Midwife Licensure Exam High-Risk Pregnancy & Complications (Recognize & Refer) — Postpartum ComplicationsConcept Map

Concept

Postpartum Hemorrhage (PPH)

Sub Concepts

• Early PPH (primary) - within 24 hours
• Late PPH (secondary) - 24 hours to 6-12 weeks
• The 4 Ts: Tone, Trauma, Tissue, Thrombin
• Uterine atony - number-one cause
• Fundal assessment and massage
• Uterotonic drugs and contraindications
• Massive transfusion protocols

Relationship To Central

Life-threatening bleeding in immediate postpartum period; leading cause of maternal death

Concept

Puerperal Infection

Sub Concepts

• Endometritis - most common form
• Risk factors: cesarean, prolonged ROM, retained placenta
• Clinical manifestations
• Broad-spectrum IV antibiotics
• Semi-Fowler positioning for drainage
• Infection prevention and hygiene teaching

Relationship To Central

Systemic infection following childbirth; defined as fever ≥38°C on any 2 of first 10 postpartum days

Concept

Mastitis

Sub Concepts

• Unilateral, wedge-shaped area of redness
• Entry via cracked nipple
• Milk stasis as predisposing factor
• Continue breastfeeding as therapeutic
• Anti-staph antibiotics
• Nipple care and prevention

Relationship To Central

Inflammation/infection of breast tissue in lactating mothers; usually Staphylococcus aureus

Concept

Thromboembolic Disorders

Sub Concepts

• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE) - medical emergency
• Risk factors: cesarean, obesity, immobility
• Anticoagulation: heparin, enoxaparin, warfarin
• Anticoagulant safety in pregnancy/lactation
• Antidotes: protamine, vitamin K
• Prevention: early ambulation, leg exercises

Relationship To Central

Hypercoagulable state post-delivery; DVT and PE risk; Virchow's triad present

Concept

Postpartum Mood Disorders

Sub Concepts

• Baby blues - mild, transient
• Postpartum depression - true major depressive episode
• Postpartum psychosis - psychiatric emergency
• Edinburgh Postnatal Depression Scale screening
• Distinguishing features and severity
• Treatment: psychotherapy, antidepressants, hospitalization
• Infanticide/suicide risk assessment

Relationship To Central

Psychiatric complications affecting maternal safety and infant welfare; spectrum of severity

Concept

Normal Involution as Clinical Baseline

Sub Concepts

• Fundal descent: 1 cm per day
• Fundal position: umbilicus to non-palpable by day 10
• Lochia progression: rubra → serosa → alba
• Lochia characteristics and abnormal findings
• Subinvolution signs
• Patient teaching about warning signs

Relationship To Central

Understanding normal postpartum recovery essential for identifying deviations and complications

To

Uterine Atony

From

Postpartum Hemorrhage

Strength

strong

Relationship

Uterine atony is the primary cause of early PPH; accounts for 80% of hemorrhage cases

To

Fundal Massage

From

Uterine Atony

Strength

strong

Relationship

Fundal massage is the first-line nursing intervention for boggy uterus; firms the fundus and promotes contraction

To

Full Bladder

From

Postpartum Hemorrhage

Strength

strong

Relationship

Distended bladder displaces fundus off midline, preventing contraction; catheterization resolves this

To

Uterotonic Medications

From

Postpartum Hemorrhage

Strength

strong

Relationship

Uterotonincs are used when fundal massage and bladder emptying fail; drug selection depends on contraindications

To

Hypertension

From

Methylergonovine

Strength

strong

Relationship

Methylergonovine is contraindicated in hypertensive patients; causes vasconstriction and blood pressure elevation

To

Asthma

From

Carboprost

Strength

strong

Relationship

Carboprost is contraindicated in asthma; causes bronchospasm and respiratory compromise

To

Endometritis

From

Puerperal Infection

Strength

strong

Relationship

Endometritis (uterine lining infection) is the most common form of puerperal infection

To

Foul-Smelling Lochia

From

Puerperal Infection

Strength

strong

Relationship

Foul odor of lochia is a key manifestation of endometritis; signals bacterial contamination and infection

To

Semi-Fowler Positioning

From

Endometritis

Strength

strong

Relationship

Semi-Fowler position promotes drainage of infected lochia from the uterine cavity by gravity

