1
2
Postpartum Complications
Outlines:
 Introduction.
 Immediate
Post
partum
complications.
1. Post partum Haemorrhage
"primary and secondary".
2. Purpural sepsis.
 Late
Post
partum
complications.
1. Thrombophelbitis.
2. Pulmonary embolism.
3. Urinary tract infection.
4. Mastitis.
5. Post
partum
depression (blue).
3
6. Post partum psychosis.
4
Post Partum Complications
General objective:
To prepare the graduate nurse
with knowledge, skills, and attitude
to provide proper nursing care for
women with abnormal puerperal
period.
Specific objectives:
By the end of this session, the
students will be able to:
5
 Introduce
postpartum
complications.
 Define postpartum hemorrhage
"PPHg".
 List predisposing factors for
PPHg.
 Identify clinical manifestations
of PPHg.
 Differentiate between types of
PPHg.
 Detect causes of each type of
PPHg.
 Detect high-risk groups for
PPHg.
 Explain the preventive measures
PPHg.
6
 Explain the medical management
for PPHg.
 Detect complication of PPHg.
 Define puerperal sepsis.
 Identify the causative organisms
of puerperal sepsis.
 Identify the predisposing factors
for puerperal sepsis.
 Detect high-risk groups for
puerperal sepsis.
 Describe clinical manifestations
of puerperal sepsis.
 Identify preventive measures of
puerperal sepsis.
 Discuss nursing intervention for
puerperal sepsis.
7
 Summarizes the topic of
immediate PP complications.
 Introduce the topic.
 Define thrombophlebitis.
 Identify
types
of
thrombophlebitis.
 Detect the high-risk groups for
thrombophlebitis.
 Describe clinical manifestations
of thrombophlebitis.
 Identify the preventive measures
of thrombophlebitis.
 Discuss nursing management of
thrombophlebitis.
 Explain medical management of
thrombophlebitis.
 Define pulmonary embolism.
8
 Detect causes of pulmonary
embolism.
 Describe clinical manifestation
of pulmonary embolism.
 Provide nursing care for
pulmonary embolism.
 Define mastitis.
 Detect causes of mastitis.
 Describe clinical manifestation
of mastitis.
 Provide nursing care for mastitis.
 Define urinary tract infection. &
its types.
 Describe clinical manifestation
urinary tract infection.
 Provide nursing care for urinary
tract infection.
9
 Introduce the topic
 Define postpartum psychosis.
 Detect causes of postpartum
psychosis.
 Describe clinical manifestation
of postpartum psychosis.
 Provide nursing care for
postpartum psychosis.
 Summarizes the topic of late PP
complications.
10
Postpartum Complications
 Introduction:
The postpartum period is a time
of increased physiological stress
and major psychological transition.
Energy depletion and fatigue of
late pregnancy and labour, soft
tissue trauma from delivery, and
blood loss increase the woman's
vulnerability to complications.
Most women recover from the
stresses
of
pregnancy
and
childbirth
without
significant
complications.
However,
postpartum complications can
occur. The potential seriousness of
11
many postpartum complications
cannot be underestimated. Among
these complications are postpartum
haemorrhage and puerperal sepsis,
which are the most common
causes of maternal morbidity and
mortality
during
postpartum
period.
Therefore,
prompt
diagnosis, treatment and provision
of
postpartum
nursing
management to minimize serious
sequel and reduce their effects on
the client’s ability to function are
essential.
 Immediate Post partum
complications.
12
Postpartum haemorrhage
In Egypt, postpartum haemorrhage
is the attributed cause for 32% of
all maternal deaths, and 46% of all
direct maternal death, ninety-nine
percent
of
all
postpartum
haemorrhage
deaths
were
avoidable.
 Definition:
It is defined as excessive loss of
blood more than 500 ml in the first
24 hr after delivery from the genital
tract at any time following baby’s
birth up to the end of puerperium.
13
 Types of Postpartum Haemorrhage:
1.
Primary
postpartum
haemorrhage, which occurs during
the first 24 hours after delivery.
2.
Secondary
postpartum
haemorrhage also may be delayed,
occurring more than 24 hours after
delivery. It can occur as long as 6
weeks after delivery.
 Predisposing Factors:
1. Previous history of P.P. Hg.
2. Advanced
maternal
age:
“Because muscles of uterus are
rigid so that is ineffective uterine
contractions”.
14
3. Multigravida:
“Successive
repeated
pregnancy
replaces
muscles fibers in the uterus
reducing its contractility. So blood
vessels become more difficult to
compress”.
4. Operative Deliveries: As forceps
extraction, ventouse, and CS.
5. Over distension of uterus: as
Hydraminos, large fetus and
multiple pregnancy.
6. Retained placenta: incomplete
delivery of placenta produce
bleeding because of this retained
segment receive blood Supply.
7. Heavy medication during labor
as syntcinon or general anesthesia
15
8. Maternal anemia: Anemia is
associated with debility which is a
more direct cause of uterine atony.
9. Pre- eclampsia & eclampsia: due
to hypertension.
10. Ketosis: for unknown causes
 Primary Postpartum Hemorrhage:
 Definition:
It is an abnormal loss of more than
500 ml of blood from genital tract
occurring during first 24 hours after
(delivery of fetus and affecting
general condition of mother.
16
Causes of Primary Postpartum
Haemorrhage:

1. Atonic uterus.
2. Trauma
"laceration
or
hematoma".
3. Hemorrhagic blood diseases.
1. Causes of Atonic uterus
1. General causes.
2. Local causes.
3. Nervous causes.
4. Idiopathic causes.
5. Hemorrhagic diseases.
 General Causes:
17
1. Anemia.
2. Multiparty: reducing uterus
contractility.
3. Prolonged Labor: Muscles of
uterus became exhausted during
1st & 2nd
stages of labor so,
Uterine
muscles
loose
its
contractility.
4. Excessive sedation and deep
anesthesia: Sedation & anesthesia
will depress high centers, which
stimulate uterine contractility.
 Local Causes:
1. Over-Distension of uterus by:
Hydraminos, multiple pregnancy
and big fetus. Myometrium
18
become excessively stretched and
less efficient during contraction.
2. Uterine-fibroid: This impact
efficient uterine action
3. Incomplete
placental
separation
with
retained
fragments: If placental tissues
remain partially embedded in the
spongy
decidua,
efficient
contraction and retraction is
interrupted retained fragments will
ooze blood so produce bleeding.
4. Presence of uterine scar: Scar
will stretch fibers and tissues of
uterus so it will limit its
movement.
5. Blood clots or piece of
membranes.
19
6. Rapid or precipitate labor:
When uterus has contracted
vigorously during 1st & 2nd stages
of labor muscle have insufficient
opportunity to retract.
7. Placenta Previa: Placental site
at lowers segment so the thinner
muscle layer contains few oblique
muscle fibres. This result in, poor
control of bleeding.
8. Abruptio-Placenta:
Blood
which oozed between muscle
fibres interfere with uterine action.
 Nervous causes:
Full Bladder or Rectum reflexes
inhibit uterine contractions.
 Idiopathic Causes:
20
Past
history
of
postpartum
haemorrhage or ante partum
haemorrhage.
 Haemorrhagic Blood
Diseases:
There are certain blood diseases,
which anticipate postpartum Hg:
(Leukaemia, Thrombocytopenia,
and Fibrinogenemia).
2. Causes of Trauma during labour:
1. Difficult or precipitate labour.
2. Birth of large baby.
3. Instrumental delivery.
4. Rupture uterus.
21
5. Inversion of uterus due to
"sudden pressure on uterus or
repeated massage with CS".
 Signs and symptoms of primary
postpartum haemorrhage:
I. General: As signs and symptoms
of hemorrhage:
 Tachycardia.
 Hypothermia.
 Pallor.
 Hypotension.
 Coldness.
 Thirsty.
 Restlessness.
 Irritability.
 Exhaustion and Lassitude.
22
II. Signs and symptoms indicated
from abdominal examination:
When the examiner palpate uterus
abdominally
 If the bleeding is concealed:
in uterus atony:
1. Uterus is boggy i.e. soft,
distended, no tone.
2. Gradually enlargement of
uterus.
3. Squeezing fundus will lead
to gush of blood.
 If the bleeding is revealed: in
Trauma
1. Uterus is subinvoluted
2. Uterus is hard, firm, and well
contracted
3. Uterus is large.
23
III Signs and symptoms indicated
from vaginal Examination:
 In case of Trauma.
1. Cervical
birth
canal
laceration or injury.
2. Bleeding will be bright red in
color.
3. Bleeding will be dark red in
retained fragments.
 Diagnostic Measures for primary
postpartum haemorrhage:
1. C.B.C. "Complete Blood Count".
2. Cross- matching & blood
grouping test.
3. RH- factor test.
24
 Nursing Management of Primary
Postpartum Haemorrhage :
 Preventive measures
During ante partum period:
1. Complete history should be
taken to identify high-risk patients
who are likely to develop PPH.
2. Improvement of health status
specially to raise the hemoglobin
level.
3. Hospital delivery of high-risk
patients who are likely to develop
PPH.
e.g.
polyhydraminios,
multiple
pregnancy,
grand
multiparous, APH and severe
anemia.
25
4. Routine blood grouping and
typing for immediate management
during emergency.
5. woman who has hemorrhagic
blood diseases should give
antifibrinolytic factors.
 During Intrapartum period:
1.
P
roper management during labor
including:

