1F - The Puerperium Flashcards
This is the period after delivery of the conceptus?
Puerperium
When does puerperium end?
6 weeks after the delivery
Starts at 30 mins after delivery of the fetus
How many weeks does it take for the involution of the genital organs to occur?
6 weeks
The fundus returns to the level of the umbilicus post pregnancy after how many hours?
<24 hrs
Patients who have undergone surgery under general anesthesia within 48 hours should be treated as?
Full stomach and receive anti aspiration measures
When does pulse rate return to normal from being elevated post pregnancy?
2nd day
A significantly low BP (>20% baseline) post pregnancy could be a sign of what condition?
PPH or septic shock
Slightly elevated temperature post pregnancy, if it happens at the 3rd or 4th day, may be caused by?
Breast engorgement
Respiratory rate level goes back to normal post pregnancy after how many days?
3-4
How much weight is lost post pregnancy?
5-6 kg
Why does the uterus undergo involution post pregnancy?
To prevent further blood loss
How much does the uterus weigh immediately post partum?
1000g
How much does the uterus weigh after 6 weeks post partum?
50g
After 1 wk post partum - 500 g
2nd week - 300g
When will the uterus regain its normal non pregnant size?
4 weeks
2 weeks - it returns to the pelvic cavity
What are the possible causes of uterine subinvolution? (3)
Retained placenta
Uterine infection
Paravaginal hematoma
Lochia can last up to how many weeks post partum?
5 weeks
Lochia - vaginal discharge
At the end of complete involution, the internal os returns to its pre pregnay state, T or F?
False. It is still wider than before pregnancy
Post pregnancy, the lower uterine segment is converted into?
uterine isthmus
This layer of the endometrium becomes the source of new endometrial layer?
basal layer
Endometrial regeneration is rapid except where?
Placental site
when is the entire endometrium restored post partum?
3 weeks
When does complete extrusion of the placental site occur post partum?
6 weeks
Stroke volume, heart rate and blood volume post pregnancy, increases or decreases post partum?
Increases
*after blood loss
When does cardiac output return to pre pregnant levels after postpartum?
2 weeks
SVR decreases during pregnancy and increases back to pre pregnant levels after how nay weeks postpartum?
2 weeks
Diastolic blood pressure decreases more than systemic blood pressure during pregnancy, t or f?
True
Heart rate after rising from baseline during pregnancy returns to normal after how many weeks?
16 weeks
When are the 3 peaks of cardiac output during pregnancy?
At 28 weeks, at labor and immediately postpartum
What hormone causes constipation postpartum?
Progesterone
Drops within 24 hours. Acid reflux and other symptoms resolve within 3-4 days
Pigment changes during pregnancy eventually resolve after how many weeks?
6-8 weeks
Striae over abdomen and legs may not disappear even after pregnancy, t or f?
True
How many months does it take for hemoglobin levels to return to normal post partum?
4-6 months
Hematocrit returns to normal pre pregnant levels after?
3-5 days
WBCs return to pre pregnant levels after how many weeks?
4 weeks
Pregnancy induced thrombocytopenia after delivery due to blood loss resolves after how many days
4-10 days
Hypercoagulable state of pregnancy resolves after how many weeks?
8-12 weeks
GFR returns to normal after how many weeks post pregnancy?
8 weeks
Lactosuria is generally not good during the start of lactation, t or f?
False. It is normal
This is increased in the milk after childbirth to provide increased immune defense?
Colostrum
What inhibits prolactin response of breast tissue?
Estrogen and progesterone
When does lactogenesis or milk secretion start postpartum?
4th day
What action of the baby promotes the synthesis and secretion of oxytocin from the posterior pituitary gland?
Suckling
What maintains galactpoiesis?
Oxytocin
Besides nutrition, what are other functions of oxytocin postpartum?
Contraception
Protection against infection for infant
Uterine involution
Prevents PPH
What condition wherein the pituitary gland forms necrosis can prevent production of oxytocin?
Sheehan syndrome
What is the expected blood loss for normal and CS declivery?
Normal - 500ml
CS - 1000ml
What is puerperal fever?
=>38 degrees within 2 of the first 10 days or puerperium excluding the first 24 hrs
Most common cause of puerperal fever?
UTI
What is the characteristic of the fever if the patient experiences metritis with bacteremia and complications?
High grade with chills
If pueperial fever last for more than 72 hours even after IV antimicrobial therapy, what condition should be considered?
Parametrial cellulitis or phlegmon
What should be done is parametrial abscess forms?
Drainage and excision of necrotic area
Where is the usual place of postpartum hematoma?
Under bladder flap or broad ligament
Treated with clamping if patient is open or aspiration with sono if closed
This is the infection of the fallopian tube?
Salpingitis
Adnexal infections postpartum are usually?
Perisalpinigitis
Treatment for persistent septic pelvic thrombophlebitis??
Heparin challenge test
What organisms cause necrotizing fasciitis?
Grp A strep, staphylococci or polymicrobial
If there is suspicion of severe sepsis with or without septic shock, what is the treatment given within one hour?
IV broad spectrum antibiotic
If therapies fail in the case of severe streptococcal or staph infection, what is given?
IV Ig
What is the treatment for MRSA?
Vancomycin or Teicoplanin
A patient with an enlarged and softer uterus postpartum may be at risk of what condition?
PPH due to uterine subinvolution
What could cause uterine subinvolution?
Retained placental products and infection
What is the initial treatment for late postpartum hemorrhage?
Oxytocin, ergotamine and prostaglandins
If PPH recurs or persists after initial treatment, what treatment may be considered?
Curettage
A mother after delivery experiences urinary retention, what nerve may have been damaged?
Pudendal nerve
An indwelling catheter is placed on the mother’s bladder post delivery to avoid urinary retention, how many hours is it placed?
12 hrs
During prolong catheterization, what is given for prophylaxis?
Prophylaxis antibiotics
If a mother, after delivery, does not breastfeed for 2 or more days post delivery, what condition could arise?
Breast engorgement
What breast problem could arise if latch on and positioning toward the breast is improper?
Fissure
Breast pump until healed
What is the usual cause of mastitis?
S aureus
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?
Postpartum blues
Occurs in 85% of women
No specific therapy
This condition is more persistent and debilitating than postpartum blues and often interferes with the mothers ability to take care of t he child?
Post partum depression
Tx - psychotherapy or pharmacological (ssris)
*6-12 mos. - first time
This is the most severe form of postpartum psychiatric illness?
Postpartum psychosis
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?
Postpartum psychosis - psychiatric emergency
How do we treat postpartum psychosis?
Inpatient treatment
What psychiatric disorder predisposes the mother to postpartum psychosis?
Bipolar disorder
