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OBSTETRICS > 1F - The Puerperium > Flashcards

1F - The Puerperium Flashcards

1
Q

This is the period after delivery of the conceptus?

A

Puerperium

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2
Q

When does puerperium end?

A

6 weeks after the delivery

Starts at 30 mins after delivery of the fetus

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3
Q

How many weeks does it take for the involution of the genital organs to occur?

A

6 weeks

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4
Q

The fundus returns to the level of the umbilicus post pregnancy after how many hours?

A

<24 hrs

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5
Q

Patients who have undergone surgery under general anesthesia within 48 hours should be treated as?

A

Full stomach and receive anti aspiration measures

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6
Q

When does pulse rate return to normal from being elevated post pregnancy?

A

2nd day

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7
Q

A significantly low BP (>20% baseline) post pregnancy could be a sign of what condition?

A

PPH or septic shock

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8
Q

Slightly elevated temperature post pregnancy, if it happens at the 3rd or 4th day, may be caused by?

A

Breast engorgement

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9
Q

Respiratory rate level goes back to normal post pregnancy after how many days?

A

3-4

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10
Q

How much weight is lost post pregnancy?

A

5-6 kg

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11
Q

Why does the uterus undergo involution post pregnancy?

A

To prevent further blood loss

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12
Q

How much does the uterus weigh immediately post partum?

A

1000g

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13
Q

How much does the uterus weigh after 6 weeks post partum?

A

50g

After 1 wk post partum - 500 g

2nd week - 300g

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14
Q

When will the uterus regain its normal non pregnant size?

A

4 weeks

2 weeks - it returns to the pelvic cavity

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15
Q

What are the possible causes of uterine subinvolution? (3)

A

Retained placenta
Uterine infection
Paravaginal hematoma

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16
Q

Lochia can last up to how many weeks post partum?

A

5 weeks

Lochia - vaginal discharge

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17
Q

At the end of complete involution, the internal os returns to its pre pregnay state, T or F?

A

False. It is still wider than before pregnancy

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18
Q

Post pregnancy, the lower uterine segment is converted into?

A

uterine isthmus

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19
Q

This layer of the endometrium becomes the source of new endometrial layer?

A

basal layer

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20
Q

Endometrial regeneration is rapid except where?

A

Placental site

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21
Q

when is the entire endometrium restored post partum?

A

3 weeks

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22
Q

When does complete extrusion of the placental site occur post partum?

A

6 weeks

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23
Q

Stroke volume, heart rate and blood volume post pregnancy, increases or decreases post partum?

A

Increases

*after blood loss

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24
Q

When does cardiac output return to pre pregnant levels after postpartum?

A

2 weeks

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25
Q

SVR decreases during pregnancy and increases back to pre pregnant levels after how nay weeks postpartum?

A

2 weeks

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26
Q

Diastolic blood pressure decreases more than systemic blood pressure during pregnancy, t or f?

A

True

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27
Q

Heart rate after rising from baseline during pregnancy returns to normal after how many weeks?

A

16 weeks

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28
Q

When are the 3 peaks of cardiac output during pregnancy?

A

At 28 weeks, at labor and immediately postpartum

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29
Q

What hormone causes constipation postpartum?

A

Progesterone

Drops within 24 hours. Acid reflux and other symptoms resolve within 3-4 days

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30
Q

Pigment changes during pregnancy eventually resolve after how many weeks?

A

6-8 weeks

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31
Q

Striae over abdomen and legs may not disappear even after pregnancy, t or f?

A

True

32
Q

How many months does it take for hemoglobin levels to return to normal post partum?

A

4-6 months

33
Q

Hematocrit returns to normal pre pregnant levels after?

A

3-5 days

34
Q

WBCs return to pre pregnant levels after how many weeks?

A

4 weeks

35
Q

Pregnancy induced thrombocytopenia after delivery due to blood loss resolves after how many days

A

4-10 days

36
Q

Hypercoagulable state of pregnancy resolves after how many weeks?

A

8-12 weeks

37
Q

GFR returns to normal after how many weeks post pregnancy?

A

8 weeks

38
Q

Lactosuria is generally not good during the start of lactation, t or f?

A

False. It is normal

39
Q

This is increased in the milk after childbirth to provide increased immune defense?

