High Risk
Pregnancy
Care of a Woman with
Postpartum
Complications
Chari V.
Rivo
NUPC
110
2nd Semester 20232024
Postpartal
• Puerperium
Period
• Women are very susceptible to
postpartum complications like
hemorrhage, infections,
thrombophlebitis which can
result to personal injury,
impaired fertility or even death
Assessment
• Elevated temperature • Relaxed uterus
• Feeling of extreme
sadness or unreality
• Pallor
• Thready, rapid, weak
pulse
• Pain and swelling
• Decreased blood
pressure
• Uterine hemorrhage
• Abdominal pain
• Pain of symphysis
pubis on walking
• Perineal pain
• Lochia with foul odor
• Pain and tenderness in
calf or leg
Nursing Diagnosis
• Deficient fluid volume r/t blood • Social isolation r/t precautions
loss
necessary to protect infant and
others from infection
• Ineffective breastfeeding r/t
transmission
development of mastitis
• Risk for impaired parenting r/t • Ineffective peripheral tissue
perfusion r/t interference with
postpartum depression
circulation secondary to
• Risk for injury to self and
development of
newborn r/t postpartal
thrombophlebitis (blood clot)
psychosis
• Risk for infection r/t
• Acute pain r/t a collection of
microorganism invasion of
blood in traumatized tissue
episiotomy, surgical incision
(hematoma) secondary to birth
site, or migration of
trauma
Outcome Identification
and
Planning
• Provide measures that will restore the
woman most quickly to health
• Promote contact among her, her child,
and her primary support person
• Promote mother-infant attachment
Implementation
Interventions should include
instruction for both self-care
and child care.
Outcome
Evaluation
• Lochia is free of foul odor.
• Fundus remains firm and midline with progressive
descent.
• Patient maintains a urinary output greater than 30 ml/hr.
• Lochia discharge amount is 6 in. or less on a perineal
pad in 1 hour.
• Patient maintains vital signs and oxygen saturation
within defined normal limits.
• Patient identifies signs and symptoms that should be
reported.
• Patient demonstrates attachment behaviors with infant
Postpartum
Hemorrhages
• Bleeding is a major threat during pregnancy, labor and postpartum
period
• (Hge) One of the primary causes of maternal mortality assoc. with
childbearing
• (hge) defined as 500 ml or more following birth (Normal Delivery)
• Blood loss of 1000 ml in CS
• Four main reasons: four T’s
•
•
•
•
Tone
Trauma
Tissue
thrombin
Uterine Atony Postpartum
Hemorrhage
• Relaxation of the uterus; most frequent cause of postpartum
hemorrhage
• Conditions
increase the risk for• postpartal
• Multiplethat
gestation
High parityHge:
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•
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Polyhydramnios
Large baby
Presence of uterine myomas
Operative birth
Rapid birth
Placenta previa
Placenta accreta
Abruptio placenta
Labor induction/augmentation
(oxytocin)
•
•
•
•
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•
•
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Advanced maternal age
Previous uterine surgery
Prolonged and difficult labor
Chorioamnionitis or
endometritis
Anemia
History of PP Hge
Prolonged use og Mg So4 or
other tocolytics
Fetal death
DIC
Uterine Atony Postpartum
Hemorrhage
• THERAPEUTIC MANAGEMENT:
• Fundal massage
• Administration of oxytocin as prescribed (bolus r
dilute)
• Administration of carboprost, prostaglandin F2a
derivative, methergine as second possibilities (IM)
• Prostaglandin E1 analogue may also be given rectally
• PG may cause diarrhea and nausea – antiemetics may
be given
• These oxytoxics may cause high blood pressure –
Uterine Atony Postpartum
Hemorrhage
• THERAPEUTIC MANAGEMENT:
• Other Measures:
• Elevate the woman’s lower extremities to
improve circulation to essential organs.
• Offer a bedpan or assist the woman to the
bathroom at least every 4 hours to be certain
her bladder is emptying because a full bladder
predisposes a woman to uterine atony. To
reduce the possibility of bladder pressure,
insertion of a urinary catheter may be
prescribed.
