Keppler- lecture 5

Question 1

Puerperium=

Answer 1

birth to 6 weeks

Question 2

Uterus and pelvis:

-involution is complete at _____

Answer 2

6 weeks, 1kg → 100g
○ Lochia through 5-6 weeks
○ Ovulation mean onset 2 months - 6 months postpartum
○ Gradual return of pelvic tone

Question 3

Puerperium:

Urinary / Renal and electrolytes– how much fluid is lost?

Answer 3

• 3-4L fluid loss over 5 weeks

- Bladder distension and retention

Question 4

Puerperium:

hematologic changes?

Answer 4

-Return to normal volume and RBC volume
○ Persistent risk of VTE through 6 weeks PP
○ Similar patterns for CV, Pulm and other systems

Question 5

Postpartum Visit:

-defined by medicaid as _____ days postpartum

Answer 5

21-56 days

Question 6

Postpartum:

-common complaints?

Answer 6

Address and normalize concerns
○ Constipation, hemorrhoids
○ Perineal pain
○ Urinary / fecal incontinence
■ Up to 6 months
○ Perineal healing
○ Return of sexual function

Question 7

Postpartum: PE (includes)?

Answer 7

• Include breast exam, gynecologic exam
  ● Perineum for normal healing, cervix, lacerations
  ● Breasts: masses, nipples for evidence of improper latch

Question 8

Breastfeeding Support:

• colostrum=
• “let down” at ____

Answer 8

• Colostrum 2-3 days

- “Let-down” at 2-3 days

Question 9

Breastfeeding support:

latching and suckling stimulates the release of ______

Answer 9

prolactin and oxytocin

• note: Nipple pain, cracking, bleeding suggest improper latch
• Utilization lactation support

Question 10

Describe Baby blues

Answer 10

Tearfulness, anxiety, irritation, restlessness
○ Up to 70%
○ Self limited

Question 11

Describe Postpartum depression

Answer 11

**Within 12 months of delivery
○ Two weeks persistent symptoms with same diagnostic criteria as MDD
○ Screening: e.g. Edinburgh, PHQ

Question 12

Patients with GDM, screen for ____

Answer 12

DM 2

Question 13

PRN follow up maternal disease and morbidity: (list 3 things)

Answer 13

Hypertensive disease
○ Hypo/hyperthyroidism
○ Autoimmune diseases
● Follow up abnormal Pap / Colpo if indicated

Question 14

Preconceptive Care (describe the components)

Answer 14

Complete H&P
● Identify and manage risks
○ Optimize existing disease
○ Example: DM - A1C > 7% increasing maternal and fetal risks
● Prenatal vitamins and folic acid PRN
● Counseling: Diet, exercise, weight loss

Question 15

Key Points:

-puerperium=

Answer 15

**The Puerperium is the time period between birth and 6 weeks postpartum,
when the uterus involutes and maternal physiology returns to baseline
● Patients should be seen for at least one postpartum visit. This visit should
include a complete exam, counseling and normalizing on postpartum symptoms,
breastfeeding support, indicated lab follow up, and depression screening

Question 16

Key points:

-Postpartum depression?

Answer 16

Postpartum depression is a common MH disorder which may appear up to 12
months postpartum and have similar diagnostic criteria as MDD. Treatment
may include counseling and pharmacotherapy.
● The postpartum visit may be a provider’s last chance at a pre-conceptive visit.
The main goals are assessing and managing maternal risk factors, discuss future
childbearing, and provide appropriate birth control.

Question 17

Which of the following accurately describes the puerperium?

Answer 17

The time between delivery and approximately 6 weeks postpartum when
maternal physiology gradually returns to baseline

Question 18

True or False: A postpartum patient with 2 months of depressed mood, anhedonia,
difficulty sleeping and trouble bonding with her newborn can be reassured that her
symptoms are just the “Baby Blues” and will improve with time?

Answer 18

FALSE