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OB > High Risk PP > Flashcards

High Risk PP Flashcards

1
Q

what “traditionally” qualifies as hemorrhage?

A

greater than 500 ml

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2
Q

what are symptoms of PP hemorrhage?

A
  • decreased BP
  • increased pulse
  • restlessness
  • decreased urine output
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3
Q

when does early (primary) postpartum hemorrhage occur?

A

within 24 hours following delivery

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4
Q

what is early (primary) pp hemorrhage related to?

A
  • poor uterine tone-atony
  • lacerations
  • episiotomy
  • retained placental fragments
  • hematoma
  • uterine rupture
  • problems with placental implantation
  • coagulation disorders
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5
Q

what can cause uterine atony?

A
  • over distention
  • prolonged labor
  • grandmultiparity (more than 5)
  • meds (mag sulf)
  • prolonged 3rd stage
  • preeclampsia
  • operative delivery
  • retained placental fragments
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6
Q

what are some ways to manage atony related hemorrhage?

A
  • massage
  • IV access
  • infusion of crystalloid
  • blood products
  • bimanual massage
  • meds (pitocin, methergine)
  • D&C
  • arterial embolism
  • uterine packing
  • ligation of the uterine or iliac artery
  • hysterectomy
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7
Q

what is associated with bright red bleeding with a firm uterus

A

lacerations

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8
Q

what are risks for laceration

A
  • nulliparity
  • epidural
  • precipitous delivery
  • macrosomia
  • operative delivery
  • pitocin
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9
Q

what results from partial separation of the placenta?

A

retained placental fragments

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10
Q

what is a possible cause of retained placental fragments?

A

massaging the fundus prior to separation

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11
Q

what should be done after retained placental fragments?

A
  • placenta should be inspected
  • uterine exploration
  • possible D&C
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12
Q

what is injury to a blood vessel from birth trauma or bleeding of a repair site allows for colelction of blood

A

hematoma

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13
Q

what are risks for PP hematoma

A
  • preeclampsia
  • first full term delivery
  • precipitous labor
  • operative delivery
  • vulvar varicosities
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14
Q

management of PP hematoma

A
  • depends on size - may reabsorb or I&D (incision and drainage)
  • ice/heat
  • antibiotics
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15
Q

what are risks for uterine rupture?

A
  • prior surgery or c/s
  • fetal malpresentation
  • grandmultiparity
  • operative vaginal delivery
  • pitocin induction
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16
Q

what is the management of uterine rupture?

A

surgery, fluids, blood replacement

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17
Q

when does late (secondary) postpartum hemorrhage occur?

A

between 24 hours and 6 weeks post partum

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18
Q

what is late (secondary) pp hemorrhage related to?

A

retained placenta
subinvolution (not returning to pre-preg state)

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19
Q

what would the PP assessment for a patient with subinvolution look like?

A
  • high fundal height
  • rubra > 2 weeks
  • scant brown lochia
  • back ache
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20
Q

what is used for management of late post partum hemorrhage due to subinvolution?

A
  • methergine (contract&constrict)
  • antibiotics (forminfection)
  • possible D&C (retained placenta)
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21
Q

what is infection of the reproductive tract occuring within 6 weeks following delivery?

A

puerperal infection

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22
Q

what classifies puerperal morbidity?

A

a temp of 38 celsius or higher for any 2 of the first 10 days postpartum, exclusive of the first 24 hours

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23
Q

what kind of delivery is at greater risk for puerperal infection?

A

c/s delivery (incision)

24
Q

what are some risks for reproductive tract infections

A
  • c/s delivery
  • diabetes
  • pprom
  • chorioamnionitis
  • multiple vag deliveries
  • lapses in aseptic technique
  • compromised health
  • internal monitoring
  • trauma
  • retained placenta/manual removal
25
Q

what is inflammation of endometrial lining?

A

endometritis

26
Q

what are s/sx of endometritis

A
  • bloody vag discharge
  • foul smelling discharge
  • uterine tenderness
  • fever
  • tachycardia
27
Q

what are causative agents of repro tract infections

A
  • GBS, chlamydia, e. coli
28
Q

what is management of repro tract infections

A

broad spectrum antibiotics

29
Q

what is a repro tract infection that can spread to the entire peritoneal cavity?

