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Perinatal Loss | 마이메르시 MyMerci
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Perinatal Loss

NCLEX Review Guide: Maternal Newborn Health - Postpartum Complications & Perinatal Loss

Postpartum Hemorrhage (PPH)

Primary vs Secondary PPH

  • Primary PPH: Blood loss >500mL vaginal delivery or >1000mL cesarean within 24 hours postpartum
  • Secondary PPH: Excessive bleeding 24 hours to 12 weeks postpartum, often due to retained placental fragments
  • Most common cause is uterine atony (90% of cases) - fundus feels soft and boggy

Memory Aid: "4 T's" of PPH

  • Tone - Uterine atony (most common)
  • Tissue - Retained placental fragments
  • Trauma - Lacerations, hematomas
  • Thrombin - Coagulation disorders
  1. Assess fundal height and firmness every 15 minutes initially
  2. Massage boggy fundus until firm
  3. Empty bladder (full bladder prevents uterine contraction)
  4. Administer oxytocin as ordered
  5. Monitor vital signs for shock

Key Points

  • Fundus should be firm, at umbilicus level immediately postpartum
  • Early signs: increased pulse, decreased BP, restlessness
  • Late sign: decreased urine output indicates hypovolemic shock

Postpartum Infections

Endometritis & Wound Infections

  • Endometritis: Infection of uterine lining, most common postpartum infection
  • Risk factors include cesarean delivery, prolonged labor, prolonged rupture of membranes
  • Temperature >100.4°F (38°C) on two occasions 6+ hours apart after first 24 hours
  • Classic triad: fever, uterine tenderness, foul-smelling lochia

Clinical Scenario

Client reports severe abdominal pain, fever 101.2°F, and foul-smelling lochia 3 days post-cesarean. Fundus is tender to palpation. Priority nursing action: Obtain cultures and prepare for antibiotic therapy.

Key Points

  • Broad-spectrum antibiotics are first-line treatment
  • Monitor for signs of sepsis: hypotension, tachycardia, altered mental status

Perinatal Loss & Grief Support

Types of Perinatal Loss

  • Stillbirth: Fetal death at ≥20 weeks gestation or ≥500g birth weight
  • Neonatal death: Death within first 28 days of life
  • Perinatal death: Includes both stillbirth and early neonatal death

Grief Support Interventions

  • Encourage parents to see, hold, and name their baby
  • Create memory items: footprints, photos, lock of hair
  • Provide private room away from nursery sounds
  • Allow unlimited visiting for family members
  • Respect cultural and religious practices

Key Points

  • Grief is individual - avoid timeline expectations
  • Acknowledge the baby as a person, use the chosen name
  • Provide resources for support groups and counseling

Commonly Confused Concepts

Concept Primary PPH Secondary PPH
Timing Within 24 hours 24 hours - 12 weeks
Common Cause Uterine atony Retained placental fragments
Assessment Boggy fundus Irregular bleeding, cramping
Infection Type Endometritis Mastitis
Location Uterine lining Breast tissue
Key Symptoms Foul lochia, uterine tenderness Breast pain, flu-like symptoms
Treatment IV antibiotics Oral antibiotics, continue breastfeeding

Study Tips & Memory Aids

PPH Assessment Memory Aid: "BUBBLE-HE"

  • Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Homans sign, Emotional status

Grief Support "DO's and DON'Ts"

  • DO: Use baby's name, acknowledge the loss, provide memory items
  • DON'T: Say "at least you can get pregnant" or "you're young, you can have more"

Quick Check Questions

  • ☐ Can you identify the 4 T's of PPH?
  • ☐ Do you know the difference between primary and secondary PPH?
  • ☐ Can you list appropriate grief support interventions?
  • ☐ Do you understand the signs of postpartum infection?

Common Pitfalls

Frequently Missed Concepts

  • Pitfall: Assuming all postpartum bleeding is normal - always assess amount, color, and clots
  • Pitfall: Forgetting that a full bladder can cause uterine atony and bleeding
  • Pitfall: Avoiding discussion of perinatal loss - therapeutic communication is essential
  • Pitfall: Not recognizing that grief doesn't follow a timeline - support is ongoing

Remember: You're preparing to be an advocate for mothers and families during their most vulnerable moments. Your knowledge of postpartum complications and compassionate care during perinatal loss will make a profound difference in their healing journey. Stay confident - you've got this!

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