Term
| Early Postpartum hemorrhage |
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Definition
| a blood loss greater than 500 mL in first 24 hours after vaginal deliver; may be greater with cesarean delivery |
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Term
| Predisposing factors of postpartum hemorrhage |
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Definition
- occurs within first 24 hrs of birth
- 600 mL/min of blood perfuse pregnant uterus at term
- most common causes are uterine atony (75%) and lacerations
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Term
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Definition
| lack of uterine muscle tone; after birth, contraction of interlacing uterine muscles occludes open areas at site of placental attachment; absence of uterine contractions can cause signifiant blood loss |
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Term
| Predisposing factors that overdistend uterus |
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Definition
- delivery of large infant
- mulitiple gestaton
- hydramnios/polyhydramnios
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Term
| Predisposing factors that affect uterine contractility |
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Definition
- multiparity
- precipitous labor
- dysfunctional or prolonged labor
- prolonged 3rd stage of labor
- retained placental fragments
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Term
| Predisposing medications for uterine atony |
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Definition
- general anesthesia
- magnesium sulfate
- oxytocin induction or augmentation of labor
- tocolytics
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Term
| Predisposing maternal conditions for uterine atony |
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Definition
| low platelet count secondary to PIH |
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Term
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Definition
| more common after operative obstetrics, a firm uterus with bright red blood or a steady stream or trickle of unclotted blood |
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Term
| Types/Locations of Lacerations |
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Definition
- perineal
- vaginal
- cervical
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Term
| Predisposing factors for lacerations |
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Definition
- primiparous state
- epidural anesthesia
- precipitous childbirth
- macrosomia
- forceps or vacuum-assisted birth
- mediolateral episiotomy
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Term
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Definition
| a collection of blood, often vulvar or vaginal, that results from injury to a blood vessel during spontaneous delivery; in an assisted vaginal delivery, most common site is lateral wall in area of ischial spine |
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Term
| Predisposing factors for hematoma |
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Definition
- prolonged pressure of fetal head on vaginal mucosa
- operative delivery (forceps or vacuum)
- prolonged 2nd stage of labor
- precipitous labor
- macrosomia
- pudendal anesthesia
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Term
| Disseminated Intravascular Coagulopathy (DIC) |
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Definition
| complex disorder of clotting mechanisms in blood; consumption of clotting factors because of widespread clotting can lead to overwhelming and diffuse hemorrhage; oozing from puncture sites or development of petechiae may be initial clues of coagulopathy |
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Term
| Predisposing factors for DIC |
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Definition
- PIH
- amniotic fluid embolism
- sepsis
- abruptio placentae
- prolonged intrauterine fetal demise
- excessive blood loss
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Term
| Causes of early-postpartum hemorrhage |
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Definition
- uterine atony
- lacerations
- hematoma
- DIC
- uterine rupture
- uterine inversion
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Term
| Late-postpartum hemorrhage |
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Definition
- subinvolution
- occurs most often within 1-2 wks after childbirth bc of retention of placental tissue
- blood loss may be excessive but usually poses less risk than immediate postpartum hemorrhage
- lochia rubra that exists longer than 2 wks is suggestive of subinvolution
- most commonly dx at 4-6 wk postpartum exam
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Term
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Definition
| failure of uterus to return to normal size after pregnancy |
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Term
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Definition
- reproductive tract
- wound
- breast (mastitis)
- UTI
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Term
| Postpartum Reproductive tract infections |
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Definition
| any infection in reproductive system within 6 wks of delivery (6% rate) |
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Term
| Predisposing factors for reproductive tract infections |
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Definition
- anemia
- prolonged ROM
- soft tissue trauma or hemorrhage
- invasive procedures including internal fetal monitoring
- multiple vaginal examinations
- retention of placental fragments
- chorioamnionitis
- pre-existing bacterial vaginosis
- manual removal of placenta
- lapses in aseptic technique by staff
- use of forceps or vacuum-extraction
- obesity
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Term
| Single most significant risk for postpartum reproductive tract infection |
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Definition
| cesarean delivery (12-15% of cases) |
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