postpartum case study evolve answers

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Case Study: 29-Year-Old Female with Postpartum Hemorrhage

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A 29-year-old female (G1P1) is readmitted two weeks post–vaginal delivery due to increased vaginal bleeding. She reports that the bleeding began on the tenth day after delivery and has increased in severity each subsequent day. The delivery was uncomplicated with minimal blood loss and the patient did not receive any epidural anesthesia. She has taken 200 mg of ibuprofen daily since delivery. The patient reports a medical history of iron deficient anemia due to menorrhagia. She is adopted and does not know her family history.

Since admission, the patient has received three units of blood. The obstetrics team has ruled out retained placental tissue and uterine atony as the cause of bleeding. Her laboratory values are as follows:

What hematologic disease is most likely contributing to her bleeding?

• NSAID-induced platelet dysfunction
• Acquired factor VIII inhibitor
• von Willebrand disease
• Disseminated intravascular coagulation
• Microangiopathy hemolytic anemia

Explanation

This patient is presenting with secondary postpartum hemorrhage with a clinical and laboratory history suggestive of von Willebrand disease (vWD). Overall, there is a 20 percent risk of peripartum bleeding with vWD, and 75 percent of women with moderate to severe vWD can experience severe bleeding. Bleeding can be seen from any type of vWD. For women with mild forms of vWD, the peripartum period can be the first manifestation of the disease. 1 Furthermore, since peripartum bleeding unrelated to a bleeding disorder is common, the diagnosis of an underlying bleeding diathesis may not be considered.

During pregnancy both factor VIII and von Willebrand factor (vWF) levels increase, with peaks at 29 to 32 weeks gestation and at 35 weeks gestation, respectively. 2 Following delivery, vWF levels may fall precipitously within the first few weeks resulting in delayed uterine bleeding. 3 Management of women with known vWD includes monitoring vWF levels during pregnancy and for three to four weeks post-partum to ensure return to baseline. Prophylaxis and treatment of vWD during pregnancy is based upon the severity of disease and specific type of vWD.

Acquired factor VIII inhibitors are a rare but serious cause of secondary postpartum hemorrhage. 4 The activated partial thromboplastin time (aPTT) is typically significantly prolonged if there is a factor VIII inhibitor. Disseminated intravascular coagulation is an important cause of post-partum hemorrhage. Significant prolongations of the aPTT and PT as well as low fibrinogen levels are necessary to make the diagnosis. Microangiopathic hemolytic anemia may occur in the peripartum period and is associated with low hemoglobin and platelets. However, this diagnosis results in manifestations of microvascular thrombosis rather than hemorrhage.

Case study submitted by James N. Cooper, MD, of the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD.

• Ragni MV, Bontemp FA, Hassett AC. von Willebrand disease and bleeding in women . Haemophilia. 1999; 5:313-317
• Sié P, Caron C, Azam J, et el. Reassessment of von Willebrand factor (VWF), VWF propeptide, factor VIII:C and plasminogen activator inhibitors 1 and 2 during normal pregnancy . Br J Haematol. 2003; 121:897-903.
• Kujovich JL. von Willebrand disease and pregnancy . J Thromb Haemost. 2005; 3:246-253.
• Paidas MJ, Hossain N. Unexpected postpartum hemorrhage due to an acquired factor VIII inhibitor . Am J Perinatol. 2014 31:645-654

American Society of Hematology. (1). Case Study: 29-Year-Old Female with Postpartum Hemorrhage. Retrieved from https://www.hematology.org/education/trainees/fellows/case-studies/female-postpartum-hemorrhage .

American Society of Hematology. "Case Study: 29-Year-Old Female with Postpartum Hemorrhage." Hematology.org. https://www.hematology.org/education/trainees/fellows/case-studies/female-postpartum-hemorrhage (label-accessed May 10, 2024).

"American Society of Hematology." Case Study: 29-Year-Old Female with Postpartum Hemorrhage, 10 May. 2024 , https://www.hematology.org/education/trainees/fellows/case-studies/female-postpartum-hemorrhage .

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Case Study: Postpartum

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Undergraduate Symposium 2024

2024 undergraduate research symposium.

  Our BSN honors students will present their posters at the 2024 Undergraduate Research Symposium on May 17 th . Please join us to celebrate the students’ achievements.