A

peritonitis

30
Q

what might you see in an assessment of a patient with an incision infection?

A
  • redness
  • foul drainage
  • warmth
  • approximation
31
Q

what can urinary tract infections be related to?

A
  • PP diuresis
  • increased bladder capacity
  • decreased bladder sensitivity
  • catheterization
  • bacteria
32
Q

what is the inability to empty the bladder due to trauma (first birth, laceration, episiotomy)

A

over distention

33
Q

what is the management of over distention

A
  • catheterize
  • encourage them to empty bladder
34
Q

what can retention of urine, bacteria, and trauma cause?

A

UTI

35
Q

what is a lower urinary tract infection called? (bladder)

A

cystitis

36
Q

what is an upper UTI (kidney) called?

A

pyelonephritis

37
Q

management of UTI?

A
  • urine C&s
  • antibiotics
  • pyridium
38
Q

what is inflammation of lobular connective tissue in the breast?

A

mastitis

39
Q

what are some characteristics of mastitis

A
  • unilateral
  • more frequent in nursing mothers
  • may progress to abscess
  • red, painful, swollen
40
Q

what are causes of mastitis?

A
  • milk stasis (buildup)
  • bacterial invasion
  • trauma (lactation)
  • obstruction of ducts
  • failure to empty breast
41
Q

treatment of mastitis

A
  • frequent breastfeeding
  • supportive bra
  • ice packs
  • meds: antibiotics or analgesics
42
Q

what is the formation of a blood clot called?

A

venous thrombosis

43
Q

what is inflammation leading to the formation of the clot?

A

thrombophlebitis

44
Q

what are causes of thromboembolic conditions?

A
  • hypercoagulablity (inc. in pregnancy)
  • venous stasis
  • vessel injury
45
Q

what are additional blood factors during PP period?

A
  • increased clotting factor
  • thrombocytosis
  • release of thromboplastin
  • increased fibrinolysis inhibitors
46
Q

what are some risk factors of thromboembolic disease?

A
  • c/s
  • immobility
  • smoking
  • prior thrombus
  • varicose veins
  • diabetes mellitus
  • AMA
  • multiparity
  • anemia
  • inherited disorders
47
Q

what are s/sx of superficial thrombophlebitis

A
  • tenderness
  • localized warmth/redness
  • normal temp/low grade fever
  • feel bump
48
Q

management of superficial thrombophlebitis

A
  • heat
  • elevation
  • analgesics
  • bed rest
  • elastic compression stocking
49
Q

what are s/sx of DVT

A
  • edema
  • tenderness
  • pale limb color
  • low grade fever, followed by spike
  • chills
50
Q

management of DVT

A
  • often require heparin therapy (in addition to superficial thrombophlebitis)
51
Q

what is post partum depression also known as?

A

post partum major mood disorder

52
Q

what are symptoms of PPD/PPMMD

A
  • sadness/crying
  • sleep disturbances
  • changes in appetite
  • difficulty concentrating/decisions
  • feelings of worthlessness/inadequacy
  • lacks interest in pleasurable activity
  • lack interest in appearance
53
Q

risk factors of PPD/PPMMD

A
  • primiparity
  • ambivalence about pregnancy
  • PP blues
  • hx of PPD
  • lack of support
  • complications
  • loss of newborn
  • domestic violence
54
Q

what is priority management of PPD/PPMMD

A
  • antidepressants
  • psychotherapy
  • educate patients about PPD prior to discharge
55
Q

what are symptoms of PP psychosis?

A
  • irrational thinking
  • delusions
  • hallucinations
  • confusion
  • agitation
  • hyperactivity
  • insomnia
56
Q

what are risk factors of PP psychosis?

A
  • previous PP psychosis
  • hx of bipolar diorder
  • obsessive personality
  • social factors
57
Q

management of PP psychosis?

A
  • safety priority
  • often hospitalized
  • meds
  • psychotherapy/cognitive behavioral therapy
  • assistance with newborn

OB (19 decks)

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