CNM Varney's Review Book Part G

Question 1

what is the postpartal period?

Answer 1

from delivery of placenta to return of woman’s reproductive tract to its nonpregnant condition

Question 2

how long doe the normal puerperium usually last?

Answer 2

6 wks

Question 3

by what time after birth is the regemeration fo the endometrium completed at all sites except the placental site?

Answer 3

3 wks

Question 4

by what week after birth has the uterus returned to its nonpregnant weight?

Answer 4

8 wks

Question 5

what is the trigger that causes lactogenesis during first 3-4 days pp?

Answer 5

fall in progesterone and estrogen levels

Question 6

what hormone is predominantly responsible for milk ejection?

Answer 6

oxytocin

Question 7

relation between milk production/ejection and not breastfeeding

Answer 7

milk production will occur but milk secretion will not take place

Question 8

What effect do fear and anxiety have on breastfeeding?

Answer 8

prevent milk ejection in bf women

Question 9

what are normal findings in a woman early pp hours?

Answer 9

Fundus palpable at or above level of umbilicus
Significantly increased urine output
pulse rate 50 bpm (?)

Question 10

how is postpartum infection dx with temp?

Answer 10

after 24 hours since birth, 100.4 or higher on two occasions 6 hours apart

Question 11

Rh immune globulin should be administerd postpartally to ?

Answer 11

woamn with Rh neg blood with an infant with Rh pos blood, with negative direct-Coomb’s test

Question 12

if a mom has a positive direct Coomb’s test, does she need Rhogam?

Answer 12

no, because she is already sensitized

Question 13

Waht is breast engorgement caused by?

Answer 13

milk and lymphatic stasis

Question 14

How can one relive breast engorgement in a non-bf mom?

Answer 14

breast binder

Question 15

indirect Coombs test

Answer 15

used prenatally and prior to transfusions. detects antibodies against RBCs that are present unbound in patient’s serum. If agglutination happens, test is positive

Question 16

direct Coombs test

Answer 16

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.

Question 17

hemolytic dz of the newborn (anti-Kell)

Answer 17

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.

Question 18

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?

Answer 18

peurperal morbidity

Question 19

What kind of infection is septic thrombophlebitis?

Answer 19

puerperal infection

Question 20

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?

Answer 20

endometritis

Question 21

Day 2 pp: pain in L leg. PE: slight temp 99.4, pulse 86, are on L calf warm to touch, extrememly tender, red

Answer 21

superficial venous thrmbophlebitis

Question 22

What is contraindicated in mangement of thrombophlebitis?

Answer 22

therapeutic massage to affected extremity

Question 23

in addition to pp blues and pp psychosis, what other conditions should be included in diff dx list for pp depression?

Answer 23

pp thyroiditis

Question 24

what is the tx of choice for uterine subinvolution dx at a 4wk pp visit?

Answer 24

Methergine

Question 25

normal temp change first 24 hr pp

Answer 25

up to 100.4F

If temp up after first 24 hrs, is abnormal

Question 26

septic thrombophlebitis

Answer 26

condition characterized by venous thrombosis, inflammation, and bacteremia

Question 27

sheehan’s syndrome

Answer 27

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.

Question 28

Asherman’s syndrome

Answer 28

unterine adhesions

Question 29

postpartum thyroiditis

Answer 29

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

Question 30

Hashimoto’s dz

Answer 30

chronic lymphocytic thyroiditis: immune system attacks thyroid = hypothyroid; Most common cause of hypothyroidism in US; primarily affects middle-aged women