11 Postpartum

Question 1

Postpartum Period is from

Answer 1

Placental expulsion to restoration of UT to pre-pregnant state

Question 2

_ week postpartum the UT fundus is just inferior to the umbilicus. The size is about ___ of what it was just after delivery

Answer 2

1 ; 1/2

Question 3

UT to return to pre-pregnant state take __ - ___ weeks

Answer 3

6-8

Question 4

Biochemical and physiological changes occur from the withdrawal of

Answer 4

hormones from pregnancy

Question 5

Ultrasound Postpartum to look for? (4)

Answer 5

Postpartum hemorrhage
Retained products of conception- placenta
Infection
C-section incision infection

Question 6

Normal length of a postpartum Ut

Answer 6

15-25cm

Question 7

Postpartum Ut has prominent

Answer 7

vessels

Question 8

Endometrium measures between?

Answer 8

5-13mm

Question 9

Look in the adnexa for? (2)

Answer 9

Broad ligaments

ovaries - breast feeding mothers will have large ovaries due to hormones.

Question 10

Postpartum Abnormalities (3)

Answer 10

Hemorrhage (excessive bleeding)
Infection
Retained products of conception (placenta)

Question 11

Causes of Postpartum Hemorrhage

Answer 11

1) Acute Atony- lack of uterine muscle
bleeding controlled by contractions of uterus
&
2) Lochia - vaginal discharge of mucous and blood tissue
normal occurrence

Question 12

Uterine Atony

Answer 12

Uterus fails to return to pre-gravid tone

flaccid

Question 13

Uterine Atony is associated with (7)

Answer 13

Multi fetal pregnancy 
Macrosomia 
Prologned labour
More than 5 full term births
Rapid labor
Polyhydramnios 
Chorioamnionitits

Question 14

Postpartum Hemorrhage Risks

Answer 14

Prior C section
Prior placenta abnormality 
Maternal age >35
Prior myomectomy (fibrods removed)
Endometrial defects - decidual basalis
Anterior placental previa with prior c-section
Placental Accreta ****

Question 15

Placental Accreta means?

Answer 15

Huge blood loss can happen at delivery

Invasion of placenta into myo or peri

Question 16

AIP stands for?

Answer 16

Abnormal Invasive Placenta

If AIP could have to have hysterectomy post delivery

Question 17

Mortality of accreta (AIP)

Answer 17

7%

*need to diagnoses placental accreta before delivery,for transfusions.

Question 18

Placental Accreta can occur with damage to the Endo-Myo interface. List 4 things that can cause this?

Answer 18

C section
D&C
Manual removal of placenta
postpartum endometriosis

Question 19

Placental Accreta can also occur in moms with no previous hx of surgery but have uterus pathology such as?

Answer 19

Bicornuate uterus
Andenomyosis. (endometriosis of the endo cavity)
submucosal fibroids
Myotonic dystrophy ( MD)

Question 20

Placenta attaching to the endometrium is normal the discidum if attache to myometrium with accreta or preccreta

Answer 20

Anterior placenta

or c section scar

Question 21

Use transducer and use pressure

check for clear zone between placenta and myo, does it bounce? This means that it is ______ Deemed acess into decidua

Answer 21

Normal

Question 22

What are 2 signs of placenta accreta

Answer 22

Numerous placental lacunae

Placenta bulge with Endo <1 mm

Question 23

Retained products of conception what is a strong indicator

Answer 23

Echogenic mass is a strong indicator for retained products
Heterogenous mass, blood clots or significant material
(no deliniation of the endometrium)

Question 24

Clinical Indication of Infection

Answer 24

Temp greater than >38 c, 100.4 F
Pain
Endometritis

Question 25

How is Infection (Endometritis) treated?

Answer 25

D&C or antibiotics

Question 26

Endometritis Sonographically

Answer 26

Overlapping appearance of endometritis and retained products | Can look Normal or dilated Ut cavity with fluid or gas

Question 27

What is a strong indicator in the endo of an infectious process?

Answer 27

Gas (looks like little flecks)

Question 28

Complications from C-section

Answer 28

Infection at incision site | Herniation of C -section scar. weakening of myo tissue causes this. bulging

Question 29

C -Section sonographically?

Answer 29

small rounded anechoic area in anterior UT wall | Look between anterior wall of the bladder and the lower Ut segment

Question 30

Potential space between the bladder and Uterus with a complex mass >2cm adjacent to scar/ or skin incision site is a?

Answer 30

Hematoma If you see a bulging area into the bladder wall (denting the bladder wall) = hematoma

Question 31

Wound infection, similar appearance to hematoma but may see gas bubbles is a?

Answer 31

Abscess

Question 32

With and abscess the patient is ___ and increased ___

Answer 32

Febrile (fever) | WBC

Question 33

Where is a transplant kidney often put?

Answer 33

RLQ | May see lymphoma or Urinoma

Question 34

Malignant Ascities is? and caused by?

Answer 34

``` Distended abdomen (6-7th decade) usually caused by malignant mass of ovaries ```

Question 35

Find a mass in pelvis pateint will be booked for ____ exam looking for?

Answer 35

Abdomen, lymph nodes and liver mets

Question 36

TAHBSO

Answer 36

Total abdominal hyseterectomy and bilateral oopherectomy

Question 37

TAHBSO all you will see is?

Answer 37

Vagina, and sweep adnexa (Sag and Trans) | will see lots of Bowel

Question 38

TAHBSO look for?

Answer 38

Tumor reoccurance

Question 39

FGM stands for

Answer 39

Female Genital Mutilation | often under 15 years old

Question 40

How many Types of FGM?

Answer 40

4

Question 41

Type 1 FGM

Answer 41

Removal of the clitoral glands

Question 42

Type 2 FGM

Answer 42

Removal of the clitoral glands and labia minor

Question 43

Type 3 FGM*

Answer 43

Narrowing of vaginal opening by cutting labia minor and major No EV

Question 44

Type 4 FGM

Answer 44

All other harmful procedures to female genitalia for non medical reasons

Question 45

Complications of FGM

Answer 45

Infection UTI Menstural retention - Hematometrocolpos