DR/HEBA OSMAN

ASSISSTANT PROFESSOR OF MATERNAL AND NEWBORN

NURSING

MATERNAL AND CHILD HEATH NURSING DEPARTMENT

NORTHERN BORDER UNIVERSITY

Postpartum Maternal
Complications
 Learning objectives
After studying this chapter, you should be able to:
•Describe postpartum hemorrhage: predisposing factors, causes,
signs, and therapeutic management.
• Explain major causes, signs, and therapeutic management of
subinvolution.
• Describe three major thromboembolic disorders (superficial
venous thrombosis, deep vein thrombosis, pulmonary embolism)
and their predisposing factors, causes, signs, and therapeutic
management.
• Discuss puerperal infection in terms of location, predisposing
factors, causes, signs and symptoms, and therapeutic
management.
 Learning objectives
5. Describe the major mood disorders (postpartum

depression, postpartum psychosis, and bipolar II

disorder) and anxiety disorders (panic disorder,
postpartum obsessive-compulsive disorder, and post-
traumatic stress disorder).

6. Describe the role of the nurse in the management of

women who have a postpartum complication
 INTRODUCTION
•Pregnancy and childbirth are
natural functions from which most
women recover without
complication.
•However, nurses must be aware of
problems that may occur and their
effect on the family.
 COMMON COMPLICATIONS
The most common complications are
•
•
Hemorrhage
Thromboembolic disorders
list
I
• Infection
• Postpartum
• Urinary
mood and anxiety disorders.
Tract infection
 POSTPARTUM HEMORRHAGE

DEFINITION Blood loss of more than 500 mL after

vaginal birth or 1000 mL after cesarean birth.

• Hemorrhage in the first 24 hours after childbirth is

called EARLY postpartum hemorrhage.

• Hemorrhage after 24 hours or up to 6 to 12 weeks

after birth is called late postpartum hemorrhage or
secondary postpartum hemorrhage
COMMON PREDISPOSING FACTORS FOR
PPH
1. Overdistention of the uterus (multiple gestation, large infant,
hydramnios)
2. Multiparity (five or more)
3. Precipitate labor or delivery Prolonged labor
4. Use of forceps or vacuum extractor
Xx
5. Cesarean birth
6. Manual removal of the placenta
7. Uterine inversion
8. Placenta previa or low implantation
9. placenta accreta
 EARLY (primary) POSTPARTUM
HEMORRHAGE
CAUSES
1. Uterine atony.
2. Trauma to the birth canal .
3. Hematomas (localized collections of blood in a space or
tissue).
4. Retention of placental fragments.
5.
6.
1 Abnormalities of coagulation.
Disseminated intravascular coagulation.
7. Placenta previa.
8. Placenta accreta (abnormal adherence of the placenta to
the uterine wall).
9. Inversion of the uterus.
 Uterine Atony
• Atony refers to lack of muscle tone
Predisposing Factors of atony
• Over distention of the uterus from any cause such as multiple
gestation, a large infant, or hydramnios (excessive volume of
amniotic fluid).
• Multiparity.
• Obese women.
• prolonged labor.
• precipitate labor.
• Induction or augmented with oxytocin.
• Retention of a large segment of the placenta does not allow
the uterus to contract firmly and therefore can result in
uterine atony.
 CLINICAL MANIFESTATIONS
Major signs of uterine atony include:
• A uterine fundus that is difficult to locate.
• A soft or “boggy” feel when the fundus is located.
•A fundus that is located above the expected level .
• Excessive lochia.
• Excessive clots expelled
Therapeutic Management
Massage the fundus until it is firm
Bimanual compression of the uterus.
Ligation of the uterine or hypogastric artery or embolization
• Hemorrhage requires prompt replacement of intravascular fluid
volume Lactated Ringer’s solution, whole blood, packed red
blood cells, normal saline, or other plasma extenders are used..
 Trauma
• Second most common cause of early postpartum hemorrhage.
• Trauma includes vaginal, cervical, or perineal lacerations and
hematomas.
• Predisposing Factors. same factors that increase the risk of uterine
atony.
• if the infant is large or if labor and delivery occur rapidly.
• Induction and augmentation of labor and use of assistive devices, such
as a vacuum extractor, increase the risk of tissue trauma.
Lacerations
• Common sites :The perineum, vagina, cervix, and the area around the
urethral meatus.
• Bleeding from lacerations of the genital tract often is bright red, in
contrast to the darker red color of lochia.
 Hematomas.
• Cause : Blood vessel injury in spontaneous deliveries and deliveries in
which vacuum extractors or forceps are used.