Uterine Atony Postpartum
Hemorrhage
• THERAPEUTIC MANAGEMENT:
• Other Measures:
• Administer oxygen by face mask at a rate of
about 10 to 12 L/min if the woman is
experiencing respiratory distress from
decreasing blood volume. Position her supine
(flat) to allow adequate blood flow to her brain
and kidneys.
• Obtain vital signs frequently and assess them
for trends such as a continually decreasing
blood pressure with a continuously rising pulse
Lacerations Postpartum
Hemorrhage
• Tears of the birth canal – may occur in
the cervix, vagina, or perineum
• Large lacerations w/c may cause
infection or Hge can occur with:
• Difficult or precipitate birth
• In primigravidas
• Birth of a large infant (<9 lb)
• Use of forceps or vacuum extraction
Lacerations Postpartum
Hemorrhage
• CERVICAL LACERATIONS
• Usually found on the sides of the cervix, near the
branches of the uterine artery
• Blood loss may come from torn artery
• Management:
• Repair/suture
• Maintain a calm environment and assure mother of
NBs condition
• Regional anesthesia if laceration is extensive or
difficult to repair
• Explain the procedure to the patient
Lacerations Postpartum
Hemorrhage
• VAGINAL LACERATIONS
• Easier to locate than cervical lacerations,
but difficult to repair due to friable vaginal
tissue
• Management:
• Balloon tamponade
• Vaginal packing to maintain pressure on the suture line
•
Record time of placement and be certain to remove it 24-48 hr
after or before discharge
• IFC as vaginal packing may cause pressure on the urethra
Lacerations Postpartum
Hemorrhage
• CERVICAL LACERATIONS
• Usually found on the sides of the cervix, near the
branches of the uterine artery
• Blood loss may come from torn artery
• Management:
• Repair/suture
• Maintain a calm environment and assure mother of
NBs condition
• Regional anesthesia if laceration is extensive or
difficult to repair
• Explain the procedure to the patient
Lacerations Postpartum
Hemorrhage
• PERINEAL LACERATIONS
• Occurs more during lithotomy than supine
position
• 4 classifications:
• First degree laceration
• Second degree laceration
• Third degree laceration
• Fourth degree laceration
Lacerations Postpartum
Hemorrhage
• PERINEAL LACERATIONS
CLASSIFICATIO DESCRIPTION
N
First degree
Vaginal mucous membrane and skin of the
perineum to the fourchette
Second degree Vagina, perineal skin, fascia, levator ani muscle,
and perineal body
Third degree
Entire perineum, extending to reach the external
sphincter of the rectum
Fourth degree
Entire perineum, rectal sphincter, and some of the
Lacerations Postpartum
Hemorrhage
• PERINEAL LACERATIONS
• Management:
• Suturing
• Document degree of laceration
• High fluid diet and stool softeners in the
first week
• No enema or rectal suppository for 3rd and
4th degree
Retained Placental
Fragments
Postpartum
Hemorrhage
• Uterine bleeding occurs due to
fragments that keeps the uterus from
contracting fully
• Usually happens with succenturiate
placenta and placenta accreta
Retained Placental
Fragments
Postpartum Hemorrhage
• Assessment:
• large fragments may cause immediate bleeding
• Small fragments –bleeding may occur in PP day 6-10
• Uterus is not fully contracted
• Management:
• Removal of fragments –D&C
• Methotrexate if fragment cannot be removed
• Advise woman to observe color of lochia and report
unusual change (serosa to alba to rubra)
• Balloon occlusion
• hysterectomy
Uterine Inversion
Postpartum
Hemorrhage
• A prolapse of the
fundus of the uterus through
the cervix that the uterus turns inside out
• may occur if traction is applied to the umbilical
cord to remove the placenta or if pressure is
applied to the uterine fundus when the uterus
is not contracted
• Total Inversion – uterus protrudes in the
vaginaä
Uterine Inversion
Postpartum
Hemorrhage
• Assessment:
• Large amount of blood suddenly gushes
from the vagina
• Fundus is not palpable in the abdomen
• Woman may show signs of blood loss
• Hypotension
• Dizziness, paleness, diaphoresis
• Exsanguination may occur within 10
minutes
Uterine Inversion
Postpartum
Hemorrhage
• Assessment:
• NEVER ATTEMPT TO:
• Replace an inversion as it could increase
bleeding
