Postpartum Hemorrhage & Complications
What is the difference between early and late postpartum hemorrhage?
Early PPH = within 24 hrs of birth; Late PPH = after 24 hrs up to 12 weeks
Name one common cause of postpartum infection.
Examples: C-section, prolonged ROM, multiple vaginal exams, catheterization.
What medication is given to promote fetal lung maturity in preterm labor?
Betamethasone (corticosteroid)
What is the difference between caput succedaneum and cephalohematoma?
Caput succedaneum: crosses suture line, resolves in 3 days.
Cephalohematoma: does NOT cross suture line, lasts weeks–months.
What does a 5-minute APGAR score of 8 mean?
Score of 8 = newborn is adjusting well, only mild interventions (stimulation) needed.
Name two risk factors for postpartum hemorrhage
Examples: high parity, macrosomia, uterine atony, multiple gestation, prolonged labor, retained placenta.
What is a classic sign of postpartum infection?
Fever, chills, localized redness/swelling/tenderness, pain.
Name one tocolytic medication and its side effect.
Nifedipine → Tachycardia, Hypotension, Dizziness, Headache, Nervousness, Facial flushing, Fatigue, Nausea
Magnesium sulfate → CNS depression
Terbutaline → tachycardia, tremors, hypokalemia
Indomethacin → GI irritation
Name one type of heat loss in newborns and how to prevent it.
Convection → keep baby wrapped.
Conduction → warm blankets on cold surfaces.
Evaporation → dry baby quickly.
Radiation → avoid placing near cold windows.
When suctioning a newborn, which is suctioned first: mouth or nose?
Mouth first, then nose – prevents aspiration.
What is the most common cause of postpartum hemorrhage, and what is its hallmark assessment finding?
Uterine atony → soft, boggy fundus and excessive bleeding
List two risk factors for thromboembolism in postpartum women
Venous stasis, obesity, C-section, immobility, history of VTE, varicosities, age >35.
What is one risk factor for shoulder dystocia?
Risk factors: macrosomia, maternal diabetes, malposition, pelvic abnormalities, prolonged 2nd stage of labor.
Differentiate physiologic jaundice from pathologic jaundice.
Physiologic jaundice: after 24 hrs, common, resolves.
Pathologic jaundice: within 24 hrs, due to ABO incompatibility/hemolysis.
Name two teaching points for parents after circumcision.
Teaching: clean with warm water, apply petroleum jelly, do not remove yellow crust, no tub baths until healed, monitor for bleeding/fever/swelling.
Which uterotonic is contraindicated in patients with hypertension?
Methylergonovine (Methergine) – contraindicated with hypertension.
What are two clinical manifestations of thromboembolism?
Pain, warmth, redness, hardened/tender vein in leg.
What is the Bishop score used for?
Assesses readiness for induction (dilation, effacement, station, position, consistency).
What are two important nursing considerations during phototherapy?
During phototherapy → only diaper & eye mask, turn q2h, no lotions, check temp, monitor bili levels, encourage feeds.
What are two normal vital signs for a newborn?
Normal newborn VS:
Temp: 97.4–99.6°F
HR: 100–160 bpm
RR: 30–60 breaths/min
BP: 65–90/45–65 mmHg
A woman has a boggy fundus, tachycardia, and heavy bleeding. List two priority nursing actions.
Massage the fundus, administer uterotonics (oxytocin, misoprostol, etc.), notify provider, monitor VS, and prepare for fluids/blood if needed.
A postpartum patient presents with tachycardia, hypotension, and cool/clammy skin. What condition is this and why is it dangerous?
Hypovolemic shock – life-threatening because blood loss leads to poor perfusion and organ failure.
A baby is born through meconium-stained fluid. What should the nurse prepare for immediately?
Prepare for neonatal resuscitation – suction if obstructed, provide oxygen, prepare surfactant/ventilation.
Compare Transient Tachypnea of the Newborn (TTN) and Respiratory Distress Syndrome (RDS).
TTN: mild tachypnea, resolves <24 hrs, more common after C-section.
RDS: surfactant deficiency, requires O2/ventilation, worsens over time.
List three abnormal signs of newborn breathing that require intervention.
Abnormal breathing: apnea >20 sec, grunting, nasal flaring, retractions, tachypnea >60, bradypnea <30, central cyanosis, unequal breath sounds.