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Post partum complications

prepared by Mrs. Raheegeh Awni

Out Line:

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Thromboembolic disease.Post partum depression.Related research findings .Summary .References .

Objectives:

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By the end of this presentation we will able to:

Define the postpartum complications :thromboembolic disease and identify

causes and risk factor , signs and symptoms , and management.

Cont---

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Identify postpartum psychological complications , incidence , risk factors , signs and symptoms , and treatment .

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Thromboembolic disease

Thromboembolic disease

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Result from inflammation of the lining of a blood vessel in conjunction with the formation of clots inside blood vessels this lead to (thrombophlibities ).

The incidence was declined in the last 20 years because of early ambulation after childbirth as (standard practice).

(lowdermilk and perry, maternity nursing, 2006)

Predisposing factors:

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C/S. hyper coagulation .Veins stasis.maternal age >35 yrs. Varicose vein.Obesity.Smoking.Oral contraceptives

(lowdermilk and perry, maternity nursing, 2006).

Types of thromboembolic condition

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1. superficial venous thrombosis.2. deep venous thrombosis (DVT).3. Pulmonary embolism.

(lowdermilk and perry, maternity nursing, 2006).

TypesTypesDefinitionDefinitionSigns and Signs and symptomsymptom

Managements Managements and and interventionintervention

Superficial Superficial venousvenous

Super fecial Super fecial suphenous venues suphenous venues system (foot).system (foot).

Most frequent in post Most frequent in post partum .partum .

Pain , tenderness Pain , tenderness in lower limb, in lower limb, redness, hardness redness, hardness the vein over the the vein over the thrombosisthrombosis

Rest, elevate leg, Rest, elevate leg, elastic stocking, elastic stocking, apply local heat, apply local heat, Inspection Inspection +palpation.+palpation.

Check homans Check homans signs.signs.

Capillary refill.Capillary refill.

Analgesia.Analgesia.

Deep vein Deep vein thrombosisthrombosis

Thrombus extend Thrombus extend from foot to the from foot to the iliofemorel region.iliofemorel region.

Common in Common in pregnancypregnancy

unilateral leg pain, unilateral leg pain, swelling, swelling,

Calf tenderness, Calf tenderness, homans signs (+). homans signs (+).

Anticoagulants IV Anticoagulants IV (heparin ) until (heparin ) until symptom relief, symptom relief, warfarin warfarin anticoagulant orally.anticoagulant orally.

Bed rest , elevate Bed rest , elevate affected leg , elastic affected leg , elastic stoking, compressionstoking, compression of legsof legs9

TypesTypesDefinitionDefinitionSigns and Signs and symptomsymptom

Managements Managements and and interventionintervention

Pulmonary Pulmonary embolismembolism

It is a It is a complication complication of deep vein of deep vein thrombosis , thrombosis , when clots when clots move toward move toward pulmonary pulmonary artery .artery .

Dyspnea, Dyspnea, tachypnea, tachypnea, cough, cough, tachycardia,tachycardia,

increase PR, increase PR, pleuritic pleuritic chest pain.chest pain.

•Continuous of Continuous of heparin heparin therapy until therapy until symptom symptom relief.relief.•Inspection Inspection +palpation.+palpation.•Check homans Check homans signs.signs.•Laboratory Laboratory refill.refill.

•AnalgesiaAnalgesia 10

Diagnostic indicator for thrombosis for deep venous thrombosis and pulmonary embolism.

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Physical examination (not sensitive).Venography (DVT) : most accurate

method for diagnosis of DVT, invasive procedure.

Doppler ultrasound.Pulmonary arteriogram (pulmonary embolism).Cardiac auscultation : may reveal murmurs

with pulmonary embolism.Electrocardiograms are usually normal, arterial

PO2 may be lower than normal.(lowdermilk and perry, maternity nursing, 2006).

