CHAPTER 27
Maternity
Postpartum Complications
Contributor: Margaret Trnka, MSN, RN
PRIORITY CONCEPTS Caregiving, Reproduction
I. Cystitis 2. Monitor vital signs and for signs of shock.
A. Description: Cystitis, an infection of the bladder, can 3. Place ice at the hematoma site.
occur in the postpartum period, and the postpartum 4. Administer analgesics as prescribed.
client should be encouraged to consume adequate u- 5. Prepare for urinary catheterization if the client
ids and void frequently to avoid bladder distention. is unable to void.
B. Assessment and interventions (refer to Chapter 55) 6. Administer intravenous (IV) uids as prescribed
to replace loss of uids.
If a urine specimen for culture and sensitivity is pre- 7. Administer blood products as prescribed.
scribed, obtain the specimen as prescribed (by voiding or 8. Monitor for signs of infection, such as increased
straight catheterization) before initiating antibiotic therapy. temperature, pulse rate, and white blood cell count.
9. Administer antibiotics as prescribed because in-
II. Hematoma fection is common after hematoma formation.
A. Description 10. Prepare for incision and evacuation of hema-
1. A hematoma is a localized collection of blood in toma if necessary.
the tissues and can occur internally, involving
the vaginal sulcus or other organs; vulvar hema- III. Uterine Atony
tomas are the most common (Fig. 27.1). A. Description: A poorly contracted uterus that does
2. Predisposing conditions include operative deliv- not adequately compress large open vessels at the
ery with forceps and injury to a blood vessel. placental site; this can result in hemorrhage. This can
3. Small hematomas usually reabsorb on their involve the anterior, posterior, or both areas of the
own. Large hematomas may require incision, uterus.
evacuation of the clots, and location and liga- B. Assessment: A soft (boggy) uterus noted on palpa-
tion of the bleeding vessel. tion of the uterine fundus
4. A hematoma can result in shock. C. Interventions
B. Assessment 1. Massage the uterus until rm (Fig. 27.2).
1. Abnormal, severe pain not relieved with treat- 2. Empty the client’s bladder (by voiding or catheteri-
ment or comfort measures zation) if that is contributing to the uterine atony.
2. Pressure in the perineal area 3. Notify the obstetrician (OB) or primary health
3. Sensitive, bulging mass in the perineal area with care provider (PHCP) if interventions do not re-
discolored skin solve the atony, because this could be an indica-
4. Inability to void tion of hemorrhage.
5. Decreased hemoglobin and hematocrit levels
6. Restlessness; changes in vital signs indicating IV. Hemorrhage and Shock
shock, such as tachycardia and hypotension A. Description
C. Interventions 1. Bleeding of greater than 1000 mL or more after
1. Monitor client for abnormal pain or perineal pres- a cesarean delivery or greater than 500 mL in a
sure, especially when forceps delivery has occurred. vaginal delivery or a 10% drop in hemoglobin