• Remove placenta as it would create a
larger surface for bleeding
• Continue oxytocin as it makes the uterus
more tense and difficult to replace
Disseminated Intravascular
Coagulation Postpartum
Hemorrhage
• Deficiency in clotting ability caused by
vascular injury
• Fibrinogen level falls to below effective
limits
• Presence of extreme bleeding and so
many PLT and fibrin that rush to site
(bleeding) that that there is not enough left
in the rest of the body
• Associated with premature separation of
the placenta, missed miscarriage, or fetal
Disseminated Intravascular
Coagulation Postpartum
Hemorrhage
• Assessment:
• Easy bruising or bleeding from IV site
• Lab: PLT, prothrombin, thrombin time,
fibrinogen
Disseminated Intravascular
Coagulation Postpartum
Hemorrhage
• Management:
• To stop the process of DIC, stop the
underlying insult
• in pregnancy, birthing of the fetus and
placental delivery is part of the solution
• Heparin to halt clotting cascade (IV then
SQ)
• Blood/platelet/FFP/Cryoprecipitate
transfusion after heparin treatment
Disseminated Intravascular
Coagulation Postpartum
Hemorrhage
• Evaluation;
• Coagulation studies
• Check if anoxia has occurred, part. In
renal and brain cells
• Fetal and NB assessment – evaluate
efficiency of placental circulation
Subinvolution Postpartum
Hemorrhage
• Incomplete return of the uterus to its
prepregnant size and shape
• May result from small retained placental
fragment, mild endometritis or uterine
myoma
• Assessment:
• At 4-6 week PP, uterus is still enlarged and
soft
Subinvolution Postpartum
Hemorrhage
• Management:
• Methylergonovine, 0.2 mg q 6 (oral)
• Tender uterus – endometritis
• Oral antibiotics
• Educate about normal process/lochia
• May result to anemia and lack or energy
from chronic blood loss
• Seek early care
Perineal Hematomas
Postpartum
Hemorrhage
• Collection of blood in the subcutaneous
layer of tissue
• May occur after rapid spontaneous
birth and in women with perineal
varicosities
• Usually represent only minor bleeding
Subinvolution Postpartum
Hemorrhage
• Assessment:
• Severe pain in the perineal area
• Feeling of pressure between her legs
• Intact skin but with area of purplish
discoloration and swelling
• Can be 2cm to 8cm in diameter
• If tissue is drawn taut, it palpates as a firm
globe and feels tender
Perineal Hematoma
Postpartum
Hemorrhage
• Management:
• Report presence of hematoma
• Estimated size
• Degree of woman’s discomfort
• Mild analgesic
• Ice pack in a towel to prevent further bleeding
• Usually resolves in 3-4 days
• If size increases, incision and ligation of vessel
may be done
Perineal Hematoma
Postpartum
Hemorrhage
• Management:
• If episiotomy incision line is opened to
drain a hematoma, it should be left
open and packed with gauze to be
removed in 24 to 48 hours
Puerperal Infections
• Infection of the reproductive tract in the
postpartum period
• Also a major cause of maternal mortality
• May progress into peritonitis and septicemia
• Causes: Grp. B strep, staphylococci, E. coli
Puerperal Infections
• Risk Factors:
• Rupture of the membranes more than 24 hours before
birth
• Retained placental fragments within the uterus
• Postpartal hemorrhage
• Preexisting anemia
• Prolonged and difficult labor, particularly with
instrument births
• Internal fetal heart monitoring electrode
• Uterus explored after birth for a retained placenta or
abnormal bleeding site
Endometritis
• Infection of the endometrium
• Usually associated with chorioamnionitis and CS
• Can lead to tubal scarring - infertility
• Assessment:
Puerperal Infections
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Fever (3rd or 4th day)
Chills
Loss of appetite
General malaise
Uterus not well contracted and painful to touch
Dark brown and foul odor lochia
Endometritis
Puerperal
Infections
• UTZ to check for placental fragments
• Management:
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Vaginal fluid culture
Antibiotics: as determined by culture
Oxytoxic agents for uterine contraction
Increase fluid intake
Analgesics
Walking for lochia drainage
Use gloves when helping woman to change pads or linen;
handwashing