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Symptomatic venous thromboembolism in Chinese patients after gynecologic surgery: incidence and disease pattern .LOUISY, PONG Y, WING K(2002)

Thromboembolism is common among Caucasians and Chinese patients and is a major cause of postoperative mortality and morbidity.

although the sites of vascular occlusion were different.

(lowdermilk and perry, maternity nursing, 2006).

Effect of Fagonia Arabica (Dhamasa) on in vitro thrombolysisSweta P, Rajpal S, Jayant Y. (2007)

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found Dhamasa could be incorporated as a thrombolytic agent for the improvement of patients suffering from atherothrombotic diseases.

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Postpartum depression

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WHAT IS POSTPARTUM DEPRESSION?

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After having a new baby it is common for women to feel down or sad.

This is often called the “Baby Blues.” Most of the time, the baby blues go away soon after

the baby is born. If the baby blues not go away after 2 or 3 weeks, this

is called postpartum depression and may need treatment.

PPD interfere with attachment to the newborn and family integration, and some may threaten the safety and well-being of the mother, newborn, and other children.

(lowdermilk and perry, maternity nursing, 2006).

Risk factor for PPD

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Prenatal depressionLow self – esteem.Stress of child care.Life stress.Lack of social support.Marital relationship problems.Low socioeconomic status.Unwanted pregnancy.

(lowdermilk and perry, maternity nursing, 2006).

PPD classified according to the level of severity in to:

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1-Baby blues.2-Nonpsychotic depression.3-Psychotic depression.

(lowdermilk and perry, maternity nursing, 2006).

Criteria for PPD ?

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Five or more of the following must be present most of the day, nearly every day for two weeks:

Depression in mood.Diminished interested of pleasure in activities.Appetite disturbance.Sleep disturbance.Fatigue, decreased energy .Decrease concentration .Recurrent thought of death or suicidal ideation.

(Jennifer P. post partum depression :identification , screening, treatment 2004)

Cont…..

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Edinbrugh postnatal depression scale (EPDS)!

(Jennifer P. post partum depression :identification , screening, treatment 2004)

TypesTypesDefinitionDefinitionSigns and Signs and symptom symptom

Intervention Intervention andand

managementmanagement

Mood Mood disorder disorder or or Baby Baby blues.blues.

predominant mental predominant mental health disorders in the health disorders in the postpartum period, postpartum period, Occurs in about 80% of Occurs in about 80% of mothers.mothers.

-Onset within 1st wk of -Onset within 1st wk of postpartum up to 3wks.postpartum up to 3wks.

mood liability, mood liability, tearfulness, sadness tearfulness, sadness anxiety, irritability, anxiety, irritability, insomnia, fatigue, insomnia, fatigue, lack of lack of concentrationconcentration..

social support and social support and education for baby education for baby blues.blues.

PPD (non-PPD (non-psychotic):psychotic):

is an intense and is an intense and pervasive sadness with pervasive sadness with severe mood swings and severe mood swings and is more serious than is more serious than baby bluesbaby blues..

excessive anxiety, excessive anxiety, irritability, sad mood, irritability, sad mood, feelings of guilt, phobias, feelings of guilt, phobias, hopelessness, sleep hopelessness, sleep problem, fatigue, lack of problem, fatigue, lack of focus and concentration, focus and concentration, loss of interest, appetite loss of interest, appetite changes (wt loss or gain).changes (wt loss or gain).

Antidepressant:Antidepressant: --serotonin reuptake serotonin reuptake inhibitors, inhibitors, tricyclics, tricyclics, quadricyclics, quadricyclics, monoamine monoamine oxidase inhibitors.oxidase inhibitors.21

TypesTypesdefinitiondefinitionSigns and Signs and symptomsymptom

Intervention Intervention and and managementmanagement

PPD with PPD with psychotic psychotic features features (psychotic):(psychotic):

(lowdermilk and perry, maternity nursing, 2006).