• Hematomas in the vagina or retroperitoneal areas cannot be seen.

• Hematomas produce deep, severe, unrelieved pain and feelings of

pressure that are not relieved by usual pain-relief measures.

Therapeutic Management

• Trauma of the birth canal, surgical repair is necessary.

• Small hematomas usually reabsorb naturally.

• Large hematomas may require incision, evacuation of the clots, and

location of the bleeding vessel so that it can be ligated.
• Prepare an ice pack for application to the area to reduce swelling.
 Late Postpartum Hemorrhage
CAUSES
• Subinvolution (delayed return of the uterus to its non pregnant size and consistency)
• Fragments of placenta that remain attached to the myometrium when the placenta is
delivered
• Infection of the uterus.
Predisposing Factors
1
Attempts

to deliver the placenta before it separates from the uterine wall
Manual removal of the placenta
 Placenta accreta
 Previous cesarean birth
Uterine leiomyomas
Therapeutic Management
 control the excessive bleeding.
 Oxytocin, methylergonovine, and prostaglandins are the most commonly used pharmacologic measures.
 Sonography can identify placental fragments that remain in the uterus.
 If bleeding continues or recurs, dilation and curettage may be necessary to remove fragments.
 Broad-spectrum antibiotics uterine tenderness, foul smelling lochia, or fever.
 HYPOVOLEMIC SHOCK
When blood loss is excessive, hypovolemic shock(acute peripheral
circulatory failure resulting from loss of circulating blood volume
• Clinical Manifestation
Tachycardia., Hypotension , The respiratory rate increases
pale and cool , cla37mmy skin, Urine output decreases and eventually
stops.
The mother becomes anxious, then confused, and finally lethargic as blood
loss increases.
Therapeutic Management
Control bleeding and prevent hypovolemic shock from becoming
irreversible.
 A second IV line with a large-bore (14- to 18-gauge) to transfuse whole
blood.
Sufficient fluid volume is infused to produce a urinary output of at least 30
mL/hr.
 Vasopressors may be needed for low blood pressure.
 Interventions may include uterine packing; ligation of the uterine,
ovarian, or hypogastric artery; or hysterectomy
 SUBINVOLUTION OF THE UTERUS
•
Sub-involution refers to a slower-than-expected return of the uterus to
its non-pregnant size after childbirth.
CAUSES
• Retained placental fragments.
• Pelvic infection.
Signs of subinvolution include
• Prolonged discharge of lochia.
• Irregular or excessive uterine bleeding.
• pelvic pain or feelings of pelvic heaviness.
• Backache, fatigue, and persistent malaise.
• The uterus feels larger and softer than normal for that time of the
puerperium.
• Therapeutic Management
• Methergine given orally provides long, sustained contraction of the
uterus.
• Infection responds to antimicrobial therapy
 THROMBOEMBOLIC DISORDERS

• A thrombus is a collection of blood factors, primarily

platelets and fibrin, on a vessel wall.
• The three major causes of thrombosis are
 Venous stasis

I
 Hypercoagulable blood
 Injury to the endothelial surface (the innermost layer) of the
blood vessel.
• Venous Stasis – Causes
• Compression of the large vessels of the legs and pelvis by the
enlarging uterus causes venous stasis.
• More common for the pregnant woman stands for prolonged
periods of time.
• Prolonged time in stirrups promote venous stasis and increase
the risk of thrombus formation.
 Hypercoagulation
• The factors that promote clot formation are
increased and factors that prevent clot
formation are decreased to prevent maternal
hemorrhage, resulting in a higher risk for
thrombus formation during pregnancy and the
postpartum period.
Blood Vessel Injury – causes
• Lower extremity trauma.
• operative delivery.
• prolonged labor can cause vascular damage .
• Cesarean birth significantly increases the risk
for thromboembolic disease.
 FACTORS THAT INCREASE THE RISK OF
THROMBOSIS

• Inactivity • Prolonged labor

• Prolonged bed rest • Prolonged time in stirrups
• Obesity in second stage of labor
• Cesarean birth • Maternal age older than 35
• Sepsis • Increased parity
• Smoking • Dehydration
• History of previous thrombosis • Use of forceps
Varicose veins
• Air travel
• Diabetes mellitus
• Trauma
 Common Thromboembolic Disorders

