11 Postpartum Flashcards
Postpartum Period is from
Placental expulsion to restoration of UT to pre-pregnant state
_ week postpartum the UT fundus is just inferior to the umbilicus. The size is about ___ of what it was just after delivery
1 ; 1/2
UT to return to pre-pregnant state take __ - ___ weeks
6-8
Biochemical and physiological changes occur from the withdrawal of
hormones from pregnancy
Ultrasound Postpartum to look for? (4)
Postpartum hemorrhage
Retained products of conception- placenta
Infection
C-section incision infection
Normal length of a postpartum Ut
15-25cm
Postpartum Ut has prominent
vessels
Endometrium measures between?
5-13mm
Look in the adnexa for? (2)
Broad ligaments
ovaries - breast feeding mothers will have large ovaries due to hormones.
Postpartum Abnormalities (3)
Hemorrhage (excessive bleeding)
Infection
Retained products of conception (placenta)
Causes of Postpartum Hemorrhage
1) Acute Atony- lack of uterine muscle
bleeding controlled by contractions of uterus
&
2) Lochia - vaginal discharge of mucous and blood tissue
normal occurrence
Uterine Atony
Uterus fails to return to pre-gravid tone
flaccid
Uterine Atony is associated with (7)
Multi fetal pregnancy Macrosomia Prologned labour More than 5 full term births Rapid labor Polyhydramnios Chorioamnionitits
Postpartum Hemorrhage Risks
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 ****
Placental Accreta means?
Huge blood loss can happen at delivery
Invasion of placenta into myo or peri
AIP stands for?
Abnormal Invasive Placenta
If AIP could have to have hysterectomy post delivery
Mortality of accreta (AIP)
7%
*need to diagnoses placental accreta before delivery,for transfusions.
Placental Accreta can occur with damage to the Endo-Myo interface. List 4 things that can cause this?
C section
D&C
Manual removal of placenta
postpartum endometriosis
Placental Accreta can also occur in moms with no previous hx of surgery but have uterus pathology such as?
Bicornuate uterus
Andenomyosis. (endometriosis of the endo cavity)
submucosal fibroids
Myotonic dystrophy ( MD)
Placenta attaching to the endometrium is normal the discidum if attache to myometrium with accreta or preccreta
Anterior placenta
or c section scar
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
Normal
What are 2 signs of placenta accreta
Numerous placental lacunae
Placenta bulge with Endo <1 mm
Retained products of conception what is a strong indicator
Echogenic mass is a strong indicator for retained products
Heterogenous mass, blood clots or significant material
(no deliniation of the endometrium)
Clinical Indication of Infection
Temp greater than >38 c, 100.4 F
Pain
Endometritis
How is Infection (Endometritis) treated?
D&C or antibiotics
Endometritis Sonographically
Overlapping appearance of endometritis and retained products
Can look Normal or dilated Ut cavity with fluid or gas
What is a strong indicator in the endo of an infectious process?
Gas (looks like little flecks)
Complications from C-section
Infection at incision site
Herniation of C -section scar. weakening of myo tissue causes this. bulging
C -Section sonographically?
small rounded anechoic area in anterior UT wall
Look between anterior wall of the bladder and the lower Ut segment
Potential space between the bladder and Uterus with a complex mass >2cm adjacent to scar/ or skin incision site is a?
Hematoma
If you see a bulging area into the bladder wall (denting the bladder wall) = hematoma
Wound infection, similar appearance to hematoma but may see gas bubbles is a?
Abscess
With and abscess the patient is ___ and increased ___
Febrile (fever)
WBC
Where is a transplant kidney often put?
RLQ
May see lymphoma or Urinoma
Malignant Ascities is? and caused by?
Distended abdomen (6-7th decade) usually caused by malignant mass of ovaries
Find a mass in pelvis pateint will be booked for ____ exam looking for?
Abdomen, lymph nodes and liver mets
TAHBSO
Total abdominal hyseterectomy and bilateral oopherectomy
TAHBSO all you will see is?
Vagina, and sweep adnexa (Sag and Trans)
will see lots of Bowel
TAHBSO look for?
Tumor reoccurance
FGM stands for
Female Genital Mutilation
often under 15 years old
How many Types of FGM?
4
Type 1 FGM
Removal of the clitoral glands
Type 2 FGM
Removal of the clitoral glands and labia minor
Type 3 FGM*
Narrowing of vaginal opening by cutting labia minor and major
No EV
Type 4 FGM
All other harmful procedures to female genitalia for non medical reasons
Complications of FGM
Infection
UTI
Menstural retention - Hematometrocolpos