Is a syndrome Is a syndrome characterized by characterized by depression, depression, delusions, and delusions, and thoughts by the thoughts by the mother of mother of harming infant harming infant or herself.or herself.

fatigue, fatigue, insomnia, insomnia, restlessness, restlessness, episodes of episodes of tearfulness and tearfulness and emotional emotional liability,, liability,, confusion, confusion, suspiciousness, suspiciousness, incoherence, may incoherence, may associated with associated with bipolar disorder, bipolar disorder, in severe cases in severe cases anxiety and anxiety and hallucination.hallucination.

Antipsychotic.Antipsychotic. mood mood stabilizers stabilizers (lithium) for (lithium) for psychotic psychotic depression.depression.Anxiolytics Anxiolytics agents.agents. electro electro convulsive convulsive therapy (ECT).therapy (ECT).

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Consideration when prescribing any medication for lactating women

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Determine whether medication is necessary .Choose the safest medication available (short

half life, safe to the infant, has low milk plasma ratio, ionized in maternal plasma).

Monitor of infant serum drug levels is recommended.

Minimize drug exposure by advising the mother to take the medication just before BF.

Breast-Feeding and Postpartum Depression:Is There a Relationship?Shaila M, Dana A, 2004

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Objective: To study the relationship between breast-feeding cessation and the onset of postpartum depression.

Conclusions: The severity of the illness did not appear to influence breast-feeding persistence significantly.

Possible alternative or complementary therapies for PPD

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Acupuncture.Acupressure.Aromatherapy.Jasmine.Herbal remedies,Healing touch.Massage.Relaxation techniques (yoga).

The effect of peer support on postpartumdepression: a pilot randomized controlled trial.Dennis CindyLee(2003)

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OBJECTIVE: To evaluate the effect of peer support (mother

to mother)on depressive.METHOD: Forty two mothers in British Columbia were

identified as high risk for PPD according to the Edinburgh Postnatal Depression Scale (EPDS) and randomly assigned to either a control group (that is, to standard community postpartum care) or an experimental group.

The experimental group received standard care plus telephone based peer support, initiated within 48 to 72 hours of randomization.

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CONCLUSIONS:

Telephone based peer support may effectively decrease depressive symptomatology among new mothers and the high maternal satisfaction and acceptance of the intervention .

Effectiveness of home visits by mentalhealth nurses for Japanese women withpost-partum depression . Atsuko Tamaki

(2008)

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Eighteen post-partum women met the inclusion criteria and were randomly allocated into the intervention

(n = 9) or control (n = 9).The intervention group received four weekly

home visits by a mental health nurse. Control group participants received usual care.

home visits by mental health nurses can contribute to positive mental health and social changes for women with post-partum depression.

clarifying thoughts, improving coping abilities, and ,removing feelings of withdrawal from others.

References

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.Lowder milk and perry , maternaty nursing ,2006. Svensson K Induction of anti-secretory factor in human milk may

prevent mastitis. Acta padiatr.2004;93:1228-1231.

Sweta P, Rajpal S, Jayant Y. Effect of Fagonia Arabica (Dhamasa) on in

vitro thrombolysis . (2007) LOUISY, PONG Y, WING K.Symptomatic venous thromboembolism

in Chinese patients after gynecologic surgery: incidence and disease pattern. Acta Obstet Gynecol Scand 2002; 81: 343–346

Dennis CindyLee.The effect of peer support on postpartum depression: a pilot randomized controlled trial. (2003)

Atsuko Tamaki.Effectiveness of home visits by mentalhealth nurses for Japanese women withpost-partum depression . International Journal of Mental Health Nursing. (2008); 17: 419–427.

Shaila M, Dana A, Breast-Feeding and Postpartum Depression:Is There a Relationship? (Can J Psychiatry.2004;42:1061–1065)

Jennifer P. post partum depression :identification , screening, treatment .wincosin medical journal .2004:103(4);45-63.

thank you

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