Welcome to a discussion of postpartum complications.
Today, we're going to review 11 of the most common complications
that the nurse might note postpartum.
Those complications are subinvolution, uterine inversion, secondary postpartum hemorrhage,
mastitis, urinary retention, urinary tract infection, postpartum depression,
amniotic fluid embolism, deep vein thrombosis, hematoma and finally episiotomy dehiscence.
Are you ready for all of that? Well, ready or not, here we go.
The first complication we'll talk about is subinvolution.
Subinvolution is a condition in which the uterus remains enlarged during the postpartum period.
If you remember during our postpartum assessment lecture,
we talked about that fact that the uterus will go down about a finger's breadth every day.
In subinvolution, this doesn't happen.
So what are the clinical features?
The first one is heavy, prolonged bleeding.
So when we ask about soaking through a pad an hour, this is when that might actually occur.
The uterus will not feel like that wonderful, firm tennis ball.
It will feel what we call, boggy, and boggy mean it's soft.
And, finally, that irregular descent of the uterus is the hallmark sign,
so not going down a finger breadth every day.
Thinking about the fact that after two weeks,
the uterus should be completely down inside the pelvis.
If it's not, that's subinvolution.
What are the risk factors for developing subinvolution?
Well, one, is infection.
If the uterus becomes infected because of chorioamnionitis or endometritis after delivery,
then that infection actually will impede the descent of the uterus.
Another thing that will make it very difficult for the uterus to contract
is if there are elements of the pregnancy still left inside,
so retained placental fragment, will also cause subinvolution.
How do we diagnose subinvolution?
We'll we talked about it already, so I'm going to remind you.
We want to measure the descent of the uterus
and it should go down by one finger breadth every day, so if it's not, that's subinvolution.
We also may find that the uterus is extremely tender,
so the uterus has been working really hard to try to contract
and get back to a nonpregnant state, but something is stopping that process,
so it may feel uncomfortable.
Also, if infection is the reason why the subinvolution is occurring,
that will also make it very tender.
So when we say abnormal, what we're specifically meaning is that there's more of it
than it should be, or if the lochia is infected it might have an unusual odor or consistency.
Thinking of what the nurse needs to do for patients experiencing subinvolution.
First of all, because of the possibility of a hemorrhage,
monitoring the uterus and the bleeding is going to be important.
Does it feel boggy? Are we getting lots of lochia when we massage the fundus?
We want to notify the provider, because if it's an infection or the bleeding is excessive,
we may need an order in order to move to the next step.
We want to encourage breastfeeding.
So, every time the fetus and the baby actually suckles the breasts,
then what happens is oxytocin is released.
So, if you remember, oxytocin is something we can give to stimulate contractions.
The body already has it, already inside.
So if the baby suckles, we'll get more oxytocin which will cause uterine stimulation.
We want to encourage frequent urination,
and this actually helps the uterus to have enough space to contract.
A very full, distended uterus will make uterine contractions very difficult.
There may be medications that are ordered to help the uterus contract,
such as oxytocin, and we want to make sure those were administered as schedule.
Sometimes, none of these tactics works
and especially in the case of retained placental fragments,
it's going to be necessary for the provider to actually go in the uterus
and remove those retained parts.
A procedure known as a dilatation and curettage may be done in order to accomplish that.