• Educate woman about S/S of endometritis upon discharge
Infection of the
Perineum Puerperal
•Infections
An episiotomy, suture line or laceration can be
a portal of entry for bacterial invasion (usually
local)
• Assessment:
• Pain, heat, feeling of pressure
• With or w/o fever
• Inflammation of the suture line, stitches may have
sloughed away and purulent drainage may be present
Infection of the
Perineum
Puerperal
• Management:
Infections
• Systemic or topical antibiotic
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Analgesic
Open sutures to allow drainage
Sitz bath, moist warm compress
Hubbard tank Tx – to hasten drainage and cleanse the area
Change perineal pads frequently
Wiping from front to back after urinating or bowel movement
Avoid placing the infant on the bottom bed sheet of the
woman’s bed
• Encourage ambulation
Peritonitis Puerperal
Infections
• infection of the peritoneal cavity, usually an
extension of endometritis
• one of the gravest complications of
childbearing and is a major cause of death
from puerperal infection
• Assessment
• rigid abdomen, abdominal pain, high fever, rapid
pulse, vomiting, and the appearance of being
acutely ill
Peritonitis Puerperal
Infections
• Management:
• Paralytic ileus – blockage of inflamed intestines
• NGT insertion
• IV or TPN
• Analgesics
• IV antibiotics
• Can cause infertility due to scarring
Thrombophlebitis
• inflammation with the formation of blood
clots
• Phlebitis – inflammation of the lining of a
vessel
• Classified as:
• SVD – superficial vein disease
• DVT – deep vein thrombosis
Thrombophlebitis
• Tends to occur during PP because;
• A woman’s fibrinogen level is still elevated
from pregnancy, leading to increased blood
clotting.
• Dilatation of lower extremity veins is still
present as a result of pressure of the fetal
head during pregnancy and birth so blood
circulation is sluggish.
Thrombophlebitis
• Tends to occur in women who;
• Are relatively inactive in labor and during the
early puerperium because this increases the risk
of blood clot formation
• Have spent prolonged time in a birthing room
with their legs positioned in stirrups
• Have preexistent obesity and a pregnancy
weight gain greater than the recommended
weight gain, which can lead to inactivity and lack
of exercise
Thrombophlebitis
• Tends to occur in women who;
• Have preexisting varicose veins
• Develop a postpartal infection
• Have a history of a previous thrombophlebitis
• Are older than age 35 years or have increased
parity
• Have a high incidence of thrombophlebitis in
their family
• Smoke cigarettes because nicotine causes
Femoral
Thrombophlebitis
• Femoral, saphenous, or popliteal veins are
Thrombophlebitis
involved
• Accompanying arterial spasm often
occurs, diminishing arterial circulation to
the leg
• Decreased circulation with edema – white
or drained appearance of the leg
• Formerly known as milk leg or phlegmasia
alba dolens (white inflammation)
Femoral
Thrombophlebitis
• Assessment:
Thrombophlebitis
• Pelvic thrombophlebitis
• Fever, chills, pain
• Redness, swelling, warmth, hard inflamed vessel
• Skin so stretched that it appears shiny and white
• Affected leg diameter (thigh/calf level) is
increased
• Homans sign
• Pain in the calf of the leg on dorsiflexion of the
Femoral
Thrombophlebitis
• Management:
Thrombophlebitis
• Early ambulation
• Use padded stirrups on examining tables
• Support stockings for first 2 weeks after birth
• Worn before getting up from bed
• Removed twice a day to assess skin
• Adequate fluid intake
• Do not sit with knees crossed
• Avoid constrictive clothing
• Quit smoking
Femoral
Thrombophlebitis
• Management:
• Anticoagulants – heparin (IV) or LMWH (SQ)
Thrombophlebitis
• blood coagulation study
• Heparin antidote; protamine sulfate
• Warfarin antidote: Vit K
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thrombolytics
Application of moist heat
Bed rest
Assess risk for pressure ulcer
Never massage the skin over the clotted area because
this could loosen the clot, causing a pulmonary or
cerebral embolism
Femoral
Thrombophlebitis
• Management:
Thrombophlebitis
• Heparin – continue BF
• Warfarin – discontinue BF
• monitor lochia