P
roper assessment.

C
areful observation for
mother and baby.

A
void misuse if oxytocin.
26

A
void bearing down in 1
stage.
st

E
mpty bladder every one
hour.

U
nhurried in delivery of
placenta.

P
revention of tear by careful
episiotomy
–
support
perineum – maintains
flexion.

A
ssessment for amount of
bleeding.
27
2.
C
areful administration of sedatives
and analgesic drugs.
3.
P
rophylactic administration of
oxytocic drugs with delivery of
anterior shoulder or at the end of
third stage.
4.
A
void massaging the uterus before
separation of the placenta.
5.
E
xamine
the
placenta
and
membranes for completeness.
6.
E
xamine the utero-vaginal canal for
trauma and prompt repair if
present.
28
7.
E
ffective management of the fourth
stage of labor.
8.
N
o forceps or breech delivery
before fully dilatation of the
cervix.
 Curative measures
 Control bleeding through the
following steps:
1. Uterine massage.
2. Exploration of uterus under
general anesthesia.
3. Bimanual compression (Uterus
is firmly squeezed between 2
hands).
29
4. Tight intrauterine packing to
exert direct homeostatic pressure
on the open uterine sinuses and
to stimulate uterine contractions.
5. If all the above measures fail to
achieve
homeostasis
a
hysterectomy is performed.
6. In traumatic PPH speculum,
examination to find out trauma
and homeostasis is achieved by
appropriate sutures.
 Observation of the Mother:
1. Record pulse and BP every 15
minutes.
2. Palpate uterus every 15 minutes
to ensure that it is well contracted.
30
3. Check temperature 4 hourly.
4. Examine lochia for amount and
consistency.
5. Examine IV infusion.
6. Intake and output chart.
7. Relieve anxiety by explaining
her condition and administer
prophylactic antibiotics prescribed
considering the risk for infection.
 Secondary postpartum Hemorrhage:
 Definition:
It is bleeding which is occur after
the first 24 hours of delivery and up
to the end of puerperium.
31
Causes of secondary Postpartum
Haemorrhage:
1. Retained
products
of
conception as:
 Placental fragments.
 Accessory lobe.
 Placental polyp.
 Retained piece of membranes.
 Blood cots.
2. Infection: It is due to
separation of septic through
site of bleeding:
 Placental site.
 Caesarian wound.
 Cervix.
32
3.
4.
5.
6.
Subinvolution of uterus.
Choriocarcianoma.
Inversion of Uterus
Local gynaecological lesions
as:
 Cervical erosion
 carcinoma in Cervix
7. Haemorrhagic blood diseases
as:
 Leukemia
 Thrombocytopenia.
 Signs and symptoms of secondary
Postpartum Haemorrhage:
 General: Tachycardia and Low
grade fever.
33
 Abdominal
examination:
Subinvolution of uterus.
 Vaginal examination: Lochia
heavier in amount, fresh in color
& offensive in odor. If infection
occurs retained placenta may
present.
 Nursing Management for secondary
Postpartum Haemorrhage:
 Call the Doctor.
 Massage fundus if it is still
palpable.
 Express any clots.
 Encourage mother to empty her
bladder.
34
 Give an oxytocin drug as
Ergometrine I.V or I.M route.
 Keep all pieces & lines to assess
volume of blood loss.
 In case of retained products of
conception, the patient is given
Ergometrine & antibiotic if the
bleeding is slight. The products
are examined histological to
exclude Choriocarcianoma.