When:  May 17, 2024, Session 1  (11:00am – 12:30pm)

Where: Mary Gates Hall

For day-of details see:

https://www.washington.edu/undergradresearch/symposium/attendees/

Poster Abstracts  

• Students: Cj Rivera & Kara Donny-Clark
• Mentor: Maya Elias, PhD, MA, RN   
• Title: Exploring the Roles of Circadian Rhythm and Chronotype on Cognitive Interventions for Older Intensive Care Unit Survivors
• Time: 11:00-12:30
• Abstract: Nearly 70% of older adults hospitalized in an intensive care unit (ICU) experience delirium, a risk factor for long-term cognitive impairment that persists beyond discharge. The severity of critical illness, coupled with the 24-hour care provided in the ICU, is associated with significant disruptions to sleep and the circadian rhythm. These circadian rhythm disturbances, which affect up to 80% of ICU patients, may decrease the efficacy and benefits of interventions to improve cognitive function. Few intervention studies have been conducted testing circadian-based approaches to optimize timing of interventions to prevent cognitive decline in older ICU survivors. The study aims are: 1) to assess the feasibility, adherence, tolerability of morning or afternoon sessions of a computerized cognitive training intervention, and 2) to explore the role of individual chronotype on intervention usability and acceptability in older ICU survivors. Participants are randomized to one of three arms: morning computerized cognitive training sessions, afternoon computerized cognitive training sessions, or usual inpatient care. Participants assigned to the intervention groups complete daily 30-minute cognitive training sessions for up to 7 days or until hospital discharge. Wearable sensors monitor circadian rhythm patterns (via continuous body temperature and activity/sleep), and participants answer a questionnaire to determine their individual chronotype (“morning” versus “evening” circadian preference). Upon study completion, participants provide quantitative and/or open-ended feedback via surveys. We hypothesize that participants whose assigned intervention timing aligns most closely with their individual chronotype will demonstrate higher intervention adherence and will report higher tolerability and acceptability. Data collection is ongoing; results will investigate the potential of circadian-based and chronotherapeutic interventions to mitigate cognitive impairment in older ICU survivors. Additional research is needed to develop personalized interventions that integrate individual circadian rhythm and chronotherapy as targets to accelerate cognitive recovery throughout critical illness.
• Students: Samantha Naomi Gomez & Molly N Hines
• Mentor: Monica R McLemore, PhD, MPH, RN
• Title: Integrative Review on Support for Pregnant Individuals Using Substances
• Abstract: There are unfortunate disparities that occur to pregnant individuals struggling from substance use disorder, causing harm rather than support and purposeful treatment. Punitive policies against these individuals are deeply rooted in systematic racism disproportionately affecting the BIPOC community, leading to increases in adverse birth outcomes, such as neonatal abstinence syndrome. Addressing the pressing need for improved prenatal and postpartum support for these individuals is imperative. This study identifies supportive interventions that improve the quality of prenatal care and follow up pregnancy care. We conducted extensive interviews with healthcare experts researching prevention policies and those working directly with the target population. Additionally, we performed a systematic review of both punitive and supportive policies regarding substance use during pregnancy. We hypothesize that punitive policies adversely affect pregnant individuals by creating disparities and hindering proper pregnancy care. The study’s findings will allow us to develop viable interventions aimed at improving pregnancy care for these individuals, ultimately preventing neonatal abstinence syndrome.
• Student: Hsin-Ni Lee
• Mentors: Basia Belza, PhD, RN, FAAN, FGSA / Sarah McKiddy, PhD Candidate
• Title: The Relationship of Ageism, Aging, and Music on Health: Perspectives of Mandarin-Speaking Elders
• Abstract: Music interventions are gaining attention due to the evidence they improve health and cognition in elders. In the US, there is an increasing number of Mandarin-speaking elders whose cultural background affects their aging experience. After English and Spanish, Chinese is the third most spoken language in the US. Three and a half million households in the U.S speak Mandarin or Cantonese. However, there is little information regarding specific music choices or culturally tailored music interventions for Mandarin-speaking elders to improve their health and aging experience. The purpose of this study was to gain insights into Mandarin-speaking elders’ views of aging, ageism, and the relationship between music and health. We conducted a qualitative study that involved interviewing Mandarin-speaking elders in Mandarin. The interview consisted of questions related to their cultural perspectives on aging, experience with ageism in the US, and the impact of music on their health. The participants selected music to play during the interview and discussed what the music meant to them and their thoughts on how music affects their health. Four interviews in Mandarin have been conducted to date. Initial findings reveal that filial piety and respect are recurring cultural themes that influence participants’ perspective and experience of aging. Internal ageism was identified in one of the interviews while the participant discussed their experience with ageism. Participants expressed that music benefits their health by providing emotional support and outlet, motivation, reminiscence of the past, brain activity, and stimulation through physical movement such as dance. The findings increase our understanding about the role of culture in the aging experience and music’s role in enhancing health for Mandarin-speaking elders. Future studies can use this information to develop music-based interventions tailored for Mandarin-speaking elders to improve their health.
