46. Physiologic puerperium Flashcards

1
Q

what is the puerperium?

A

the period following delivery of the baby and placenta to 6 weeks postpartum.

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2
Q

what occurs to uterus and cervix in puerperium?

A

the uterus rapidly decreases in weight from 1000 grams at delivery to 100-200 grams 3 weeks postpartum.
The cervix loses its elasticity and regains its pre-pregnancy firmness

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3
Q

what type of vaginal discharge is seen postpartum?

A

Shedding of serous exudate, RBCs, WBCs, decidua, epithelial cells, and bacteria (lochia rubra, serosa and alba)

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4
Q

what is lochia rubra?

A

for a few days after delivery, vaginal discharge appears red.

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5
Q

what is lochia serosa?

A

from the 4th day postpartum to approx. 2-3 weeks postpartum, vaginal discharge appears pale yellow.

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6
Q

what is lochia alba?

A

up to a few weeks postpartum, vaginal discharge appears white.

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7
Q

potential pathologies seen with postpartum vaginal discharge

A
  1. Endometritis → infection of the endometrial lining; associated with foul-smelling lochia.
  2. Subinvolution → uterine fails to return to its normal size; potentially presents as prolonged lochia, abnormal uterine bleeding, pelvic pain.
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8
Q

what vaginal and pelvic muscle physiological changes are seen in puerperium?

A

Fascial stretching and trauma during childbirth result in pelvic muscle relaxation, which may not return to the pregravid state.

*important to perform pelvic floor muscle training (kegel exercises)

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9
Q

Potential subsequent pathologies of pelvic muscle during puerperium?

A
  1. Pelvic organ prolapse.
  2. Urinary incontinence.
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10
Q

what occurs to the peripheral vascular resistance in pueperium?

A

Marked increase because of the removal of the low-pressure uteroplacental circulatory shunt.

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11
Q

what occurs to the cardiac output and plasma volume in puerperium?

A

gradually return to normal values during the first
2 weeks postpartum.
As a result of the loss of plasma volume and the diuresis of extracellular fluid, a marked weight loss occurs in the first week.

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12
Q

Peripartum dilated cardiomyopathy occur due to

A

ventricular dilatation and decreased contractility
that develops in < 0.1% of pregnancies during the last month of pregnancy to 5 months postpartum.

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13
Q

peripartum dilated cardiomyopathy risk is associated with?

A

increased maternal age and multiparity.

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14
Q

what are the psychological changes in puerperium?

A
  1. Postpartum blues (‘baby blues’).
  2. MDD with peripartum onset (postpartum depression).
  3. Postpartum psychosis.
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15
Q

In women who do not nurse, menstrual flow usually returns by?

A

6-8 weeks, although variable

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16
Q

what occurs to the maternal insulin requirements during puerperium?

A

decrease significantly because of the removal of the placenta, which produces many insulin antagonists. Insulin requirements may go below prepregnant levels during the puerperium, particularly in breastfeeding women

17
Q

when should women with gestational D.M undergo a 75-g OGTT postpartum?

A

4-12 weeks postpartum

18
Q

First gynecological F/U postpartum is recommended at?

A

6 weeks postpartum

19
Q

what should a woman that is Rh negative receive postpartum?

A

an IM injection of Rhogam within 72 h’ postpartum
Rhogam contains antibodies to the Rh-D antigen such that any Rh-positive fetal cells that mix with maternal blood during the time of delivery will be removed from the circulation, before sensitizing the mother’s immune system.

20
Q

what vaccinations should be given postpartum?

A
  1. MMR and Varicella (contraindicated during pregnancy)
    2.Tdap
21
Q

how can we monitor the postpartum mood?

A

with the PHQ-9 questionnaire or the Edinburgh postnatal depression scale.

22
Q

Discharge instruction and clinician discussion

A
  • Perineal care
  • Wound care in case of cesarean delivery or episiotomy sutures
  • Breastfeeding and breast care
  • Normal vaginal discharge (lochia) vs. abnormal vaginal discharge (delayed PPH)
  • Postpartum contraception
  • Postpartum blues and potential problems in the transition to home settings