Complications of postpartum
hemorrhage:
1. Postpartum shock.
2. Sheehan’s syndrome.
Postpartum Shock
Definition:
Shock is a state of circulatory
35
impairment in which the circulating
blood is less than what is needed
for the normal cellular function and
metabolism.
Types of shock:
I-Hypovolemic shock: It is due to
post partum hemorrhage.
2-Nurogenic shock: May result
from various causes especially
trauma and tissue damage as:
Rupture of the uterus, cervical
tears, acute inversion of the uterus.
3-Idiopathic Obstetric Shock:
This is shock developing without
evident
cause.
e.g.:
after
spontaneous labor or easy forceps.
36
In the cases of rupture uterus,
incomplete inversion of the uterus,
amniotic fluid embolism or
pulmonary embolism.
4-Septic shock: Mortality rate
from septic shocks about 50%. The
mainly cause endotoxin pathologic
gram-negative organisms. It occurs
also in case of (Gram +ve bacilli)
5-Other causes of shock: Shock
associated
with
Disseminated
Intravascular Coagulation "DIC"
and Anaphylactic shock.
Predisposing factors:
 Anaemia and malnutrition.
 Ante- postpartum haemorrhage.
37
 Prolonged
labor
with
dehydration and acidosis.
 Hypertensive status (Toxemia)
of pregnancy.
Clinical picture of shock:









Hypotension.
Rapid weak pulse.
Cyanosis of the fingers.
Dimness of vision.
Oliguria or anuria.
Tachycardia.
Pallor.
Cold sweat.
Mental confusion.
38
Complications of shock:
 Anuria.
 Postpartum anterior pituitary
necrosis (Sheehan's Syndrome)
 Death.
39
Management of shock:
1 -Put her in Trendlinberg
positions.
2-Applying two lines for I.V fluids
and blood transfusion.
3-Maintain warmth.
4-Provide oxygen inhalation.
5-Monitor vital signs.
6-Morphine
7-Antibiotics as order.
Sheehan’s Syndrome
Definition:
It is past delivery anterior pituitary
necrosis follows hypovolemic
shock and DIC.
40
Incidence:
In 15% of women who survive,
severe
hypovolemic
shock
associated
with
postpartum
hemorrhage.
Signs and Symptom of Sheehan’s
syndrome:
1 - Failure of the mother to lactate.
2- Decrease in breast size.
3- Loss of axillary and pubic hair.
4-Genital atrophy.
5-Amenorrhea.
6- Apathetic and easily suffer
fatigue.
41
Treatment of Sheehan’s syndrome:
 Thyroid hormone.
 Cortisone.
 Estrogen replacement.
 Puerperal sepsis
 Introduction:
Puerperal sepsis is one of the most
common causes of maternal
morbidity and mortality during the
postpartum period. In Egypt, it is
the third leading cause of death
associated with child bearing.
Puerperal sepsis is the attributes
cause of 12 % of all direct obstetric
deaths and 8 % of all maternal
deaths.
42
Definition:
It is an infection of the genital tract
that occurs at any time between the
onset of rupture of the membranes
or labor and the 40 day following
delivery or abortion.
Common micro- organisms that cause
postpartum genital tract infections:
 Aerobes
gram
positive:
Streptococcus,
group
B
streptococci, alpha hemolytic (A)
and staphylococcus.
 Anaerobes gram positive:
Peptococcus and clostridum.
43
 Micro organism that can
transmitted through sexual
contact include: Chlamydia
trachomatis,
Neisseria
gonorrheae, and Mycoplasma
hominis.
Predisposing factors for developing
postpartum infections:
I. General Risk Factors:
1. Anemia.
2. Poor nutrition.
3. Lack of prenatal care.
4. Obesity.
5. Low socioeconomic status.
44
6. Sexual intercourse after rupture
of membranes.
7. Immunosuppression.
II. Lobar Management:
1. Prolonged labor.
2. Prolonged
rupture
of
membranes.
3. Chorioamninitis.
4. Intrauterine fetal monitoring.
5. Number of examinations during
labor.
6. Hemorrhage.
7. Retained placental fragment.
8. Intrauterine manipulation.
9. Infection control practice during
different stage of labor.
45
III. Factors Related to Operative
delivery:
1.
2.
3.
4.
5.
6.
7.
Cesarean delivery.
General anesthesia.
Urgency of operation.
Breaks in operative technique.
Manual placental removal.
Forceps delivery, Episiotomy.
Lacerations.
Signs and Symptoms of puerperal
sepsis:
 Specific: elevation of body
temperature
to
38.5
C
persisting for two consecutive
46
days within the first 6 weeks
postpartum.
 Abdominal:
1. Pelvic and / or suprapubic
pain.
2. Subinvolution.
 Vaginal: Foul smelling colored
lochia.
 General symptoms: malaise
Fatigue,
tachycardia,
and
abdominal
distension,
meteorism: reflex paralysis of
Aurbach's plexus of nerves in
colon and intestine.
Diagnostic measures for puerperal
sepsis:
47
• Blood cultures.
• Uterine and / or high cervical
cultures.
• CBC (complete blood count).
• Fasting Blood Sugar.
• Urine Analysis.
Nursing management of Puerperal
Sepsis
 Preventive Measures:
 During antepartum care:
 Eliminate septic focus located
in teeth, gums, tonsils, middle
ear or skin.
48
 Correct anemia and prevent
pregnancy-induced
hypertension.
 Avoid contact with persons
having communicable diseases.
 Maintain
good
personal
hygiene.
 Early detection of high risk
group.
 Hospital delivery of high risk
group.
 Improve standards of maternity
services.
 Follow up and health education.
 During intrapartum care:
 Proper
admission.
assessment
on
49
 Close observation for labor
progress.
 Follow strict asepsis during
conduct of labor.
 Isolate women with infection.
 Minimize vaginal examinations.
 Preserve membranes as long as
possible.
 Unhurried
in
placental
expulsion.
 Inspection of placenta &
membranes.
 Proper inspection of genital
tract after delivery for any
laceration & repair it promptly.
 Replace excess blood loss to
improve general body resistance.
50
 Prophylactic
antibiotics
in
premature rupture of membranes.
 Prolonged labor and operative
delivery.
 During postpartum care:
 Follow strict aseptic technique
while caring for perineal
wound.
 Avoid too many visitors.
 Frequent changing of sanitary
pads.
 Swab vulva and perineum using
antiseptic solution after each
voiding or defecation.
 Maintain proper environmental
sanitation.
51
Nursing Intervention:
 Assess vital signs every 2-4
hours.
 Obtain blood sample for
cultures, CBC, blood glucose
levels. And send it to the lab.
 Collect urine and send it to the
laboratory for analysis.
 Interpret the result findings.
 Evaluate pain and lochia.
 Administer IV antibiotics,
fluids, and analgesics as
prescribed.
 Prepare
woman
for
ultrasonography for detection
of any intrauterine contents.
52
 Provide routine postpartum
care. Use meticulous handwashing techniques.
 Provide warm baths and
compresses or heat lamp.
 Provide
reassurance
and
support. Isolate woman as
indicated.
53

