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Repro Week 3 > ICL 15.11: Postpartum Complications > Flashcards

ICL 15.11: Postpartum Complications Flashcards

1
Q

how many women are effected by perinatal depression?

A

1/7 women

10-20% of women will experience depression during pregnancy

anxiety disorders generally worsen during pregnancy

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2
Q

what are risk facts for depression and anxiety during or after pregnancy?

A
  1. h/o depression
  2. family history
  3. difficult pregnancy or birth experience
  4. multiple gestation
  5. unplanned pregnancy
  6. problems with partner
  7. financial problems
  8. no support from friends or family
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3
Q

what are postpartum blues?

A

self limiting

less than 2 weeks duration

may occur in first few days after postpartum

normal response to delivery!

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4
Q

what are the symptoms of postpartum blues?

A
  1. restless
  2. weeping
  3. insomnia
  4. labile mood
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5
Q

how do you treat postpartum blues?

A

no therapy indicated due to short duration

it’s a totally normal reaction to giving birth and now having to take care of a baby

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6
Q

what is postpartum depression

A

depression symptoms with gradual onset within the first month postpartum with peak occurrence at 2 months

symptoms of MDD with a significant anxiety components

find it difficult to sleep when baby is sleeping and express concerns about their capacity to care for their babies

may be accompanied by intrusive egodystonic thoughts or images of harm to the bay that are frightening to the woman

no increased risk of self harm , often accompanied by protective behavior, does not necessitate separation of mother and baby

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7
Q

what is postpartum psychosis?

A

earlier and rapid onset within 2 weeks postpartum and often within 48-72 hours

patients will be labile with agitation, restlessness, disorganization, confusion accompanied by delusion and or auditory hallucinations

may have thoughts of harming the baby or herself driven by delusions ro auditory hallucinations –> risk of harm is serious, risk of infanticide is 4% and risk of suicide is 5%

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8
Q

what is lochia?

A

discharge after pregnancy for 3 days after pregnancy that’s red

becomes serous for 4-9 days and then white after that

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9
Q

what is the blood flow to the uterus?

A

uterine artery and the ovarian artery which provides collateral circulation to the uterus

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10
Q

what is postpartum hemorrhage?

A

1000+ mL bleeding with 24 hrs of delivery

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11
Q

what is late postpartum hemorrhage?

A

late bleeding 24 hrs-6 weeks postpartum

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12
Q

what are the causes of immediate postpartum hemorrhage?

A
  1. uterine atony***
  2. vaginal lacerations
  3. retained products of conception (RPOC): like part of the placenta stays stuck
  4. uterine inversion
  5. coagulopathy
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13
Q

why do RPOC cause immediate postpartum hemorrhage?

A

prevents uterus from contracting and indirectly causes uterine atony since part of the placenta is still left

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14
Q

why does uterine inversion cause immediate postpartum hemorrhage

A

uterus can’t contract

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15
Q

what are the risk factors for postpartum hemorrhage?

A

anything that could prevent the uterus from properly contracting:

  1. multiple gestation (uterine overextension)
  2. macrosomia
  3. uterine fibroids
  4. chorioamnionitis
  5. prior history of PPH
  6. placenta accreta/previa
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16
Q

why are fibroids a risk of PPH?

A

it’s a bundle of smooth muscle that isn’t contractile functional and so the uterus can’t contract

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17
Q

why is chorioamnionitis a risk factor for PPH?

A

inflamed chorion and amnion are a risk for PPH because inflamed muscles don’t work as well as non-inflammed muscles aka myometrium won’t be able to contract as well

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18
Q

how do we treat PPH?

A
  1. prostaglandin F2 alpha
  2. pitocin
  3. methlergonovine

Ca channel blockers wouldn’t help at all because Ca is needed for the myometrium to contract and if you block Ca channels she’d bleed!!

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19
Q

how does methlergonovine work?

A

good for PPH because it causes smooth muscle constriction

20
Q

how does pitocin work?

A

good for PPH after delivery because it binds to oxytocin receptors and causes uterine contractions

21
Q

how does prostaglandin F2 alpha work?

A

good for PPH prostaglandins act directly on smooth muscle and cause it to constrict

22
Q

what drug class is used to stop contractions?

A

Ca channel blockers

Ca is needed for muscle contractions!

23
Q

patient platelet count is 40,000. she has no lacerations. what is the most likely etiology of her bleeding?