• Student: Margaret Njoroge
• Title : The Relationship of Ageism, Aging, and Music on Health in Older Adults from Kenya
• Abstract: Music is considered a therapeutic tool to improve physical, cognitive, and emotional health. The nature of music varies across cultures and backgrounds around the world. This research project explored the connections between music, aging, and ageism in older adults from Kenya and the therapeutic role of music in improving physical, cognitive, and emotional well-being. This project considers cultural similarities and differences between Kenya and the United States and examines the unique nature shaped by different cultures. In this study, we explore how music affects the perception of age in older adults from Kenya and their perceptions of ageism. This research project focuses on using interpretive research method where data is collected through interviews to gain a deeper understanding of the topic. The study involves three older adults from Kenya between the ages of 60 and 65. The interview questions focus on understanding the cultural influences of Swahili speakers in the context of music and ageism. Through research on the differences in aging between Kenyan and American older adults, this project seeks to identify cultural factors and explore ways that music can enhance well-being among older adults. This project provides valuable insight into cultural aspects that influence aging and the potential benefits of music-based interventions. The findings have the potential to improve our understanding of how cultural differences influence attitudes toward aging and the impact of music on the health and well-being of older adults.
• Student: Jeff Paine
• Mentor: Omeid Heidari, PhD, MPH, ANP-C
• Title: Integration of Substance Use Treatments Into a Primary Care Setting
• Abstract: Millions of people in the United States of America are suffering from substance use disorders (SUD); of particular concern is opioid use disorder (OUD) due to the high risk of overdose and death. This epidemic is a public health crisis that impacts people in every community. OUD is especially harmful to vulnerable populations who face arduous challenges in accessing treatment. People with chronic pain or complex comorbid conditions, housing-unstable communities, and the under/uninsured are all particularly vulnerable to OUD. Safe and effective medical treatments are available to mitigate overdose risk, but accessing them can be bureaucratically challenging for providers to navigate, which results in the relegation of OUD treatment to separate specialty facilities. This fragmentation of care impedes access and decreases provider follow-up. Substance users seeking help often face undue burdens in the form of strict sobriety requirements or incremental prescriptions necessitating frequent clinic visits. Madison Clinic at Harborview Medical Center provides care for people living with HIV and AIDS. This population is particularly vulnerable to medical stigma and bias, job instability, homelessness, chronic pain, and substance use. Using a qualitative descriptive method, we conducted a thematic analysis of semi-structured interviews to explore the thoughts, opinions, and perspectives of providers at the Madison Clinic and people living with HIV or AIDS using substances regarding the integration of medical treatments for substance use into the primary care setting. Interview transcripts were analyzed through a mix of inductive and deductive coding. Ideally, this integration would help remove barriers and alleviate the complexity of coordinating fragmented care. We anticipate co-locating routine care and treatment for opioid use simultaneously may lead to better adherence to medication regimens and increased patient and provider satisfaction with care. This research will influence the creation of a healthcare model for integrating substance use treatment into primary care settings.
• Students: Amanda Angela Quach & Carly Cassidy Watson
• Mentors: Allison R Webel, RN, PhD, FAAN / Vitor Oliveira, PhD
• Title : Improving Body Composition Through Exercise Interventions in Older People with HIV
• Abstract: As healthcare advances, older people with HIV (PWH) have a longer life expectancy. Biotechnological advancements, such as antiretroviral therapy (ART), suppress HIV replication, resulting in decreased mortality among PWH, while increasing quality of life. However, despite these advances, older PWH generally experience an earlier onset of comorbidities due to increasing age, increased adiposity related to HIV medications and sedentary lifestyle, poorer physical function, and high symptom burden. Physical activity is a significant non-pharmacological approach to mitigate chronic disease in older adults and promote healthy living. Among different physical activity types, exercise can be defined as structured and repetitive bodily movement, objectively improving or maintaining physical function. Exercise can take many forms and be performed at different intensities. HEALTH Study participants perform continuous moderate exercise (CME) of walking or jogging at 50% of heart rate (HR) or high-intensity interval training (HIIT) of alternating short intervals of high- and low-intensity aerobic exercise at 80-90% and 50% HRmax. Healthy aging among PWH includes decreased fatigue, greater functional mobility, and fewer symptoms of HIV and its related treatments. What is unknown, and currently investigated in the HEALTH Study, are exercise types to improve physical health outcomes in older PWH. This study aims to explore the relationship and associations between exercise interventions on body composition across older PWH participants. In this year-long undergraduate research project, we conducted a secondary data analysis to compare the effectiveness of exercise interventions, HIIT versus CME, on DEXA scan outcomes of body fat and bone density in older PWH. DEXA scans are medical imaging x-ray tests to quantify body composition. We anticipate that with increased physical activity, especially in HIIT participants, body fat will decrease, and bone density and lean mass will increase. These findings may indicate how exercise interventions can mitigate fatigue and provide recommendations to prompt healthy aging in older PWH.