• Assess for signs bleeding:
• Bleeding gums
• Ecchymotic spots on the skin
• Oozing from episiotomy suture line
PelvicThrombophlebiti
• Involves
ovarian, uterine, or
s
Thrombophlebitis
hypogastric veins
• Occurs later than femoral
thrombophlebitis
• Inflammation may cause partial
obstruction leadint to slowed blood flow
and clots (stagnant blood)
• Prevention of endometritis helps
PelvicThrombophlebiti
s
Thrombophlebitis
• Assessment:
• High fever, chills, abdominal pain,
weakness, general malaise
• Severe infection necroses veins –
pelvic abscess
• Can become systemic – lung, kidney
or heart valve abscess
PelvicThrombophlebiti
s
Thrombophlebitis
• Management:
• Total bed rest
• Analgesics, antibiotics,
anticoagulants
• Abscess – USG to locate and
incision via laparotomy
PelvicThrombophlebiti
s
Thrombophlebitis
• Management: (Edx)
• Wear nonconstricting clothing in
lower extremities
• Rest w/ feet elevated
• Ambulate daily
• Inform OB about previous history
Pulmonary Embolus
Thrombophlebitis
• Obstruction of the pulmonary
artery by a blood clot
• Complication of
thrombophlebitis – blood clot
moves from leg vein to
pulmonary artery
Pulmonary Embolus
Thrombophlebitis
• Assessment:
• Sudden sharp chest pain
• Tachypnea
• Tachycardia
• Orthopnea
• cyanosis
Pulmonary Embolus
Thrombophlebitis
• Management:
• Oxygen administrations
• Strict monitoring - ICU
Mastitis
• Infection of the breast
• Organism enters the cracked and
fissured nipples, which comes from the
nasal-oral cavity of the infant –
epidemic mastitis/ epidemic breast
abscess
• Staph. Aureus or MRSA, or candidiasis
(hosp. acquired)
Mastitis
• Assessment:
• Unilateral or bilateral (epidemic mastitis)
• Painful, swollen, and reddened breast
• Fever
• Scant breastmilk
Mastitis
• Management:
• Antibiotics – dicloxacillin or
cephalosphorin
• Cold or ice compress/warm, wet
compress
• Good supportive bra
• I&D if with abscess, purulent drainage
Mastitis
• Management:
• To prevent nipples from cracking:
• Making certain the baby is positioned correctly and
grasps the nipple properly, including both the nipple and
areola
• Helping a baby release a grasp on the nipple before
removing the baby from the breast
• Washing hands between handling perineal pads and
touching breasts
• Exposing nipples to air for at least part of every day
• Possibly using a vitamin E ointment daily to soften
nipples
• Encouraging women to begin breastfeeding (when the
infant sucks most forcefully) on an unaffected nipple (if a
Urinary Retention
Urinary
System
Disorders
• Bladder is unable to empty completely
• Bladder sensation for voiding is decreased
due to bladder edema caused by pressure
of birth
• Compounded by prolonged labor, perineal
lacerations and use of epidural anesthesia
• Incomplete emptying causes overdistention
w/c may lead to permanent damage to
bladder tone – permanent incontinence
Urinary Retention
Urinary System Disorders
• Assessment
• Primary overdistention – doesn’t void at all
• With retention and overflow – woman voids
frequently in small amounts
• If first voiding is less than 100ml, suspect
urinary retention
• Residual urine is greater than 100 ml
Urinary Retention
Urinary System Disorders
• Management:
• Catheterization for residual urine
• bladder training
• Encourage voiding
• Analgesic for relaxation
• Reinsertion of catheter if woman is unable
to void 8 hrs after removal of IFC
UTI Urinary System Disorders
• Pushing with labor may have
allowed some secretions to enter
the urinary urethra
• Bacteria may be introduced during
catheterization
UTI Urinary System Disorders
• Assessment:
• Burning urination
• Hematuria
• Feeling of frequency or she always has to void
• Pain in voiding
• Resistance to voiding (due to pain) may cause
urinary stasis,
• Low grade fever
• Lower abdominal pain
UTI Urinary System Disorders
• Assessment:
• Clean-catch urine for analysis –
independent nursing action
UTI Urinary System Disorders
• Assessment:
• Clean-catch urine for analysis –
independent nursing action
• Make sure urine is not contaminated by
lochia – provide sterile cotton ball to tuck
in her vagina after perineal cleansing
• Mark the specimen “possibly contaminated by