• Superficial venous Clinical Manifestations • Therapeutic Management

thrombophlebitis (SVT),
• Swelling of the involved • Analgesics, rest, and elastic
• Deep vein thrombosis extremity
(DVT), support.
• redness.
• pulmonary embolism (PE). • Elevation of the lower extremity.
• Tenderness, and warmth.
Superficial Venous • Warm packs may be applied to
Thrombosis • Palpate an enlarged, the affected area.
hardened, cordlike vein.
• Superficial
thrombophlebitis is most • She may experience pain • Anticoagulants are not needed
often associated with when she walks. but anti-inflammatory
varicose veins and limited medications may be used.
to the calf area.
• It can also occur in the
• Avoid standing for long periods.
arms as a result of IV
therapy.
 Deep Venous Thrombosis
• DVT occur are caused by an inflammatory process and obstruction of venous return.
Signs and symptoms
• Pain in the leg, groin, lower back or right lower quadrant .
• Swelling of the leg (more than 2 cm larger than the other leg), erythema, heat, and tenderness .
• A positive Homans’ sign (presence of leg pain when the foot is dorsiflexed)
• Pain on ambulation, chills, general malaise, and stiffness of the affected leg.
Diagnosis
• Venous ultrasonography with vein compression
• Doppler flow analysis
• Magnetic resonance imaging (MRI) may be sensitive and accurate in diagnosing pelvic and leg
thrombosis.

Therapeutic Management (Preventing Thrombus Formation )

• Heparin is discontinued during labor and birth and resumed approximately 6 to 12 hours . Bed rest
• Analgesics, ,antibiotic ,Warfarin therapy is continued for at least 6 weeks postpartum .
• Warfarin (Coumadin) is contraindicated during pregnancy because of teratogenic effects and the risk of fetal
hemorrhage. Warfarin is safe for use during lactation.
• Moist heat for relief of pain and to increase circulation.
• Gradual ambulation, which is allowed when symptoms have disappeared.
• Sitting with the legs dependent should be avoided.
•
Mr Pulmonary Embolism
Pulmonary embolism (PE) is a serious complication of DVT and a leading cause of
maternal mortality.
• Approximately 70% of patients with PE also have symptoms of DVT .
• PE occurs when fragments of a blood clot dislodge and are carried to the lungs.
• An embolus can also consist of amniotic fluid and its debris, a condition called
anaphylactoid syndrome .
• If pulmonary circulation is severely compromised, death may occur within a few
minutes.

• Manifestation
 Dyspnea,Chest pain, Tachycardia, Tachypnea are the most common signs
 Syncope (fainting) is uncommon and may indicate massive emboli
 Pulmonary rales, cough.
 Hemoptysis ( bloody sputum),
 Abdominal pain, and low-grade fever
 Therapeutic Management
1.Oxygen is used to decrease hypoxia.

2.Analgesics such as morphine are given to reduce pain and apprehension.

3. Bed rest with the head of the bed elevated is used to help reduce dyspnea.

4.Pulse oximetry and arterial blood gases are evaluated.

5.Heparin therapy is initiated and is continued throughout pregnancy if the

embolism occurs prior to birth.

6.Therapy may be continued with warfarin for months after birth to prevent further
emboli.

7.Sedatives may be given to help control anxiety.

 Emergency medications

• Dopamine, may be used to support falling blood pressure.

• Thrombolytic drugs, such as streptokinase, may be used for life threatening

pulmonary emboli but are associated with bleeding.

• Embolectomy (surgical removal of the embolus) is rare

 Nursing Considerations

• Monitoring for Signs.

• Oxygen is used to decrease hypoxia.

• Bed rest with the head of the bed elevated.

• Assess for respiratory rate and auscultate breath sounds.

• Additional signs such as air hunger, dyspnea, tachycardia, pallor, and

cyanosis should be assessed.

• Oxygen should be administered at 8 to 10 L/min.

 PUERPERAL INFECTION
• Puerperal infection is a term used to describe bacterial
infections after childbirth.
The most common postpartum infections are
• Endometritis (an infection of the inner lining of the uterus)
• Wound
f infections
• Urinary tract infections
• Mastitis (infection of the breast)
• Endomyometritis is an infection of the muscle and inner lining
of the uterus.
• Endoparametritis is an infection of the outer lining and inner
lining of the uterus.
• Metritis is the infection of the decidua, myometrium, and
parametrial tissues of the uterus.
• Septic pelvic thrombophlebitis.
 Definition
• Puerperal infection is a temperature of 38°C
(100.4°F) or higher after the first 24 hours and
occurring on at least 2 of the first 10 days
following childbirth.

