Transcript 15_postpartum complication_(Infections)

Postpartum Complications
Postpartum Infections

Endometritis – malodorous lochia, fever (100.6),
chills, abdominal pain, uterine tenderness,
tachycardia and subinvolution
 The infection may spread to cause peritonitis and septic pelvic
thrombophlebitis
 Treat with IV antibiotics
 Emotional support
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Postpartum Infections
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Puerperal sepsis: any infection of genital
canal within 28 days after abortion or birth
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Most common infecting agents are
numerous streptococcal and anaerobic
organisms
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Endometritis
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Wound infections
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Urinary tract infections
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Mastitis
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Complications of Puerperium
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Fever
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UTI/Pyelonephritis
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DVT/Thrombophlebitis
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“Milk fever” (Lasts < 24 hours)
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Drug reaction
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Perineal infection(Day five)
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Pulmonary Atelectasis (48 hours)
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Mastitis (2-3 weeks post partum)
Postpartum Infections
Endometritis
Postpartum Endometritis
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Infection of the decidua (pregnancy
endometrium)
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Incidence
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<3% after vaginal delivery
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10-50% after cesarean delivery
• 5-15% after scheduled elective cesareans
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Risk Factors
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Prolonged labor, prolonged ROM, multiple vaginal
exams, internal monitors, maternal DM, meconium,
manual removal of placenta, low socioeconomic status
PP Endometritis
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Polymicrobial, ascending infection
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Mixture of aerobes and anaerobes from genital tract
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BV and colonization with GBS increase likelihood of
infection
Clinical manifestations (occur within 5 days pp)
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Fever – most common sign
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Uterine tenderness
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Foul lochia
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Leukocytosis
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Bacteremia – in 10-20%, usually a single organism
PP Endometritis
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Workup
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CBC
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Blood cultures
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Urine culture
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DNA probe for GC/chlamydia
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Imaging studies if no response to adequate
abx in 48-72h
• CT scan abd/pelvis
• US abd/pelvis
PP Endometritis
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Treatment
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Broad spectrum IV abx
• Clindamycin 900mg IV q8h and
• Gentamicin 1.5mg/kg IV q8h
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Treat until afebrile for 24-48h and clinically improved;
oral therapy not necessary
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Add ampicillin 2g IV q4h to regimen when not improving
to cover resistant enterococci
Prevention
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Abx prophylaxis for women undergoing C-section
• Cefazolin 1-2g IV as single dose
Postpartum Infections
Mastitis - A breast infection occurring 1-2 weeks after
childbirth
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Engorgement and blocked mild duct increases risk
 Fever, localized breast pain, redness,warmth and inflammation
 Breastfeeding should continue
 Antibiotics
 Nurse's role is to support, educate and refer
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Mastitis
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Infection of the lactating breast- 2nd or 3rd
week after birth
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Caused by S. aureus, often on hands of
mother or caregivers
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Can enter through a crack in the nipple
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Engorgement & stasis of milk frequently
precede mastitis
Mastitis Continued
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SIGNS & SYMPTOMS:
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Feels like the flu with fatigue & aching muscles
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Fever of 101.1F
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Localized area of redness & inflammation
THERAPEUTIC MANAGEMENT
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ATB & decompression of breast by
breastfeeding or pumping
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Bedrest during acute phase
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Fluids & analgesics for discomfort
Postpartum Infections
Mastitis
Puerperal Mastitis usually caused by common skin bacteria
particularly staphylococcus being introduced into the ductal system
through
Postpartum Infections
Mastitis
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Breast infections may cause
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pain,
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redness,
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warmth of the breast along with the following
symptoms:
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Tenderness and swelling
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Body aches
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Fatigue
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Breast engorgement
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Fever and chills
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Rigor or shaking
Postpartum Infections
Mastitis
Most breast infections occur in breastfeeding women when bacteria
enters the breast through cracks in the nipple. In severe infections,
abscesses may occur. Antibiotics may be indicated for treatment.
Postpartum Infections
Mastitis
Postpartum Infections
Mastitis
Postpartum Infections
Care Management
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Prevention is the best intervention
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Hand washing
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Good maternal perineal hygiene
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Antibiotic administration
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Wound management
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Breast care
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Sequelae of Childbirth Trauma
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Disorders of uterus and vagina related to
pelvic relaxation and urinary incontinence,
are often result of childbearing
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Uterine displacement and prolapse
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Posterior displacement, or retroversion
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Retroflexion and anteflexion
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Prolapse a more serious displacement
• Cervix and body of uterus protrude through vagina
and vagina is inverted
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Sequelae of Childbirth Trauma
Uterine prolapse
Uterine prolapse occurs when
the uterus falls through the
cervix (the connection between
the uterus and the vagina) into
the vagina. Symptoms and
treatment depends on how
much of the uterus has fallen
into the vagina.
