This document discusses various postpartum complications including uterine subinvolution, breast conditions, deep vein thrombosis, and psychological complications. It provides details on definitions, causes, signs and symptoms, and treatment for conditions like puerperal pyrexia, subinvolution, breast mastitis, breast abscess, lactation problems, and puerperal venous thrombosis. Risk factors, classifications, investigations and management of complications are outlined.
This document discusses various postpartum complications including uterine subinvolution, breast conditions, deep vein thrombosis, and psychological complications. It provides details on definitions, causes, signs and symptoms, and treatment for conditions like puerperal pyrexia, subinvolution, breast mastitis, breast abscess, lactation problems, and puerperal venous thrombosis. Risk factors, classifications, investigations and management of complications are outlined.
This document discusses various postpartum complications including uterine subinvolution, breast conditions, deep vein thrombosis, and psychological complications. It provides details on definitions, causes, signs and symptoms, and treatment for conditions like puerperal pyrexia, subinvolution, breast mastitis, breast abscess, lactation problems, and puerperal venous thrombosis. Risk factors, classifications, investigations and management of complications are outlined.
This document discusses various postpartum complications including uterine subinvolution, breast conditions, deep vein thrombosis, and psychological complications. It provides details on definitions, causes, signs and symptoms, and treatment for conditions like puerperal pyrexia, subinvolution, breast mastitis, breast abscess, lactation problems, and puerperal venous thrombosis. Risk factors, classifications, investigations and management of complications are outlined.
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WELCOME
COMPLICATIONS IN PUERPERIUM • SUBINVOLUTION OF UTERUS • BREAST CONDITIONS • DVT & THROMBOPHLEBITIS • PSYCHOLOGICAL COMPLICATIONS BRIEF REVIEW
PUERPERIUM • Definition • Duration • Classification COMPLICATION OF PUERPERIUM
puerperial pyrexia puerperial sepsis subinvolution urinary complication breast complication puerperial venous thrombosis pulmonary embolism obstetric palsies psychiatric disorders ICD CLASSIFICATION FOR COMPLICATION OF PUERPERIUM 670-676 670 -Major puerperal infection (Endometrioid) 671 -Venous complications in pregnancy and the puerperium (Thrombophlebitis) 672 - Pyrexia of unknown origin during the puerperium 673 - Obstetrical pulmonary embolism 674 - Other and unspecified complications of the puerperium, not elsewhere 675-Infections of the breast and nipple associated with childbirth( Abscess of breast, postpartum Mastitis)
676 - Other disorders of the breast
associated with childbirth (Engorgement of breasts) UTERINE COMPLICATIONS
Brief Review On Uterine Changes
• First the area where the placenta was
implanted is sealed off to prevent bleeding. • Second the organ is reduced to its approximate pre gestational size UTERINE SUBINVOLUTION DEFINITION slowing of the process of involution or shrinking of the uterus CAUSES Endometritis retained placental fragments pelvic infection uterine fibroids SIGNS AND SYMPTOMS. (1) Prolonged lochial flow. (2) Profuse vaginal bleeding. (3) Large, flabby uterus. MEDICAL TREATMENT.
Oxytocic
Antimicrobial therapy
Dilation and curettage
What we nurses can do …………. BREAST COMPLICATION IN PUERPERIUM Review of anatomy and physiology Physiology
• Preparation of Breast (Mammogenesis)
• Synthesis and Secretion from Breast Alveoli(Lactogenesis) • Galactokinesis : Onset of copious milk secretion • Galactopoieses: maintenance of milk secretion LACTATIONAL PROBLEM- DEFICIENT LACTATION Deficient lactation Management Fluids
Diet breastfeeding CRACKED NIPPLES Causes Management FLAT NIPPLE/INVERTED NIPPLE How we can manage the condition ?????? ACUTE MASTITIS Causative organism Staphylococcus aureus
infected baby Clinical picture
Painful, tender, red , hot
Enlarged axillary Fever
lymph nodes Treatment BREAST ABSCESS Pus formation in breast
Causes Manifestation
pain edema edema
Fever enlarged lymph nodes Management
medical surgical
Antibiotic therapy Incision
and drainage GALACTOCELE It is a retention cyst of a large mammary duct due to its obstruction. If it is persistent it is excised or aspirated. LACTATION INHIBITION INHIBITION OF LACTATION Maternal: Foetal:
Decompensated heart Cleft palate. failure. Marked prematurity. Active pulmonary tuberculosis. Death of the infant. (AIDS). Acute illness as pneumonia. Methods
Cold fomentation Fluid restriction
Breast binders Medications
Breast binders Medications Dopamine agonists:
– Bromocriptine (Parlodel) 2.5mg twice
daily. – Lysuride (Dopergin) 0.2 mg twice daily. starting as early as possible for 14 days BREAST ENGORGEMENT
inc overfilling of milk re as in the breasts ed pr es su re ov er v ein s Painful -engorgement PREDISPOSING FACTORS o A fissure or abrasion on the nipple. o Blocked milk ducts. o An incomplete let down reflex, usually due to emotional trauma. o A tight bra or prolonged intervals between breast-feeding. o Alveolar milk accumulation. Causes
Infant demand Milk supply a suddenly increased milk production that is common during the first days after the baby is delivered
when the baby suddenly stops breastfeeding
when the mother does not nurse .
