17 Postpartum Issues

Question 1

PP day 1, mom shows no interest in baby

Answer 1

Impaired Maternal-Infant Bonding

Psychosocial evaluation and support

Question 2

Contraception Planning

Answer 2

Exc breastfeeding - upto 3mos anovulation

Diaphraghm, IUD - 6wks PP

Combi modalities - nonlactating 3wks PP

POCs immediately after delivery

Question 3

PP hemorrhage

descending order

Answer 3

Uterine atony 80%
Lacerations 15%
RPF 5%
DIC rarer

Question 4

MC risk factors for PP hemorrhage

Atony, lacerations, RPF, DIC

Answer 4

UA - rapid protracted labor
Lacerations - uncontrolled vaginal delivery
RPF - accessory lobe
DIC - Abruptio placenta

Question 5

Uterus not palpable

Beefy appearing bleeding mass in the vagina

Answer 5

Uterine inversion

*uterine replacement, IV oxytocin

Question 6

Uterus like dough

Answer 6

Uterine Atony

• uterine massage
• uterotonics : oxy, ergot, PG F2a

Question 7

Diffuse oozing

Answer 7

DIC

*remove POC, ICY, blood products prn

Question 8

Postpartum Fever

Day 0 Lung crackles, mild fever assoc with GA

Day 1-2 flank pain, dysuria, fever

Day 2-3 tender uterus

Day 5-6 wound infection, pelvic mass

Day 5-6 picket fence fever

Answer 8

Atelectasis - ambulation, pulmo exercise
Pyelonephritis - single IV antibiotics 
Endometritis IV genta clinda
Wound infection - wet to dry packs
Septic TBP - full heparinization