lochia”
UTI Urinary System Disorders
• Management:
• Increase OFI – a glass per hour
• Analgesics - acetaminophen
• Sulfa drug are CI in BF – may
cause neonatal jaundice
• Broad-spectrum antibiotics
• Amox/ampicillin
Cardiovascular
System
Disorders
• Excess volume and pressure
changes can still be present
in the postpartal period
Postpartal
Preeclampsia
Cardiovascular
• Symptoms are the same with
System Disorders
Preec in pregnancy
• Rarely develops in this period
• Usually occurs due to retention
of placental material – usually
resolves after D & C
Cardiovascular
Disorders
•System
Management:
• Bed rest
• Quiet atmosphere
• Monitoring of VS and UO
• MgSO4 or antihypertensives
• Seizures may occur 6 to 24 hours after
birth
• If seizures occur more than 72 hrs after
birth, it may be unrelated to childbearing
Cardiovascular
Disorders
•System
Management:
• Bed rest
• Quiet atmosphere
• Monitoring of VS and UO
• MgSO4 or antihypertensives
• Seizures may occur 6 to 24 hours after
birth
• If seizures occur more than 72 hrs after
birth, it may be unrelated to childbearing
Reproductive System
Disorders
• Organs may be weakened or
displaced by pregnancy,
especially in grand multiparty
or those who had an
instrument birth
Reproductive Tract
Displacement Reproductive
Disorders
•System
Retroflexion,
anteflexion, retroversion,
and anteversion or prolapse of the
uterus
• Ligaments of the uterus are weakened
due to pregnancy
• Can interfere with childbearing and fertility
• May cause pain or lower abdominal
Reproductive Tract
Displacement Reproductive
System
Disorders
• Cystocele – outpouching of the
bladder into the vaginal wall due to
weakened vaginal walls
• Rectocele – outpouching of the
rectum into the vaginal wall
Reproductive Tract
Displacement Reproductive
Disorders
•System
Management:
• Surgery or repair if extensive
• Stress incontinence (involuntary voiding on
exertion)
• Kegel’s exercise to strengthen perineal
muscles
• Pelvic floor physical therapy
• botox
Separation of the
Symphysis Pubis
Reproductive
System
Disorders
• Due to relaxation of the joint and
tearing or stretching of ligaments
caused by large babies or abnormal
fetal positions
Separation of the
Symphysis Pubis
Reproductive System Disorders
• Assessment:
• Pain on turning or walking
• Legs tend to rotate externally – waddling
gait
• Defect over symphysis pubis can be
palpated
• Area is swollen and feels tender to touch
Separation of the
Symphysis Pubis
System Disorders
•Reproductive
Management:
• Bed rest
• Pelvic binder to immobilize joint, relieve pain
and allow healing
• 4-6 week for complete healing
• Avoid heavy lifting
• Have someone to help her with child care
• Maybe advised CS for future pregnancy
Emotional and
Psychological
•Complications
Depression may cause
impaired mother-infant
bonding
Postpartal Blues
• Baby Blues
• MC and least severe
• Occurs w/in 3-5 days after birth
• A normal, hormonally generated PP
occurrence
• Mothers who delivered prematurely
and those who have an infant in
NICU are at risk
Postpartal
•Depression
May be related to hormonal shifts
as pregnancy hormones decline
• Women notices immediate feelings
of sadness – postpartal blues
• More serious problem that may
continue beyond postpartum period
– postpartum depression
Postpartal
•Depression
Manifested by overwhelming sadness,
extreme fatigue, inability to stop crying,
increased anxiety about infant’s health,
insecurity, psychosomatic symptoms (N
& V, diarrhea), extreme mood
fluctuations
• Can occur in new mothers and fathers
• Can interfere with BF, childcare and
Postpartal
•Depression
Risk factors
• History of depression
• Troubled childhood
• Low self-esteem
• Stress in the home or at work
• Lack of effective support
• Different expectations between partners (e.g., if a
woman wants a child and her partner does not)
• Disappointment in the child (e.g., a boy instead of
a girl)
Postpartal
Depression
• Assessment: Tests
• Postpartum Depression Predictors
Inventory (PDPI)
• Postpartum Depression Screening
Scale (PDSS)
Postpartal
Depression
• Management:
• Selective Serotonin Reuptake
Inhibitors (SSRIs)
• Safe for BF
• E.g.