Sequelae of Childbirth Trauma
Uterine prolapse
Sequelae of Childbirth Trauma
Uterine prolapse
Sequelae of Childbirth Trauma
Uterine prolapse
Sequelae of Childbirth Trauma
Uterine prolapse
Sequelae of Childbirth Trauma
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Cystocele and rectocele
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Cystocele: protrusion of bladder downward
into vagina when support structures in
vesicovaginal septum are injured
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Rectocele is herniation of anterior rectal wall
through relaxed or ruptured vaginal fascia and
rectovaginal septum
Urinary incontinence
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Sequelae of Childbirth Trauma
Cystocele and rectocele
Sequelae of Childbirth Trauma
Cystocele and rectocele
Sequelae of
Childbirth Trauma
Cystocele and
rectocele
Sequelae of Childbirth Trauma
Cystocele and rectocele
Sequelae of Childbirth Trauma
Cystocele and rectocele
Sequelae of Childbirth Trauma
Cystocele and rectocele
Sequelae of Childbirth Trauma
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Genital fistulas
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May result from congenital anomaly, gynecologic
surgery, obstetric trauma, cancer, radiation
therapy, gynecologic trauma, or infection
• Vesicovaginal: between bladder and genital tract
• Urethrovaginal: between urethra and vagina
• Rectovaginal: between rectum or sigmoid colon and
vagina
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Types of Fistulas That May Develop
in Vagina, Uterus, and Rectum
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Postpartum Psychologic Complications
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Mental health disorders in postpartum
period have implications for mother,
newborn, and entire family
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Interfere with attachment to newborn and
family integration
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May threaten safety and well-being of mother,
newborn, and other children
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Postpartum Psychologic Complications
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Postpartum depression without psychotic
features
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PPD: an intense and pervasive sadness with
severe and labile mood swings
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Treatment options
• Antidepressants, anxiolytic agents, and
electroconvulsive therapy
• Psychotherapy focuses fears and concerns of new
responsibilities and roles, and monitoring for
suicidal or homicidal thoughts
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Postpartum Psychologic Complications
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Postpartum depression with psychotic
features
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Postpartum psychosis: syndrome
characterized by depression, delusions, and
thoughts of harming either infant or herself
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Psychiatric emergency, and may require
psychiatric hospitalization
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Antipsychotics and mood stabilizers such as
lithium are treatments of choice
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Loss and Grief
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Losses of what was hoped for, dreamed
about, and/or planned
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Any perception of loss of control during
the birthing experience
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Birth of a child with handicap
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Maternal death
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Fetal or neonatal death
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Loss and Grief
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Conceptual model of parental grief
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Acute distress
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Intense grief
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Reorganization
Anticipatory grief
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Loss and Grief
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Plan of care and implementation
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Communicating and care techniques
• Actualize the loss
• Provide time to grieve
• Interpret normal feelings
• Allow for individual differences
• Cultural and spiritual needs of parents
• Physical comfort
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Loss and Grief
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Plan of care and implementation
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Options for parents
• Seeing and holding
• Bathing and dressing
• Privacy
• Visitations: other family members or friends
• Religious rituals/funeral arrangements
• Special memories
• Pictures
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Maternal Death
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Rare for woman to die in childbirth
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Families are at risk for developing
complicated bereavement and altered
parenting of surviving baby and other
children in family
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Referral to social services can help
combat potential problems before they
develop
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Key Points
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Postpartum hemorrhage is most common
and serious type of excessive obstetric
blood loss
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Hemorrhagic (hypovolemic) shock is an
emergency situation; the perfusion of
body organs may become severely
compromised and death may ensue
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Potential hazards of therapeutic
interventions may further compromise the
woman with hemorrhagic disorders
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Key Points
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Postpartum infection is a major cause of
maternal morbidity and mortality
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Postpartum urinary tract infections are
common because of trauma experienced
during labor
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Breast infection affects about 1% of
women soon after childbirth
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Key Points
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Structural disorders of uterus and vagina
related to pelvic relaxation are often the
delayed but direct result of childbearing
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Understanding of grief responses and
bereavement process is fundamental to
the nursing process
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Therapeutic communication and
counseling techniques can help families in
identifying their feelings and in feeling
comfortable in expressing their grief
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Key Points
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Follow-up after discharge is an essential
component in providing care to families
who have experienced a loss
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Nurses need to be aware of their own
feelings of grief and loss to provide a
nonjudgmental environment of care and
support for bereaved families
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