Chapter 35: The Postpartum Uterus Flashcards
formation of a blood clot owing to inflammation
thrombophlebitis
Radiographic examination of the vein performed after injection of a radiopaque contrast medium
Venogram
stones within the kidney
nephrolithiasis
radiographic images of the kidneys, ureters, and bladder after injection of a radiopaque dye
intravenous pyelogram
reduction of an organ to its normal size and appearance
involution
removal of the uterus
hysterectomy
collection of blood outside the vessels
hematoma
moving particles, such as thrombosis or air, within the bloodstream
emboli
portion of the uterine lining which forms the maternal portion of the placenta
decidua basalis
defect in the body’s clotting mechanism resulting in bleeding
coagulopathy
inflammation of the amnion and chorion owing to a bacterial infection
chorioamnionitis
lack of normal muscle tone
atony
The puerperium:
a. describes the postdelivery condition of the female external genitalia
b. starts immediately post delivery including the placenta and continues until the uterus retains it prenatal shape
c. is an infection of the placental site within the uterus
d. extends from placental delivery until the first normal menstruation
b
Lactation termination usually produces:
menstrual resumption
sonography in the puerperium period is used for all except:
a. evaluation puerperal infection
b. postpartum hemorrhage
c. complications following cesarean delivery
d. to routinely determine whether the uterus has returned to prepregnancy state
d
Select the true statement regarding the postpartum uterus.
a. the internal os will be visualized as closed and well delineated following placental delivery
b. the endometrium will measure 3 to 8 mm within 24 hours of delivery
c. free fluid in the endometrial cavity indicates intrauterine infection
d. longitudinal uterine measurements range from 14 to 25 cm
d
during pregnancy, ovaries generally:
a. remain the same as prepregnancy state with the exception of a few more cysts in the first trimester
b. involute
c. enlarge owing to hormone production
d. develop a thickened outer cortex
a
A placenta that completely invades the uterine myometrium extending into the serosa is:
placenta percreta
Select the condition that is not likely to be related to postpartum hemorrhage.
a. decreased hematocit
b. shock
c. hypertension
d. hysterectomy
c
RPOC has a similar sonographic appearance to:
highly echogenic mass in the endometrial canal
Usually the first indication of uterine (pueperium) infection is:
uterine tenderness
the only infection that is not typically related to postpartum infection is:
salpingitis
which of the following is not identified with uterine atony?
a. chorioamnionitis
b. prolonged labor
c. oligohydramnios
d. macrosomy
c
The most common signs of POVT are:
fever, right sided pelvic mass, and pelvic pain
cesarean section delivery:
a. has an increased risk of infection
b. is mostly performed with a vertical incision
c. requires a low-frequency transducer when hematoma occurs adjacent to the bladder flap
d. accounts for approximately 13.8% of all US deliveries
a
the most frequent site of postpartum thrombophlebitis is:
right ovarian vein
Endometritis:
a. is an infection of the endometrium that may extend to the myometrium, which may lead to postpartum bleeding
b. appears as an extremely thin endometrium and irregular walls
c. produces a fluid-filled endometrium
d. causes a flaccid uterus post deliver
a
The postpartum period may also be called the ______
puerperium
complications seen most frequently following cesarean section are _____ and ____ at the incision site
Hematomas
Abscesses
It is essential to remember to use a _____ pressure than when imaging the nongravid uterus
Lighter
If a post C-section patient cannot tolerate trans abdominal or transvaginal imaging, the ____ or _____ imaging method may visualize the C-section incision
Translabial
Transperineal
The adnexal ligaments of the postpartum patient are typically _____ immediately following delivery, usually returning to their pregravid states within ______
Flaccid
1 month
Postpartum hemorrhage is considered over ____ mL of blood with a vaginal delivery and over _____ mL of blood in a cesarean delivery.
500
1000
The cause of placenta accreta, percreta, and increta is complete or partial absence of the _______
Decidua basalis
Antepartum rupture of the uterus causes emergency delivery and ______
Hysterectomy
Sonography helps identify the multiple intraplacental ____ that are indicators of placental invasion of the myometrium
Lakes
The sonographic appearance of endometritis is that of a _____, irregular endometrium that may have ______ in the endocervical canal.