A. atony
B. retained placenta
C. thrombocytopenia
D. undiagnosed coagulopathy

A

uterine atony

platelets are needed for clotting but if she has no lacerations, why does she need her clotting cascade? she doesn’t…so something else must be causing the bleeding and it’s a dysfunction of the myometrium causing the bleeding

you dont need platelets to stop PPH caused by uterine atony

if she stopped bleeding and then starting bleeding later then maybe it’s thrombocytopenia

24
Q

what are the risk factors for uterine atony?

A
  1. uterine over distention

twins, polyhydramnios, macrosomia

  1. labor

induction, rapid, prolonged

  1. chorioamnionitis
  2. retained products of conception
25
Q

how do you treat PPH?

A
  1. uterine artery ligation (watch out for the ureter!!)

2. tamponade

26
Q

what are the degrees of perineal lacerations that can happen with immediate PPH?

A

1st degree = couchette, perineal skin, mucous membranes torn

2nd degree = muscles of perineal body torn

3rd degree = +anal sphincter is torn

4th degree = + rectum is town

27
Q

what types of hematoma can happen with immediate PPH?

A
  1. vulvar
  2. vaginal
  3. retroperitoneal
28
Q

what is the most common cause of late postpartum bleeding?

A

abnormal involution of the placental site

so basically after the placenta is delivered the area will involve but if that doesn’t happen or the scab doesn’t form properly it can cause late PPH

usually develops 7-14 days postpartum

will find large, soft uterus on PE but US isn’t helpful

29
Q

how do you treat late postpartum bleeding?

A

pharmacologic: pitocin, ergotamine, PGs

antibiotics if there’s a concurrent infection

curettage if above does not work

30
Q

what are the normal changes with lactation?

A
  1. breast engormenet cause by lymphatic and vascular congestion and interstitial edema
  2. flat, dimpled or inverted nipples
  3. soreness
31
Q

what are the contraindications to breast feeding?

A

HIV

32
Q

how do you suppress breast feeding?

A
  1. ice packs
  2. tight bra

bromocriptine is NOT recommended

33
Q

which bacteria is the most common cause of mastitis? how do you treat? is breastfeeding okay?

A

staph aureus from the neonate’s oropharynx

treat with dicloxacillin

breast feeding is encourage to clear out the clogged ducts

34
Q

what are the symptoms of mastitis?

A
  1. inflammation
  2. tenderness of breast
  3. erythema and fever
35
Q

how do you treat mastitis?

A
  1. continue breastfeeding or pmping
  2. antibiotics
  3. if no improvement consider diagnosis of abscess – so make sure all mastitis patients follow up in 6 days to make sure mastitis has resolved
36
Q

what is a breast abscess?

A

persistent symptoms of mastitis despite therapy

may exhibit increased leukocytosis, fever and possible palpable mass

37
Q

how do you treat breast abscess?

A
  1. incision an drainainge
  2. possible surgical consultation
  3. antibiotics for 7-10 days
  4. loosely pack open wound

if MRSA suspected give vancomycin

38
Q

what are the most common causes of postpartum fever? (mnemonic)

A

WWWWB

Ⓦind: pulmonary

Ⓦound: perineum, vagina, cervical

Ⓦomb: endomymometritis, parametritis

Ⓦater: UTI, pyelonephritis

Ⓑreast: engorgement, mastitis

39
Q

what qualifies as a fever?

A

over 38 C

40
Q

what are the causes of postpartum fever?

A
  1. UTI
  2. endometritis
  3. mastitis
  4. episiotomy infection
  5. necrotizing fascitis
  6. pulmonary process
  7. septic pelvic thombophlebitis
  8. drugs
41
Q

what is the biggest risk factor for endometritis?

A

C-section

20x risk

42
Q

how do you diagnose postpartum endometritis?

A
  1. fever without other cause for more than 24 hours
  2. uterine tenderness
  3. foul smelling lochia
  4. +/-leukocytosis

blood cultures are NOT necessary!! this is because it’s a local infection that is caused by the amnotic chorion and since the baby has been delivered the source of infection is now gone

43
Q

how do you treat postpartum endometritis?

A

IV antibiotics until 24 hours afebrile

no additional oral natibiotics are necessary

44
Q

if you diagnose your patient with endometritis what is the next best management step?

A

start antibiotics

45
Q

which contraceptive options are good postpartum?

A
  1. progesterone (doesn’t interfere with breast feeding)
  2. depo-provera
  3. IUD or diaphragm 6 weeks postpartum
  4. breastfeeding

Repro Week 3 (26 decks)

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