Late
Post
partum
complications.
 Thrombophlebitis:
Definition:
It is an infection of the vascular
endothelium with clot formation
attached to the vessel wall.
Types of thrombophlebitis:
 Pelvic Thrombophlebitis: An inflammatory process involving
the ovarian and uterine veins.
54
 Femoral Thrombophlebitis:In with femoral, popliteal or the
saphenous vein is involved.
Femoral Thrombophlebitis:
It has many signs and symptoms
as:
1. Pain.
2. Fever.
3. Swelling in the affected leg.
4. These symptoms are due to the
formation of a clot in the veins of
the leg itself.
5. Malaise.
6. Chilliness.
55
7. Stiffness and pain in the affected
part.
Treatment:
1. Rest
2. Elevation of the affected leg.
3. Analgesics for relieving of
pain.
4. Anticoagulants such as
heparin.
5. Antimicrobial drugs in cases
where
more
generalized
infection is known or suspected.
6. Heat or ice bags may be used
along the course of the affected
vessels.
56
* Surgical treatment: it is
indicated in some severe cases. It
consist of incision of affected
vessel removal of clot and repair'
the vessel.
Pelvic Thrombophlebitis: Signs and symptoms:1-Rise in temp.
2-Chills.
3-Physiological and emotional
change.
4-Breast feeding have been
interrupted.
5-Patients are depressed.
6-The affected area is painful,
57
reddeners and edematous and the
source of profuse discharge.
7-Malaise.
8-Headache.
9-General discomfort.
 Treatment:
1-Antimicrobial therapy.
2-Heparin is given to prevent more
formation of thrombi.
3-Blood transfusion may be given.
Pulmonary Embolism
Definition:
58
It is the thrombus or embolus
occludes pulmonary, It obstructs
the passage of blood into the lungs.
Causes:
It is due to the detachment of the
small part of a thrombus. Which is
washed along the blood until it
becomes lodged in the right side of
the heart.
Signs and Symptoms of
embolism:
pulmonary
 Sudden in tense pain in the
chest.
 Dyspnea.
59