To

Staphylococcus aureus

From

Mastitis

Strength

strong

Relationship

S. aureus is the most common organism causing mastitis; enters via cracked or fissured nipple

To

Cracked Nipple

From

Mastitis

Strength

strong

Relationship

Cracked nipple is the primary portal of entry for S. aureus; results from poor latch or positioning

To

Continue Breastfeeding

From

Mastitis

Strength

strong

Relationship

Continuation of breastfeeding is therapeutic; emptying breast prevents milk stasis and abscess formation

To

Dicloxacillin

From

Mastitis

Strength

strong

Relationship

Dicloxacillin is anti-staph antibiotic of choice for mastitis; covers S. aureus

To

Virchow Triad

From

Thromboembolic Disorders

Strength

strong

Relationship

Virchow triad (stasis, vessel injury, hypercoagulability) is present in postpartum state; explains DVT/PE risk

To

Leg Elevation

From

Deep Vein Thrombosis

Strength

strong

Relationship

Leg elevation reduces venous stasis and promotes drainage from affected limb

To

Never Massage Leg

From

Deep Vein Thrombosis

Strength

strong

Relationship

Massage can dislodge thrombus and cause embolism; absolute contraindication in DVT

To

Heparin in Pregnancy

From

Anticoagulation

Strength

strong

Relationship

Heparin does not cross placenta and is safe antepartum; preferred anticoagulant during pregnancy

To

Warfarin Teratogenic

From

Anticoagulation

Strength

strong

Relationship

Warfarin crosses placenta and causes fetal abnormalities; contraindicated in pregnancy but safe postpartum/lactation

To

Protamine Sulfate Antidote

From

Heparin

Strength

strong

Relationship

Protamine sulfate reverses heparin anticoagulation; dose 1 mg per 100 units heparin

To

Vitamin K Antidote

From

Warfarin

Strength

strong

Relationship

Vitamin K reverses warfarin effect; takes 12-24 hours; FFP for rapid reversal

To

SSRIs Safe in Lactation

From

Postpartum Depression

Strength

strong

Relationship

SSRIs (sertraline, paroxetine) enter breast milk minimally and are preferred antidepressants for breastfeeding

To

Never Leave Alone with Infant

From

Postpartum Psychosis

Strength

strong

Relationship

Command hallucinations and infanticidal ideation require constant supervision; critical safety measure

To

Psychiatric Hospitalization

From

Postpartum Psychosis

Strength

strong

Relationship

Postpartum psychosis is a psychiatric emergency requiring immediate hospitalization and acute psychiatric care

To

Self-Limiting Reassurance

From

Baby Blues

Strength

strong

Relationship

Baby blues is benign and self-resolving within 2 weeks; treatment is supportive and reassurance

To

Edinburgh Depression Scale

From

Postpartum Depression

Strength

strong

Relationship

Edinburgh Postnatal Depression Scale is screening tool to identify mothers at risk for postpartum depression

To

Fundal Descent 1 cm Daily

From

Normal Involution

Strength

strong

Relationship

Normal fundus descends approximately 1 cm per day; deviation signals abnormality

To

Lochia Progression Rubra-Serosa-Alba

From

Normal Involution

Strength

strong

Relationship

Lochia color progression from dark red to pinkish to yellowish-white reflects normal healing; deviation suggests infection/hemorrhage

To

Retained Placental Tissue

From

Subinvolution

Strength

strong

Relationship

Retained placental fragments prevent complete uterine contraction and involution

To

Late Postpartum Hemorrhage

From

Subinvolution

Strength

strong

Relationship

Subinvolution predisposes to late PPH (24 hours to 6 weeks) from incomplete involution

To

Hemodynamic Instability

From

Postpartum Hemorrhage

Strength

strong

Relationship

Any blood loss causing hemodynamic instability (tachycardia, hypotension, altered mental status) meets PPH criteria

To

Puerperal Infection Risk

From

Cesarean Birth

Strength

strong

Relationship

Cesarean delivery is the major risk factor for postpartum infection (endometritis, wound infection)

To

Thromboembolic Risk

From

Cesarean Birth

Strength

strong

Relationship

Cesarean delivery increases risk for DVT and PE due to surgical trauma and immobility