings, irritability, and tearfulness. Mothers may experience negative mood symptoms mixed with intense periods of joy. Up to 85% of new mothers are affected by postpartum blues, with symptoms starting within a few days after childbirth and lasting up to two weeks in duration.
■Causes:-
•excessive bleeding
•uterine infection and infection of C-section
•depression and anxiety
•swollen breast and breast infection
•stretch marks
•Cardiomyopathy and heart disease
Treatment is supportive, including ensuring adequate sleep and emotional support. If symptoms are severe enough to affect daily functioning or last longer than two weeks, the individual should be evaluated for related postpartum psychiatric conditions, such as postpartum depression and postpartum anxiety. It is unclear whether the condition can be prevented, however education and reassurance are important to help alleviate patient distress
■Nursing Interventions:-
Nurses must be alert in sensing the current psychological state of the patient too. They must provide a precise data of the patient’s well-being to give way to a more accurate care plan for a woman with postpartum depression.
▪Assist the woman in planning for her daily activities, such as her nutrition p rogram, exercise, and sleep.
▪Recommend support groups to the woman so she can have a system where she can share her feelings.
▪Advise the woman to take some time for herself every day so she can have a break from her regular baby care.
▪Encourage the woman to keep in touch with her social circle as they can also serve as her support system.
▪To prevent infections after delivery, it is preferable to take showers rather than a tub baths for two weeks.
• Dvt
■Definition:- a blood clot, almost always in one of the deep veins in legs. ■Risk factor:-
•previous dvt -infection
•prolonged labor -DM
•old age -smoking -obesity
•Dehydration •heart diseases
■complication:- pulmonary embolism.
■signs, symptoms:-
•pain
•tenderness
•swollen
•redness
•warm skin
•edema
■investigation:-
- Duplex ultrasonography:-
is an imaging test that uses sound waves to look at the flow of blood in the veins. It can detect blockages or blood clots in the deep veins. It is the standard imaging test to diagnose DVT. A D-dimer blood:-
test measures a substance in the blood that is released when a clot breaks up
CT or MRI scans:-
Either can provide visual images of your veins and might show if you have a clot.
Sometimes these scans performed for other reasons reveal a clot.
■Treatment:-
•prophylactic anticoagulants(heparin)
•leg exercises,bed rest
•Compression stockings:- To help prevent swelling associated with deep vein thrombosis, these are worn on your legs from your feet to about the level of your knees.
تعليقات
إرسال تعليق