• Slight elevation of temperature may occur

during the first 24 hours because of dehydration
or the exertion of labor.
 RISK FACTORS FOR PUERPERAL INFECTION

• History of previous infections (urinary tract infection, mastitis, thrombophlebitis)

• Colonization of lower genital tract by pathogenic organisms
• Cesarean, Trauma Provides entrance for bacteria and makes tissues more
susceptible.
• Prolonged rupture of membranes (>18 to 24 hours)
• Catheterization Could introduce organisms into bladder.
• Excessive
l number of vaginal examinations
• Regional anesthesia that decreases perception to void (causes urinary stasis and
increases risk of urinary tract infection)
• Poor general health (excessive fatigue, anemia, frequent minor illnesses)
• Poor nutrition , Poor hygiene,diabetes mellitus, Low socioeconomic status,Retained
placental fragments ,Hemorrhage, Staff attending to woman are ill (promotes
droplet infection from personnel)
• Compromised health status, such as anemia, obesity, smoking, drug abuse (reduces
the body’s immune system and decreases ability to fight infection).
 Signs and symptoms

• Fever, chills
• Pain or redness of wounds

• Purulent wound drainage or wound edges not approximated

• Tachycardia
X
• Uterine subinvolution

• Abnormal duration of lochia, foul odor

• Frequency or urgency of urination, dysuria, or hematuria

• Suprapubic pain

• Localized area of warmth, redness, or tenderness in the breasts

• Body aches, general malaise

 Endometritis
• Endometritis is usually caused by organisms that are normal inhabitants of
the vagina and cervix.
• Clinical Manifestations
• Temperature of 38°C (100.4°F) or higher within 36 hours of birth
• Chills, Malaise, Anorexia,
• Abdominal pain and cramping.
• Uterine tenderness, and Purulent, foul- smelling lochia.
• Tachycardia and sub involution.
• signs and symptom occur within the 36 hours after birth
• Therapeutic Management
• Administration of IV antibiotics Antibiotics are continued until the woman
has been afebrile and asymptomatic for about 24 hours.

• Antipyretics for fever .

• Oxytocics such as methylergonovine to increase drainage of lochia and

promote involution.

•
 Complications
is
1. Salpingitis ,or oophoritis which could result in sterility.
2. Peritonitis may occur and lead to formation of a pelvic
abscess.
3. The risk of pelvic thrombophlebitis is increased when
pathogenic bacteria enter the bloodstream during episodes of
endometritis.
 Nursing Considerations
• Place the mother in a Fowler’s position to promote drainage of
lochia.
• Assess vital signs every 2 hours while fever is present and every 4
hours afterward.
• Monitor the woman’s response to treatment, and note signs of
improvement or of continued infection (nausea and vomiting,
abdominal distention, absent bowel sounds, and severe abdominal
l
pain).
• Comfort measures include warm blankets, cool compresses, cold or
warm drinks, or use of a heating pad.
• Foods high in vitamin C along with oral fluids to maintain
hydration.
• Teaching should include signs and symptoms of worsening
condition, side effects of therapy, and follow-up care.
 Wound Infection

The most common sites are

• Cesarean surgical incisions
• Episiotomies
• lacerations.
• Approximately 3% to 5% of cesarean incision sites become
infected.
 Risk factors
1. Obesity
2. Diabetes

1
3. Hemorrhage
4. Anemia
5. Chorioamnionitis
6. Corticosteroid therapy
7. Multiple vaginal
examinations.
 Clinical Manifestations

1. Edema, Warmth, Redness,

Tenderness, and Pain.
2. The edges of the wound may pull
apart, and seropurulent drainage
may be present.
3. If untreated, generalized signs of
infection, such as fever and malaise,
also may develop.
4. Necrotizing fasciitis is a rare
infection that may occur at any
incision site.
 Therapeutic Management
• The wound exudate is cultured, and provide

broad-spectrum antibiotics

• Analgesics x

• warm compresses or sitz baths .