Syncope.
Pallor.
Irregular pulse.
Cyanosis in some cases.
Death may occur.
Management:
60
 Preventing the accident.
 Early ambulating following
delivery.
 O2 is administered without
delay.
 Anticoagulants are given.
 Morphine is given to relieve
pain.
During hospitalization:  The pt must be kept warm and
comfort.
 The pt must be free from worry.
 Give the pt light nourishing diet
during early convalescence.
 Urinary Tract Infection
Definition:
61
It is inflammation of urinary
system.
Incidence:
5% of postpartum patient’s.
Management:
1.Observation in early postpartum
period the over distension and
draining the residual urine by
catheter.
2. Urine culture.
3. Give the antibiotics according
to the organism.
62
4.
Antimicrobial
ampicillin.
drug
as
Mastitis
Definition:
It is inflammation of the breast,
may vary from a "'simple
inflammation of the tissues around
the nipple to abscess formation in
the glandular tissue.
Etiology:
It is usually caused by hemolytic
streptococcus
organisms.
The
disease is proceeded by fissures or
63
erosions of the nipple or areola.
Signs and symptoms of mastitis:
1. Warm.
2. Hardened.
3. Tender.
4. Chills.
5. Fever.
6. Painful acute pain in the breast.
7. Redness
Management of mastitis:
 Prophylactic measures must by
learn the mother special care of
her breasts during latter months
of pregnancy.
64
 After delivery, appropriate
breast care continues to prevent
the development of lesions.
 If the mother complains of sore,
tender nipples they should be
inspected immediately.
 Early treatment by antibiotics.
 The breast should be well
supported with a firm breast
binder or well-fitted brassiere.
 Heat application to hasten the
localization of the abscess.
Discontinued B. F immediately.
Remove the pus when abscess
formation occurs by respirate it.
 After evacuation of pus a gauze
drain is inserted.
Postnatal Blue "Depression"
65
Definition:
It is reactive illness. Onset tends to
be gradual developing after the
second postnatal week. So the
patient in need for support in
subsequent pregnancies.
 Incidence:
1: 10 mother. The condition last for
3-6 months. In some cases persists
throughout the first year of the
baby life & affects the baby's
performance in developmental
tests.
Causes:
66
1- In woman who has experienced
other stress inducing life events e.g.
moving
house,
bereavement,
relationship disharmony, low selfesteem, lack of support.
2- Dramatic falls in estrogen &
progesterone lead to maternal blues
that exaggerated to depression.
Clinical picture:
 Over anxious about her baby.
 Irritable
 Difficulty falling a sleep or
sleep for a long period
67
 The woman feel well in the
morning but deteriorate as the day
goes on.
 Tired & unable to cope with the
needs of her baby.
 She feels a failure as a mother.
Prevention:
1. Progesterone prevents recurrence
of postnatal depression 100 mg
daily until 7 days following
delivery.
2- If the woman believes strongly
enough that a particular remedy is
likely to prevent her from
developing depression.
68
Nursing
Treatment:
Management
and
I- Early detection & initiation of
treatment.
2- Report the doctor if there are
signs of depression.
3-Mild sedation or antidepressant.
4- Initiation of counseling.
5- Involvement of partner & other
close family member.
6- Mother support by health care
team.
7- Put the mothers with the same
diagnosis in contact with each
other.
8- Woman with disabilities may
require additional emotional &
69
practical support.
9- Admission in psychiatric
hospital.
10-Usage of family planning
method & early alleviation of
symptoms in any subsequent
pregnancy.
Puerperal Psychosis
Definition:
It is Psychotic illness occur during
puerperium with rapid onset within
the few days of delivery and rarely
beyond the first 2-3 weeks.
70
Incidence:
Relatively low incidence 1:450 it is
more common in primigravida.
Clinical Picture:
 At first ask for help or state how
she feels to someone.
 She may experience other
thoughts & feelings like suicidal
impulses or desire to harm her
baby.
 This illness may be acute onset
or develops more gradually.
 A woman may be emotionally
normal at first & there is a feeling
of guilt & anxiety.
71
 Degree of euphoria.
 Hyperactivity.
 Restlessness.
 Inability to sleep.
 Insomnia unassociated with
disturbance by her baby.
 Bizarre behavior.
 Delusions and hallucination.
 Temporarily detachment from
the reality.
 She may appear depressed or
weepy.
Nursing Management:
1- Keep the patient under
constant observation by midwife
72
or other health professional until
help obtained.
2- Refers the patient to a
psychiatric
hospital
for
admission.
Advantages of admission:
* Reestablishment of the maternal infant relationship. To rebuilds
self-esteem by encouraging care of
the baby with in a safe
environment.
3. If the appropriate psychiatric
referral isn't be made the midwife
must contact a supervisor.
4. Remember the sooner the
woman receives correct psychiatric
assistance the sooner the woman
will recover.
73
5. Heavy sedation at the time of
onset.
6- Give anti psychotic like lithium
&
electro-convulsive
therapy
pharmacological treatment varies
according to the presenting
symptoms & should be managed
under the care of the psychiatric
team.
7- The midwife should continue to
visit both mother & baby for
postnatal care.
8Family
support
needs
consideration.
9- After recovery it is possible that
further episodes of illness may
occur & recurrence in subsequent
74
pregnancies so the patient in need
for support in sequent pregnancies.
References
1.
Burroughs,
A.
(1999):
Maternity Nursing, 7th ed, W.B
Saunders Company
PP 340,
348, 477-489, 279, 298.
2. Corrie, M and Mackinney , E.
(2000): Foundations of Maternal
Nursing 2nd ed W.B Saunders
Company, PP 426-480, 782-806
, 581-607.
3. Daler, D (2003): Fundamental
of
Gynaecology
and
Obstetrics
2nd
ed
J.B
75
Lippincott Co., USA., P597607
4. Sharon, J.(2003): Maternity
NG, 15th ed .J.B Lippincott
Co., London, P.(515-546)
76
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