8/27 Lecture Flashcards
For post term pregnancies especially, what is an indirect measure of placenta function. Most important assessment for fetal well-being
BPP (biophysical profile)
What does the BPP look at?
Fetal movement
Amniotic fluid
Fetal Tone
Fetal Breathing (diaphragm contracting)
What is the first 6 weeks of post partum
Puerperium
What is the vaginal discharge 14 days after giving birth?
Lochia
If a women isn’t lactating when will ovulation return?
45 days
If a women is lactating when will ovulation return?
6 months (189 days)
What is the major reason women die from postpartum?
Post partum hemorrhage
What are some etiology for peripertum cardiomyopthay?
inflammatory cytokines myocarditis abnormal immunity genetic hemodynaic factors
What are some risks for peripartum cardiomyopathy?
>30 multiparity morbid obesity multigravida maternal cocaine abuse
What is the test for postpartum thyroiditis?
Antithyroid peroxidase antibody
What is postpartum thyroiditis often misdiagnosed as?
Postpartum depression
What is normal bleeding for a vaginal birth?
500 mL
What is normal bleeding for a C-Section?
1,000 mL
What does each 1% drop in HCT about equal?
100 mL blood loss
What are some signs of postpartum hemorrhage?
Tachycardia
tachypnea
orthostatic changes
oliguria
What is the biggest reason for postpartum hemorrhage?
Uterine atony
What are some risk factors of uterine atony?
Over distention of utreus
augmented labor
protracted labor
C-section
How do you treat uterine atony?
Empty bladder
Give uterotonic agents (pitocin)
Bimanual uterine massage
Surgical
Another reason for postpartum hemorrhage, not as common, involved placenta.
Retained placenta
What should you look at the placenta for?
Whole placenta
Look for incomplete separation of placenta
How do you treat a retained placenta?
Manual removal
When should you give prophylactic antibiotics?
After manual removal of the placenta
When is a hematoma of the lower tract acceptable?
<5 cm and stable
treat with ice packs
If a hematoma is >5 cm what do you do?
Incision and Drain
When can uterine rupture happen?
Protracted/ arrest labor
Previous C/S incision or other surgical procedure
A C-section in what section is more likely to result in uterine rupture?
Upper uterine section
What puts a mom at risk for amniotic fluid embolism?
PROM
What is the prevention of thrombophelbitis and DVT?
Have the mom move around or put compression hose on
What is a Homan’s sign?
Have them pull back their foot and will have calf pain
If a women has a temp x 2 during first 10 days PP, tachy, dyspnea, malodorous Lochi, uterine tenderness what should you suspect?
Postpartum infection
How do you treat urinary retention?
Catheterization
What is a common post partum problem with the bladder?
Stress incontinence
When does stress incontinence usually resolve?
12 weeks PP
When does post partum depression occur?
8-20 weeks after
Anorexia, depressed, insomnia, loss of libido, cognitive issues/ lapses
What is where women have anxiety, restless, manic w/ paranoia or delusions. Abnormal responses to family. Onset at 1st or 2nd week postpartum.
PP psychosis (need to be admitted)
How long should women breast feed?
Exclusively for 1st 6 months
encourage for the first year
How do you know a baby is getting enough food?
6-8 wet diapers per day
How many times should you breast feed in 24 hours?
8-12 times
What causes engorded breasts?
Baby not emptying the milk fully
What is reddened/ painful breast, chills, malaise, body aches? caused by S. aureus
Puerperal mastitis
How do you treat puerperal mastitis?
Warm soaks
Analgesia
check breast feeding technique
antibiotics PRN
What are some contraindications for breast feeding?
Illicit drug use
untreated active TB, HIV/ AIDS
Chemo Rx
radioactive dyes/ contrast dyes