• Surgical debridement is performed for necrotizing

fasciitis.
 Nursing Considerations
• Provide reassurance and supportive care to a
woman.
• Comfort measures include sitz baths, warm
compresses, and frequent perineal care.
• Good hand washing techniques are emphasized.
• Adequate fluid intake and a healthy diet are
important.
• Activity may be modified depending on the site,
severity, and treatment of the wound infection.
 Urinary Tract Infections
Etiology
• Trauma of The Bladder And Urethra By
Pressure From The Descending Fetus.
• Insertion of A Catheter.
• Urinary Stasis
l
• Urinary Retention .
• Cystitis
• pyelonephritis.
 Organisms

•E. coli.
• Klebsiella pneumoniae.
• Proteus species
 M
Clinical Manifestations

•Symptoms typically begin on the

first or second postpartum day.
• Dysuria.
• Urgency, frequency, and
suprapubic pain.
• Hematuria
• A low-grade fever .
 Contd.

On the third or fourth day, some

women may develop an upper
urinary tract infection, such as
1. Pyelonephritis,
2. Chills, spiking fever
3. Costovertebral angle tenderness
4. Flank pain, and
5. Nausea and vomiting.
 Therapeutic Management
•Hydration( drink at least 2500 to 3000 mL of
fluid each day) and IV administration of
broad-spectrum antibiotics.
• Urinary analgesics such as phenazopyridine
(Pyridium) may also be ordered.
•Grapefruit and carbonated drinks should be
avoided because they increase urine
alkalinity.
•Teaching should also include measures to
prevent urinary tract infections, such as
using proper perineal care, increasing fluid
intake, and urinating frequently.
 Mastitis

Incidence and Etiology.

•Mastitis, an infection of the breast, occurs
most often 2 to 4 weeks after childbirth.
•Approximately 2% to 10% of lactating
women are affected .
•It usually affects only one breast.
 Organisms

1. Mastitis is often caused by

2. Staphylococcus aureus,
3. E. coli,
4. streptococci
α
 Risk factors

1. Crack or blister,on the nipple

2. Soreness and pain of a nipple.
3. Engorgement and stasis of milk.

Ñ 4. Constriction of the breasts by a bra that is

too tight .
5. The mother who is fatigued or stressed
with low immune system
 Clinical Manifestations

1. Initial flu-like symptoms such as fatigue and aching

muscles.
2. Temperature of 39°C (102.2°F) or higher
3. Chills, malaise, and headache.
4. localized lump or wedge-shaped area of pain,
redness, heat, inflammation, and enlarged axillary
lymph nodes.
5. Mastitis may progress to breast abscess.
 Therapeutic Management

1. Antibiotic therapy and continued emptying of the

breast by breastfeeding or breast pump constitute
the first line of treatment.
2. With early antibiotic treatment, mastitis usually
resolves within 24 to 48 hours,Antibiotics should be
continued for a full 7 days.
3. Approximately 10% of women with mastitis
develop a breast abscess If breast abscess treat
with surgical drainage and antibiotics.
4. Supportive measures include application of moist
heat or ice packs, breast support, bed rest, fluids,
and analgesics.
5. The mother should continue to breastfeed from both
breasts.
 Nursing Considerations

1. Provide adequate information for

prevention.
2. Measures to prevent mastitis include
eposi- tioning the infant correctly and
avoiding nipple trauma and milk stasis.
3. The mother should breastfeed every 2 to 3
hours
4. Avoid continuous pressure on the breasts
from tight bras or infant carriers.
5. Fluid intake should be 2500 to 3000 mL
per day.
 Septic Pelvic Thrombophlebitis

• Incidence and Etiology. Occure in 1 of 3000

pregnancies.

• It usually is not seen until 2 to 4 days after

childbirth.

• It develops more often in women with

wound infection and usually involves one or
both ovarian veins, called ovarian vein
syndrome.
 Clinical Manifestations

1. Pain in the groin,Abdomen, or flank.

2. Fever
3. Tachycardia
4.
5.
Nausea
Vomiting MCQ
6. Bloating
7. Gastrointestinal distress, and
8. Decreased bowel sounds.
 Diagnosis

1. Complete blood count(CBC) with differential,

blood chemistries, coagulation studies, and
cultures.