After the first 3 to 4 postpartum days, the quantity of
colostrum is quickly replaced by an increased milk production. Pathophysiology Overdistention Involution of milk Severe of alveoli secreting glands engorgement
Breast engorgement Collapse of alveolar
Nipple flattens structure
Apoptosis Cessation of milk Inable to suck
production
Stagnation Symptoms
Diagnosis TREATMENT OF BREAST ENGORGEMENT
Breast feeding warm compress
chilled cabbage leaves Express milk
Massage breasts Fitting Bra
Proper latching Cabbage leaves application Supportive medical
•Ice packs •Analgesics
•An uplift support bra •Prophylactic antibiotics to minimize edema •Anti inflammatory drugs •Breast massage •Oxytocin nasal •manually express Antibiotic therapy should continue for 10 days. • penicillin G • erythromycin or kanamycin Incision and drainage of the abscess HOME REMEDIES Application • oatmeal, • coconuts • Using cold cabbage leaves Apply a warm and wet washcloth around the breasts 15-20 Wear lose fitting and comfortable bras PUERPERIAL VENEOUS THROMBOSIS PUERPERIAL VENEOUS THROMBOSIS Thrombosis of the leg veins and pelvic veins Ethiopathogenesis Pregnancy is a hypercoagulable state
Rise in the concentration
of coagulation factors I,II,VII, Plasma fibrinolyitic inhibitors VIII ,IX,X,XII are produced by placenta
l m ona ry pelvic Pu s thrombophlebitis embolu Diagnosis for deep vein Thrombosis Clinical manifestation
• Pain in calf muscles
• Legs oedema • Rise in skin temperature Physical examination
1. leg oedema 2. Positive homan’s sign
Investigation
1. Doppler ultrasound- velocity of blood flow
2. Real time u/s- intramural thrombus Doppler ultrasound 3.Venography (non ionic water soluble radio opaque dye )- filling defect in the venous lumen PELVIC THROMBOPHEBITIS
It originates in thrombosed vein at the
placental sites anaerobic streptococci localised in the pelvis pelvic thrombophlebitis EXTRA PELVIC SPREAD left renal vein
Phlegmasia alba dolens
inferior inferior left iliofemoral vena venacava cava renal vein vein Phlegmasia alba dolens
Pregnancy Puerperium In pregnancy In puerperium
compression of the thrombus
formation left common iliac vein against the pelvic rim by the enlarged uterus Pathophysiology Thrombus in deep veins
Drainage through superficial veins
not able to handle the blood supplied
No oxygenated blood
White appearance Next step Occlusion of superficial system
Prevents venous outflow
More swollen and painful (phlegmasia cerulea dolens)
Gangrene Phlegmasia alba dolens
Mild pyrexia Headache
Malaise Rising pulse rate
Leg will be swollen , painful white and cold
PROPHYLAXIS FOR THROMBOPHLEBITIS elastic Exercise and prevention compression ambulation stocking
Medical treatment analgesic Antibiotic Fibrinolytic agents like streptokinase Anticoagulants- • heparin (IV) 15000 U are 10, 000 U 4-6 hourly (4-6 injections). • Enoxaparin 40 mg daily • Warfarin *3 days(orally) Surgical treatment • Venous thrombectomy -massive illiofemoral vein thrombosis PULMONARY EMBOLISM deep vein thrombosis in the leg or in the pelvis
sudden collapse with acute chest pain
and air hunger
death Signs and symptoms
Tachypnea Dyspnea chest pain
Fever
Cough Tachycardia Haemoptysis
Diagnosis
Chest X ray E.C.G Aterial Blood gas -PO2> 85 mmHg Doppler ultrasound Pulmonary angiography Active management
Thrombolytic therapy- cardiac massage , Streptokinase oxygen therapy , loading dose of 600000 I.U intravenous heparin bolus continued with 5000IU 100000 IU per hour morphine 15 mg Digitalis for tachycardia PSYCHOLOGICALCOMPLICATIONS Review on psychological changes of puerperium Taking – in phase. Taking – hold phase. Letting – go phase. HIGH RISK FACTORS FOR POST PARTOM MENTAL ILLNESS
Past history : Psychiatric illness , puerperal
psychiatric illness Family history: Major psychiatric illness , Marital conflict Present Pregnancy:Caessarean delivery, Difficult labour , Neonatal complications Others :unmet Expectations PUERPERAL BLUES Maternity Blues Or Baby Blues Definition A transient state of mental illness 4-5 days after delivery last for few days Incidence 70-80% Causes
POST PARTUM DEPRESSION. hypothalamus-pituitary-adrenal axis gradual in onset4-6 months following delivery
Incidence 10-20 % of women Causes
Hormonal changes Physical changes
Stress. RISK FACTORS FOR POSTPARTUM DEPRESSION • a previous history of depression • medical complications • relationship difficulties • lack of support system • Single Marital Status • Low socioeconomic status • Unplanned/unwanted pregnancy • Cigarette smoking • Low self esteem • Childcare stress • Prenatal depression during pregnancy Clinical manifestations
loss of energy loss of appetite social withdrawal
irritability suicidal attitude
50 -100% recurrence in subsequent pregnancy.
Effect on baby Mother is unable to take care of herself and her child
Behavioral Delayed problems cognition
Depression
Social Emotional problems problems Treatment Medications
Antidepressants SSRIs – Zoloft (sertraline) – Paxil (paroxetine) – Celexa (citalopram) – Prozac (fluoxetine) Support Take care of herself -Adequate sleep -Find time to relax and to take rest -Nutritious diet -Get out in the sunshine - Excercise -good relationship POST PARTUM PSYCHOSIS Rare disorder Sudden onset within 4 days of delivery. In women with past history of psychosis or a positive family history Incidence 1 in 500 to 1000 mothers Clinical manifestation
fear restlessness confusion followed by hallucinations delusion disorientation Suicidal infanticidal impulses Management
• Psychiatric consultation • Compulsory admission • Chlorpromazine 150 mg stat 50-150 mg tid • Lithium manic depressive psychosis • Unresponsive case ECT • Sublingual oestradiol NURSING MANAGEMENT RESEARCH ARTICLE THANK U…………