Thick
Fluid
Retained products of conception image as an _____ mass within an irregularly shaped uterus
Echogenic
Sonographically, POVT images as a dilated anechoic to hypoechoic _____ structure extending superiorly from the adnexa
Tubular
Hematomas found in the bladder flap region are sonographically ______ with ill-defined borders that range in size from less than 1 cm to greater than 15cm
Anechoic
A ____-frequency transducer is sometimes needed to adequately assess postpartum cesarean section hematomas
High
Infections following cesarean sections have appearances of anechoic, _____, _____, and with or without definite margins
Cystic
Complex
The postpartum period may also be called the:
puerperium
period of time extending from immediately following the expulsion of the placenta and uterine contents to 6 to 8 weeks after birth or whenever uterus regains its prenatal shape
peurperium
Changes to postpartum uterus back to prepregnancy because of:
withdrawal of pregnancy-induced hormones
Discontinuance of lactation results in:
resumption of ovulation and menstruation
The uterus returns back to the pelvic area between the _____ and ____ within _____ of delivery
pubic symphysis
umbilicus
1 week
Heavier pressure compresses the uterus resulting in:
thinning of the AP diameter
increasing transverse diameter
It is common to image the internal os on day ___ as partially open and ill-defined as it continues to close following delivery
1
The myometrium should measure __-__ cm in thickness
7-10
The endometrium can measure up to ___mm
13
The endometrium will decrease to normal thickness by:
end of postpartum period
It is common to visualize free fluid within the endometrium though it should not measure greater than ___-____ cm.
1.2
1.4
The sagittal postpartum uterus will measure between __ and ___ cm
14
25
The transverse postpartum uterus will measure between __ and ___ cm
7
14
The _____ are typically flaccid immediately following delivery and usually return to pregravid state within one month.
adnexal ligaments
Postpartum hemmorrhage limits vaginal and csection
vaginal 500 mL
csection 1000mL
most common causes of postpartum hemorrhage include
placenta accreta
placenta increta
placenta percreta
Placenta accreta, increta, percreta are due to:
complete or partial absence of the decidua basalis
occurs when placenta adheres to myometrium of uterus instead of endometrium
placenta accreta
occurs when placenta invades myometrium of uterus further than is seen with accreta
placenta increta
occurs when placenta completely penetrates uterine myometrium and extends into uterine serosa
placenta percreta
indicators of placental invasion of the myometrium
placental lakes
through to be caused by atypical blood flow because of abnormal decidual basalis
placental lakes
severe bleeding immediately following delivery
acute hemorrhage
Acute hemorrhage usually results in:
emergency hysterectomy
bleeding that occurs over several days to a few weeks in postpartum period
delayed hemorrhage
Hemorrhage is associated with:
decreased hematocit
hypotension
hysterectomy
renal failure
shock
sometimes death
any infection in the postpartum period characterized by a temperature over 100.4 degrees on any two successive days after first 24 hours postpartum
puerperal infection
signs/symptoms of puerperal infection:
uterine tenderness
chills
headache
malaise
anorexia
lochia or vaginal discharge
Most puerperal infections are:
urinary tract infections
infection of the endometrium
endometritis
usually caused by migration of normal vaginal flora
endometritis
thick, irregular endometrium that may have fluid in the endometrial canal
endometritis
incomplete expulsion of miscellaneous products of conception during labor and delivery
RPOC
highly echogenic mass in the endometrial canal, placental polyp, remnants of placental tissue, heterogeneous mass may contain necrotic tissue, clot, or infection, affects about 1% of term deliveries
RPOC
one of the most frequent causes of puerperineal infection
uterine atony
uterus fails to reach pregravid tone and becomes flaccid and unable to hold its shape
uterine atony
natural reaction to bleeding
clot
inflammation of a vein caused by a thrombus found in lumen of vessel
thrombophlebitis
rare condition found typically in postpartum period, but can also occur with malignancies and PID
thrombophlebitis
hypercoagualability of blood during pregnancy and postpartum period
venous stasis
venous wall damage as a result of uterus expansion and contraction
Virchow’s triad
Majority of thrombophlebitis involves:
right ovarian vein
______ flow in the left ovarian vein reduces spread of infection from uterus
retrograde
During the postpartum period, body decreases blood production, resulting in _____
venous stasis
Thrombophlebitis symptoms typically occur during the first __-__ hours following delivery
48
96
dilated anechoic to hypoechoic tubular structure extending superiorly from adnexa, lack of color or spectral Doppler signal, echogenic thrombus in lumen
thrombophlebitis
Most common site for thrombophlebitis
where IVC and right ovarian vein meet
common csection complications
hematoma
abscess
peritoneum between urinary bladder and uterus
bladder flap
site of most hematomes
bladder flap
occur when there is bleeding at site of incision and body has not reabsorbed blood
hematoma
Placenta accreta, increta, and percreta are abnormal placental penetration of the myometrium, which may lead to _____
postpartum bleeding
______ is an infection of the endometrium that may extend to the myometrium and parametrial tissues
endometritis
______ and endometritis have a similar sonographic appearance
RPOC
Failure of the uterus to contract can lead to:
hemorrhage
Postpartum ovarian vein thrombophlebitis occurs more often in the:
right ovarian vein
_____ and ____ are two complications of a cesarean section
hematomas
infection
