Chapter 10: Postpartum Complications & Nursing Care

Postpartum Complications & Nursing Care provides an in-depth examination of the nursing care and medical management required for women experiencing complications during the postpartum period, focusing on the four primary categories of adverse events: hemorrhage, thromboembolic disorders, infections, and mood disorders. The text begins with a comprehensive analysis of Postpartum Hemorrhage (PPH), utilizing the "Four Ts" mnemonic to categorize causes into Tone (uterine atony), Trauma (lacerations and hematomas), Tissue (retained placenta), and Thrombin (coagulopathies like DIC and von Willebrand disease). It elucidates the physiological progression of hypovolemic shock, emphasizing the critical role of the nurse in monitoring vital signs for tachycardia and hypotension, and outlines interventions ranging from fundal massage and bladder emptying to the administration of uterotonics like oxytocin, methylergonovine, and tranexamic acid. The summary explores late PPH causes such as subinvolution and the specific management of hematomas. Attention then shifts to thromboembolic disorders, explaining how the hypercoagulable state of pregnancy increases risks for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), while detailing preventive measures like early ambulation and treatments involving low-molecular-weight heparin or warfarin. The chapter further investigates puerperal infections, defining puerperal fever and breaking down specific conditions such as endometritis, urinary tract infections, and wound infections assessed using the REEDA method. Special emphasis is placed on mastitis, describing its pathophysiology and the importance of continued breastfeeding and antibiotic therapy. Finally, the text addresses Perinatal Mood Disorders (PMD), clearly distinguishing between the transient "baby blues" and serious clinical diagnoses including perinatal anxiety, depression, and the psychiatric emergency of perinatal psychosis, while advocating for routine screening with tools like the Edinburgh Postnatal Depression Scale to ensure maternal and infant safety.