2. Computed tomography(CT)

3. Magnetic resonance imaging (MRI) use

4. Pelvic ultrasound .
 Therapeutic Management

1.Readmission to the hospital

MCQ
2. Primary treatment includes
anticoagulation therapy with IV
E heparin and IV antibiotics.
3. Warfarin may be given when
heparin is discontinued..
4. Supportive care is similar to that
for DVT and includes monitoring for
safe levels of anticoagulation.
AFFECTIVE DISORDERS
• Postpartum women have an increased risk for mood
disorders (blues, depression and psychoses, and rarely,
bipolar disorders) and
• Anxiety disorders (obsessive-compulsive disorder,
generalized anxiety disorder, panic disorder).
• postpartum Mood Disorders
• Mood disorders are disturbances in function, affect, or
thought processes that can affect the family after
childbirth.
• Postpartum blues (baby blues) is a transient, self-
limiting mood disorder.
• Postpartum depression (PPD), postpartum psychosis, and
bipolar disorder are more serious disorders that disrupt
the family and require intervention.
 Postpartum Depression
Definition: “peripartum depression” as a period of depression with onset
during pregnancy or within 4 weeks after childbirth that lasts at least 2 weeks.
It usually develops during the first 3 months but may occur at any time during the first
year postpartum.
Signs and Symptoms •
• loss of interest in almost all activities, Changes in appetite or weight
• Feelings of anxiety, Sleep disturbances (insomnia or excessive sleeping).
• Generalized fatigue, irritability, complaints of ill health.Feelings of worthlessness or
guilt, Recurrent thoughts of death
• Difficulty thinking, concentrating, or making decisions
• Risk factors for postpartum depression
• Depression during pregnancy or previous PPD (strong predictors)
• Preeclampsia, diabetes mellitus, anemia, or postpartum thyroid dysfunction
• History of depression, mental illness, or alcoholism
• Marital dysfunction or difficult relationship with the significant other, resulting in lack
of support, Single status ,Young maternal age
• Anger or ambivalence about the pregnancy
• Therapeutic Management
• Combination of psychotherapy, social support, and medication.
• Psychotherapy may be helpful to assist the woman to cope with changes in her life.
 • Postpartum Psychosis
• Psychosis is a mental state in which a person’s ability to recognize
reality, communicate, and relate to others is impaired.
• It can occur as early as 2 days after delivery and is a psychiatric
emergency which usually requires hospitalization.
• Types
• Depressed
• Manic type of psychosis
Manifestations
• Include agitation, Irritability, Rapidly shifting moods, Disorientation,
and
• Disorganized behavior.
• Some mothers also have delusions about the baby and may experience
hallucinations .
• Management
• Requires hospitalization, pharmacologic treatment, and psychiatric
care.
• Mothers who experience this condition must be referred to specialists
for comprehensive therapy.

•
 • Bipolar II Disorder
• Women with bipolar disorder suffer from periods of
irritability, hyper- activity, euphoria, and grandiosity.
• They exhibit little need for sleep and are seldom aware they
have a problem.
• The poor judgment and confusion they experience make
self-care and infant care impossible and can be life-
threatening for the mother and infant.

Manifestations
• Tearfulness
• Preoccupations of guilt
• Feelings of worthlessness
• Sleep and appetite disturbances, and
• An inordinate concern with the baby’s health.
• Delusions about the infant being dead or defective are
common.
• Hallucinations may also be present.
• Risk of suicide or harming the infant and treated according
to the severity of the threat.
 • Postpartum Anxiety Disorders
• Itincludes
• panic disorder
• postpartum obsessive-compulsive disorder
(OCD), and
• post-traumatic stress disorder.
 • Panic disorder
• Panic disorder manifests as episodes of
tachycardia, palpations, shortness of breath,
chest pain, and fear of dying or of “going crazy.”
• Episodes are repetitive and interfere with the
woman’s daily life.
• Anti- anxiety and antidepressant medications
and counseling are the treatment for this
condition.
Postpartum OCD

• The woman has consuming thoughts

that she might harm the baby and
fears being alone with the baby
• Anxiety and depression occur, and the
woman may perform compulsive
behaviors to avoid acting on her
thoughts.
• Treatment includes antianxiety and
antidepressant medications and
counseling.
Post-traumatic Stress Disorder
(PTSD)
• women perceive child- birth as a traumatic
event.
• Women with PTSD have nightmares and
flashbacks about the event, anxiety, and
avoidance of reminders of the traumatic
event; many have depression after giving
birth.
• Feeling a lack of caring or communication or
having a birth very different from what they
expected may contribute to this disorder.
• They may feel isolated from their infants and
have prolonged difficulty feeling close to
them.
Thank u…..