CNM Varney's Review Book Part G Flashcards
normal peurperium; complications of peurperium
what is the postpartal period?
from delivery of placenta to return of woman’s reproductive tract to its nonpregnant condition
how long doe the normal puerperium usually last?
6 wks
by what time after birth is the regemeration fo the endometrium completed at all sites except the placental site?
3 wks
by what week after birth has the uterus returned to its nonpregnant weight?
8 wks
what is the trigger that causes lactogenesis during first 3-4 days pp?
fall in progesterone and estrogen levels
what hormone is predominantly responsible for milk ejection?
oxytocin
relation between milk production/ejection and not breastfeeding
milk production will occur but milk secretion will not take place
What effect do fear and anxiety have on breastfeeding?
prevent milk ejection in bf women
what are normal findings in a woman early pp hours?
Fundus palpable at or above level of umbilicus
Significantly increased urine output
pulse rate 50 bpm (?)
how is postpartum infection dx with temp?
after 24 hours since birth, 100.4 or higher on two occasions 6 hours apart
Rh immune globulin should be administerd postpartally to ?
woamn with Rh neg blood with an infant with Rh pos blood, with negative direct-Coomb’s test
if a mom has a positive direct Coomb’s test, does she need Rhogam?
no, because she is already sensitized
Waht is breast engorgement caused by?
milk and lymphatic stasis
How can one relive breast engorgement in a non-bf mom?
breast binder
indirect Coombs test
used prenatally and prior to transfusions. detects antibodies against RBCs that are present unbound in patient’s serum. If agglutination happens, test is positive
direct Coombs test
detects if antibodies or complement system factors have bound to RBC surface antigens.
A positive test indicates that an immune mechanism is attacking the pateint’s own RBCs.
hemolytic dz of the newborn (anti-Kell)
second most common cause of severe hemolytic dz of newborn after Rh incompatiblity. Caused by mismatch of Kell antigens between mother and fetus. ~91% ppl are Kell neg; 9% Kell pos. Antibodies can cross placenta to fetal circulation.
Finding of anti-Kell antibodies in maternal blood test (indirect Coombs) is indication for early referal to specialist.
A woamn who is in ninth day pp and who yesterday had temp o f 100.6 and tody has temp of 101.4 can be considered to be suffereing from waht?
peurperal morbidity
What kind of infection is septic thrombophlebitis?
puerperal infection
Day 4 pp, last 36 hrs temp 100.8 to 103.1. Uncomplicated prenatal course with twins with exception of 2 UTIs suxxessfully tx. Intrapartum course complicted by 3rd degree laceration and immediate pp hemorrhage for which bimanual uterine compression was applied. PE:
BP 130/78
Temp 102.7
HR 110 bpm
Lungs: clear bilat to ausc
Breasts: tender, slightly engorged bilaterally, cracked nipples
ABdomen: U/1, lower abdominal and uterine tenderness on palpation, neg CVAT, slight bdominal distension
Lochia: scant, odorless
Perineum: laceration repair, edges well approx, mod edematous
Extremitieis: wnl; +1 pedal edema
What is most likely cause of sx?
endometritis
Day 2 pp: pain in L leg. PE: slight temp 99.4, pulse 86, are on L calf warm to touch, extrememly tender, red
superficial venous thrmbophlebitis
What is contraindicated in mangement of thrombophlebitis?
therapeutic massage to affected extremity
in addition to pp blues and pp psychosis, what other conditions should be included in diff dx list for pp depression?
pp thyroiditis
what is the tx of choice for uterine subinvolution dx at a 4wk pp visit?
Methergine
normal temp change first 24 hr pp
up to 100.4F
If temp up after first 24 hrs, is abnormal
septic thrombophlebitis
condition characterized by venous thrombosis, inflammation, and bacteremia
sheehan’s syndrome
severe bleeding during childbirth can result in tissue death of the pituitary. is a type of hypopituitarism.
Sx: not being able to bf, fatigue, lack of menstrual bleeding, loss of pubic and axillary hair, low blood pressure. sx may not show up for years.
Asherman’s syndrome
unterine adhesions
postpartum thyroiditis
painless inflammation of thyroid after birth; last weeks to months; may lead to long-term hypothyroidism.
First s/s are of hypERthyroid:
anxiety, irritability, rapid HR/palpitations, unexplained weight loss, increased sensitivity to heat
Then, as thyroid cells become impaired by inflammation:
fatigue, weakness, unexplained weight gain, increased sensitivity to cold
Hashimoto’s dz
chronic lymphocytic thyroiditis: immune system attacks thyroid = hypothyroid; Most common cause of hypothyroidism in US; primarily affects middle-aged women
