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Medicine II: OBGYN > Complications of the Postpartum Period > Flashcards

Complications of the Postpartum Period Flashcards

1
Q

What is the definition of post partum hemorrhage?

A

EBL>500ml after a vaginal delivery

EBL>1000ml after a cesarean

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2
Q

What is the number one cause of post partum hemorrhages? How do you manage these patients?

A

uterine atony such as drugs, chorioamnionitis, uterine overdistention, and uterine malformation

Uterine massage-methergine-PGF2a

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3
Q

What are other causes of postpartum hemorrhages?

A

retained placenta (accreta- superficial)
Lacerations (vaginal and cervivcal)
coagulopathy

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4
Q

What are vaginal lacerations most likely from?

A

instrumental vaginal delivery

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5
Q

What are cervical lacerations most likely from? How do you manage it?

A

precipitous labor; repair laceration

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6
Q

What are examples of coagulopathy related causes of postpartum hemorrhages? How do you manage these patients?

A

severe preclampsia
abruptio placentae
sepsis
amniotic fluid embolism

cryoprecipitate

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7
Q

What are the classifications of puerperal infection?

A

endometritis
wound infection
UTI

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8
Q

What are the risk factors for endometritis?

A 
labor
ruptured membranes
multiple vaginal exams
preexisting vaginal infections (BV, GBS)
Cesarean delivery (10-15% compared to vag delivery)
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9
Q

What is the main risk factor of endometritis?

A

Cesarean

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10
Q

What are the bacteriods?

A

anaerobic gram - rods

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11
Q

What are the coliforms?

A

aerobic gram -: e. coli and klebsiella

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12
Q

what are the streptococci?

A

GBS, Staph, Anaerobic strep

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13
Q

What are the requirements of dilation for a vaginal delivery?

A

atleast a +3- +5 dilation otherwise cesarean; need to see the babies head

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14
Q

What are the clinical manifestations of endometritis?

A

fever
tachycardia
pelvic pain and tenderness
no other localizing sign of infection

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15
Q

What are the antibiotic treatments for endometritis?

A

clindamycin plus gentamicin
**metronidazole plus penicillin or ampicillin plus gentamicin
broad spectrum cephalosporin or penicillin (cefotetan, timentin)

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16
Q

What is the frequency of a wound infection after a cesarean?

A

3-5%; usually in sub cut. fascia, dont let it spread farther

17
Q

What are the principal risk factors for wound infections?

A

obesity
pre-existing infection- ie chorioamnionitis
emergency procedure- inadequate skin prep
diabetes
immunodeficiency disorder

18
Q

What are the main organisms responsible for wound infections?

A

mixed flora (most)
strep
staph

19
Q

What is the clinical presentation of a wound infection?

A

Incisional abscess- pus

cellulitis- bright red and tender

20
Q

What is the treatment for a wound infection?

A

Surgical drainage if an abscess

modify antibiotic coverage to target staphylococci and streptococci (nafcillin and vancomycin)

21
Q

What are the frequencies of UTIs after labor and delivery?

A

3-5%

22
Q

What are the risk factors for a UTI?

A

Prior infection
Prolonged bladder catheterization
sickle cell dz
immunodeficiency disorder

23
Q

What are the main microbes responsible for these UTIs?

A

E. coli**
Klebsiella
Proteus
Gram +

24
Q

What are the clinical manifestations of a UTI?

A

Cystitis- infected bladder ( dysuria, polyuria, hesitency, hematuria, lowgrade fever, suprapubic pain)
Pyelonephritis (fever, chills, flank pain)

25
Q

How do you make a diagnosis of a UTI?

A

Duffs way: in and out cath!

Urine analysis (pH, leukocyte esterase, nitrite test)
Urine culture
26
Q

What is the treatment for a UTI?

A

Oral abx:
trimethoprim-sulfamethoxazole- proteus
**nitrofurantoin- hits all but proteus, cheap
amoxicillin-clavulanic acid- if highly resistent but want to treat orally

27
Q

How do you treat a patient via IV if the have kidney problems?

A

aztreonam

28
Q

Virchow’s Triad

A

endothelial injury
venous stasis
hypercoagulable state

29
Q

What is the prevelance of a thromboembolism?

A

<1%

30
Q

What re the principal risk factors of a thromboembolism?

A 
****Cesarean delivery
obesity
prolonged bedrest prior to delivery
hereditary thrombophilia
sickle cell disease
31
Q

What are the classifications of thromboembolisms?

A

DVT

PE

32
Q

What are the clinical manifestations of a DVT?

A

Erythema
Swelling
Palpable cord

33
Q

What are the clinical manifestations of a PE?

A 
Dyspnea
Tachypnea
Chest pain
Anxiety
Cardiovascular collapse
34
Q

How do you diagnose a DVT?

A

Most widely used: dopple flow

Most definitive test: venography

35
Q

How do you diagnose a PE?

A

***Spiral CT
Ventilation perfusion scan
pulmonary angiogram

36
Q

What is the management for a DVT and PE?

A 
Screen for hereditary thrombophilia
Thrombolytic therapy- for massive embolism
**Anticoagulation
-unfractioned heparin
-LMW heparin
-coumadin (lovanax)
37
Q

What are the principal risk factors for postpartum endometritis?

A

cesarean section

Medicine II: OBGYN (18 decks)

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