A

Colostrum

40
Q

What inhibits prolactin response of breast tissue?

A

Estrogen and progesterone

41
Q

When does lactogenesis or milk secretion start postpartum?

A

4th day

42
Q

What action of the baby promotes the synthesis and secretion of oxytocin from the posterior pituitary gland?

A

Suckling

43
Q

What maintains galactpoiesis?

A

Oxytocin

44
Q

Besides nutrition, what are other functions of oxytocin postpartum?

A

Contraception
Protection against infection for infant
Uterine involution

Prevents PPH

45
Q

What condition wherein the pituitary gland forms necrosis can prevent production of oxytocin?

A

Sheehan syndrome

46
Q

What is the expected blood loss for normal and CS declivery?

A

Normal - 500ml

CS - 1000ml

47
Q

What is puerperal fever?

A

=>38 degrees within 2 of the first 10 days or puerperium excluding the first 24 hrs

48
Q

Most common cause of puerperal fever?

A

UTI

49
Q

What is the characteristic of the fever if the patient experiences metritis with bacteremia and complications?

A

High grade with chills

50
Q

If pueperial fever last for more than 72 hours even after IV antimicrobial therapy, what condition should be considered?

A

Parametrial cellulitis or phlegmon

51
Q

What should be done is parametrial abscess forms?

A

Drainage and excision of necrotic area

52
Q

Where is the usual place of postpartum hematoma?

A

Under bladder flap or broad ligament

Treated with clamping if patient is open or aspiration with sono if closed

53
Q

This is the infection of the fallopian tube?

A

Salpingitis

54
Q

Adnexal infections postpartum are usually?

A

Perisalpinigitis

55
Q

Treatment for persistent septic pelvic thrombophlebitis??

A

Heparin challenge test

56
Q

What organisms cause necrotizing fasciitis?

A

Grp A strep, staphylococci or polymicrobial

57
Q

If there is suspicion of severe sepsis with or without septic shock, what is the treatment given within one hour?

A

IV broad spectrum antibiotic

58
Q

If therapies fail in the case of severe streptococcal or staph infection, what is given?

A

IV Ig

59
Q

What is the treatment for MRSA?

A

Vancomycin or Teicoplanin

60
Q

A patient with an enlarged and softer uterus postpartum may be at risk of what condition?

A

PPH due to uterine subinvolution

61
Q

What could cause uterine subinvolution?

A

Retained placental products and infection

62
Q

What is the initial treatment for late postpartum hemorrhage?

A

Oxytocin, ergotamine and prostaglandins

63
Q

If PPH recurs or persists after initial treatment, what treatment may be considered?

A

Curettage

64
Q

A mother after delivery experiences urinary retention, what nerve may have been damaged?

A

Pudendal nerve

65
Q

An indwelling catheter is placed on the mother’s bladder post delivery to avoid urinary retention, how many hours is it placed?

A

12 hrs

66
Q

During prolong catheterization, what is given for prophylaxis?

A

Prophylaxis antibiotics

67
Q

If a mother, after delivery, does not breastfeed for 2 or more days post delivery, what condition could arise?

A

Breast engorgement

68
Q

What breast problem could arise if latch on and positioning toward the breast is improper?

A

Fissure

Breast pump until healed

69
Q

What is the usual cause of mastitis?

A

S aureus

70
Q

This is postpartum psychiatric illness peak at the 4th or 5th day postdelivery and last for several days but spontaneously remit within the first 2 weeks postpartum?

A

Postpartum blues

Occurs in 85% of women

No specific therapy

71
Q

This condition is more persistent and debilitating than postpartum blues and often interferes with the mothers ability to take care of t he child?

A

Post partum depression

Tx - psychotherapy or pharmacological (ssris)

*6-12 mos. - first time

72
Q

This is the most severe form of postpartum psychiatric illness?

A

Postpartum psychosis

73
Q

A patient has delusions against her baby postpartum that she thinks the baby is the son of Satan, what is the condition of the mother?

A

Postpartum psychosis - psychiatric emergency

74
Q

How do we treat postpartum psychosis?

A

Inpatient treatment

75
Q

What psychiatric disorder predisposes the mother to postpartum psychosis?

A

Bipolar disorder

OBSTETRICS (36 decks)

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