Nursing Care of Women With Complications After Birth

The postpartum period, also known as the puerperium, starts after delivery of the fetus and the placenta, and it extends through the first six weeks after birth.

Complications can arise during this period, including hemorrhage, venous thromboembolism, and infection. As the nurse, you’ll collaborate with the registered nurse, or RN, to provide care for your patient experiencing postpartum complications.

Postpartum hemorrhage is a significant loss of blood after giving birth and is an obstetric emergency. It’s generally defined as losing more than 500 milliliters of blood after a vaginal delivery or more than 1000 milliliters after a cesarean birth.

It can also be defined as blood loss accompanied by clinical manifestations of hypovolemia within 24 hours of delivery, which may include tachycardia, tachypnea, hypotension, or palpitations.

If left untreated, postpartum hemorrhage can result in hypovolemic shock and even death. Common causes of postpartum hemorrhage include uterine atony, or lack of uterine muscle tone; lacerations, or tears in the perineum; hematomas, which are a collection of blood in the tissues resulting from birth trauma; and retained placental fragments, or pieces of the placenta left inside the uterus after delivery of the fetus.

Now, when caring for your patient during the postpartum period, you’ll monitor closely for clinical manifestations of postpartum hemorrhage.

If you note heavy bleeding, numerous large clots or consistent blood flow that saturates a perineal pad within 15 minutes, especially if you note changes in vital signs that are consistent with loss of circulating volume, notify the RN immediately.

Next, palpate your patient’s uterus, and if it’s boggy, massage it until it becomes firm. Also, replace lost volume by infusing the ordered IV crystalloid solution; place a urinary catheter to track urine output; and draw blood to monitor your patient’s CBC.

You’ll also assist the RN by gathering medications, such as oxytocin or methergine, and obtaining blood products, as ordered.

Then, continue to take your patient’s vital signs frequently, per your facility’s protocol. You’ll also check your patient’s perineum for the presence of a hematoma, which could manifest as swelling and pain in the vaginal and perineal area.

If present, apply ice packs and administer the ordered analgesics. Continue to monitor your patient closely for signs of a concealed hematoma such as a feeling of perineal or vaginal pressure or severe pain that isn’t relieved by analgesics.

If your patient has these symptoms, notify the RN immediately. Next, venous thromboembolism, or VTE, includes deep vein thrombosis, or DVT, which is a clot in a large, deep vein; and pulmonary embolism, or PE, which is when a clot travels to the pulmonary vasculature, usually from a DVT.

During the postpartum period, VTE risk is increased because hypercoagulability is increased, meaning the blood is more likely to form clots, due to clotting factors that normally increase in preparation for blood loss during delivery.

Other risk factors include venous stasis, which occurs due to compression of blood vessels by the enlarged uterus and positioning during delivery; and endothelial injury, or injury to inner lining of blood vessels, which occurs if the vessels are damaged during a cesarean delivery or with use of birth-related procedures.

While caring for your postpartum patient, monitor them closely for signs of DVT, like unilateral pain, swelling, warmth, or redness, most often in a lower extremity like the calf.

Sometimes a positive Homans’ sign, which is pain when the foot is dorsiflexed, will be present. For patients with a DVT, elevate the affected extremity, apply heat to the area to promote blood flow, and administer the ordered anticoagulants.

Also monitor closely for manifestations of PE, such as chest pain, tachycardia, shortness of breath, and hemoptysis, or coughing up blood.

If you note these signs and symptoms, apply oxygen per protocol, and immediately notify the RN. Lastly, postpartum infections most often occur in the genitourinary tract or surgical wounds.

When caring for your postpartum patient, take steps to prevent infection by practicing scrupulous hand hygiene. Use the REEDA criteria to observe your patient’s perineal area or any incisions, for redness, edema, ecchymosis, discharge, and approximation.

Also monitor for clinical manifestations of infection including an oral temperature of 101.4° F or 38° C, or higher. Notify the RN if your findings are consistent with a postpartum infection; and obtain wound cultures, draw blood to monitor their WBC count, and administer the ordered antimicrobials.

Alright, as a quick recap...The postpartum period, also known as the puerperium, starts after delivery of the fetus and placenta, and it extends through the first six weeks after birth.

Complications can arise during this period, including hemorrhage, venous thromboembolism, and infection. As the nurse, you’ll collaborate with the registered nurse, or RN, to provide care for your patient experiencing postpartum