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
Postpartal Depression
• Nursing Interventions
• Teach pt about warning signs
• Encourage verbalization of feelings
• Help the woman understand that it’s normal to feel
sadness or a lack of enthusiasm about motherhood.
• Instruct the woman and her family that postpartum
depression can occur at any time after delivery.
• Advise the family of the warning signs of postpartum
depression. Inform them that it’s important not to ignore
even the subtlest of signs. Urge them to immediately
report these signs to the practitioner.
• Assist the woman in contacting a support group that can
help to alleviate her feelings of isolation
Postpartal Psychosis
• 1 woman in 500 are considered
psychiatrically ill a year after birth
• A response to the crisis of
childbearing
• Exists when a person has lost
contact with reality
Postpartal Psychosis
• Occurs 2-3 weeks after birth but can occur as
early as first or second day PP
• An emergency situation that requires immediate
intervention
• Causes: (predisposing factors)
• Changing hormone levels
• Lack of support system
• Low self-esteem
• Financial difficulties
• Major life changes
• History of mental illness
Postpartum Psychosis
• Assessment: Look for:
• feelings that her baby is dead or defective
• hallucinations that may include voices telling her to
harm the baby or herself
• severe agitation, irritability, or restlessness
• poor judgment and confusion
• feelings of worthlessness, guilt, isolation, or
overconcern with the baby’s health
• sleep disturbances
• euphoria, hyperactivity, or little concern for self or
infant
Postpartum Psychosis
• Assessment: Tests:
• PDSS
• Eating/sleeping disturbances
• Anxiety/insecurity
• Emotional liability
• Mental confusion
• Loss of self
• Guilt/shame
• Suicidal thoughts
Postpartal Psychosis
• Management:
• Do not leave the woman alone
• Do not leave her alone with infant
• Do not contradict her opinions, instead, refer
her to psychiatric counselor
• Immediate hospitalization
• Antipsychotics
• Antidepressants
• Suicidal precautions
• Involve the family in the treatment plan
Postpartal Psychosis
• Nursing Interventions:
• Include teaching about postpartum depression and
psychosis as part of the patient’s discharge teaching
plan.
• Instruct the woman and her family that postpartum
depression and psychosis can occur at any time
after delivery.
• Advise the family of the warning signs of postpartum
depression and psychosis. Inform them that it’s
important not to ignore even the subtlest of signs.
Urge them to immediately report these signs to the
practitioner
Women with Unique
Postpartal
Care
Needs
• The Woman Whose Child Is Born With an Illness or
a Physical Challenge
• Loss of self-esteem due to an imperfect child and also
see themselves as imperfect
• Woman responds with grief reaction thinking that the
image of a perfect child has died
• Parents should be shown their child moments after birth
so if a condition or problem exists, the newborn’s
condition, prognosis, and usual plans for care can be
immediately explained to them
Women with Unique
Postpartal
Care
Needs
• The Woman Whose Child Is Born With an
Illness or a Physical Challenge
• Encourage parents to care for their child so they
can touch, relate to, and “claim” the infant in as
nearly normal a manner as possible
• Open communication with parents and staff to
discuss feelings of fear
Women with Unique
Postpartal
Care
Needs
• The Woman Whose Newborn has
Died
• Show her the baby to help them begin
grieving
• Clean the baby and wrap in an infant
blanket
• Remain with them but give them time to
handle and inspect their child
• Prepare the forms needed for parents to