Chapter 2: Tatiana Bennett (Later Postpartum Hemorrhage)

Question 1

criteria for PCOS

Answer 1

need 2 out of 3
* irregular period or lack of period (amenorrhea)
* high testosterone levels (hirsutism, deeper voice)
* polycystic ovaries seen in ultrasound

Question 2

problems associated with PCOS diagnosis?

Answer 2

• increased diabetes risk
• difficulty getting pregnant

Question 3

What laboratory tests are expected in a woman diagnosed with PCOS?

Answer 3

• free and total testosterone
• cortisol
• TSH
• prolactin
• IGF-I
• fasting lipids
• two-hour OGTT
• fasting glucose or hemoglobin A1c

Question 4

what to do if you miss 1 oral contraceptive pill?

Answer 4

take 1 pill as soon as remembered

Question 5

what to do if you miss 2 oral contraceptive pills?

Answer 5

• take 2 when remembered
• take 2 next day
• use protection

Question 6

what to do if you miss 3 oral contraceptive pills, or miss 2 pills in week 3?

Answer 6

• take 1 pill daily until sunday
• start new pack
• use protection
• may miss period

Question 7

when do pap tests start and frequency?

Answer 7

• age 21 regardless of sexual history
• every 3 years until 29

Question 8

when is hpv tested with pap tests?

Answer 8

• age 30-64
• every 5 years
• no more screening after 65+

Question 9

autosomal recessive inheritance pattern

Answer 9

• Need 2 copies of the mutation, one from each parent
• Ex) cystic fibrosis

Question 10

Autosomal dominant inheritance pattern

Answer 10

• Need one copy of the mutation
• Ex) Huntington’s and Rh factor

Question 11

what are braxton hicks contractions?

Answer 11

• False labor, uterine contractions that do not cause cervical effacement and dilation
• Relieved by drinking water or resting

Question 12

True labor characteristics

Answer 12

• 411 rule: contractions that are 4 minutes apart, last at least a minute for at least an hour
• Location: back and front
• Contractions regular
• Not relieved by drinking water, resting

Question 13

Potential side effects of epidural & spinal anesthesia

Answer 13

• hypotension
• pruritis
• urinary retention or bladder distention
• spinal headaches relieved when lying down
• resp depression

Question 14

group b strep treatment

Answer 14

• penicillin G
• IV infuse over 15-30 minutes

Question 15

postpartum assessment frequency

Answer 15

• first hr: every 15 min
• second hr: every 30 min
• hours 3-24: every 4 hours
• after 24 hours: every 8-12 hours

Question 16

what to check in postpartum assessment?

Answer 16

• uterus
• lochia (bleeding)
• perineum
• pain
• IV site
• urinary output
• maternal affect
• Abd incision if c-section
• ambulation, mobility, sensation

Question 17

cause of later postpartum hemorrhage

Answer 17

endometritis
inflammation of uterine lining

Question 18

endometritis treatment

Answer 18

gentamycin and clindamycin

Question 19

postpartum hemorrhage treatment

Answer 19

Methylergonovine maleate

Question 20

risk factors for PPH

Answer 20

• multiple pregnancies
• advanced maternal age
• bleeding or coagulation disorders
• history or family history
• uterine atony
• retained placenta
• hypertensive disorders
• asian or hispanic ethnicity
• maternal obesity
• multiple previous births

Question 21

breastfeeding colostrum composition

Answer 21

• first milk
• immunologic components

Question 22

breastfeeding transitional milk composition

Answer 22

fats, calories, and lactulose increase

Question 23

breastfeeding mature milk composition

Answer 23

almost complete nutrition for infant (carbs, fats, protein, vitamins, minerals, digestive enzymes)

Question 24

breastfeeding latch

Answer 24

• lips flanged out over the breast and not tucked in
• areola fully in mouth
• try to get in first hr of birth

Question 25

frequency of breastfeeding

Answer 25

• hourly
• week old: 8-12 times a day for 5-20 minutes
• infants will cry if hungry
• need vit D supplementation for breastfeeding