• Student: Amy Nicole Trader
• Mentor: Anita M Souza, PhD
• Title: Understanding Worker Well-being of Homeless Service Employees
• Abstract: Compassion fatigue, also known as secondary traumatic stress or vicarious trauma, is a condition characterized by emotional and physical exhaustion, often experienced by individuals who provide care, support, or assistance to people who are suffering or traumatized. This phenomenon commonly affects professionals in helping and caregiving roles such as healthcare workers, social workers, counselors, and first responders as they’re constantly exposed to secondary traumas. This study investigates five domains of worker well-being of social services employees at a local Homeless Services Agency in King County. Seventy-five social workers and case managers were invited to participate in the online, anonymous survey that contains the National Institute for Occupational Safety and Health (NIOSH) Worker Well-being Questionnaire. This questionnaire consists of sixty-eight questions related to work evaluation and experience, workplace policies and culture, workplace physical environment and safety climate, health status, and home, community, and society. We hypothesize that those who have been employed at the Compass Housing Alliance for more than 2 years will exhibit higher compassion fatigue through their survey responses. The insights gathered will aid in understanding the working environment on service employees’ well-being. Results will offer areas to support workers and hopefully serve to mitigate the potential development of compassion fatigue among staff members.
• Student: Lihaana S
• Title: Examining Worker Well-Being Amongst Social Service Workers who Aim to Alleviate Homelessness
• Abstract: As the percentage of individuals facing homelessness rises, many organizations working closely with unhoused populations aim to secure consistent housing and essential resources for those who lack this necessity. There are roughly 14,000 individuals facing homelessness in the greater Seattle area. Previous studies have shown positive correlations between employee well-being and job performance. Our research aims to investigate worker well-being among staff members who are currently employed at the Compass Housing Alliance, an organization working closely with unhoused populations to provide both housing and access to other essential needs. This research utilized the National Institute for Occupational Safety and Health (NIOSH) worker well-being survey. We collected data on five factors that
• influence the perceptions of 75 staff members on their overall well-being including workplace safety, mental wellness, leadership support, coping strategies and job satisfaction. Expected results from our survey indicate that staff members’ perceptions significantly impact their overall well-being. Collecting data using quantitative methods enables us to gain a deeper understanding of these current perceptions in order to utilize relevant resource implementation in areas where gaps are identified to support the needs of staff and improve their well-being.
• Students: Adrianne Tung & Cindy Tan
• Mentor: Tamara C. Cunitz, MN, RN
• Title: Nashi Warm Line Needs Assessment: Supporting Ukrainian Refugees with Emotional Health and Resource Allocation
• Abstract: On February 24, 2022, Russia began its full-scale invasion of Ukraine. Washington state was already the home of over 42,000 Ukrainian immigrants, and since the invasion, upwards of 22,000 Ukrainian refugees have arrived. Refugees face significant challenges due to obstacles stemming from the trauma of war, displacement, resettlement, and the lack of access to essential health and social services. The Nashi Immigrants Health Board is a non-profit, community-based organization founded by public health professionals. Nashi partners with the Ukrainian community via health promotion, education, and advocacy programs and provides culturally and linguistically appropriate public and mental health services. Nashi’s warm-line was created as a caller line for Ukrainian-speaking communities, primarily refugees fleeing Ukraine to provide psychosocial support and connection to community resources. The purpose of this study is to examine the data collected during warm-line calls to identify the greatest needs and streamline resources for the community. Warm-line operators collect anonymous information such as age, zip code, primary language, the purpose of the call, and action taken are recorded. Caller data are entered into a database with specific categories and analyzed for trends and patterns of needs, which will help Nashi refine the pathways to interventions and resource allocation. We hypothesize the callers will be mainly calling about needs such as housing, health insurance, and job opportunities. We expect the navigators to provide emotional support in addition to resources, even if callers are not expecting or requesting it. The findings would help Nashi inform the Office of Refugee and Immigrant Assistance (ORIA) for future programming and quality improvement interventions. The study results are not inclusive of every need in the Ukrainian refugee population. Ongoing efforts of resource allocation would continue to evolve based on the changing needs of the Ukrainian community.

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