Keppler- lecture 5 Flashcards
Puerperium=
birth to 6 weeks
Uterus and pelvis:
-involution is complete at _____
6 weeks, 1kg → 100g
○ Lochia through 5-6 weeks
○ Ovulation mean onset 2 months - 6 months postpartum
○ Gradual return of pelvic tone
Puerperium:
Urinary / Renal and electrolytes– how much fluid is lost?
- 3-4L fluid loss over 5 weeks
- Bladder distension and retention
Puerperium:
hematologic changes?
-Return to normal volume and RBC volume
○ Persistent risk of VTE through 6 weeks PP
○ Similar patterns for CV, Pulm and other systems
Postpartum Visit:
-defined by medicaid as _____ days postpartum
21-56 days
Postpartum:
-common complaints?
Address and normalize concerns ○ Constipation, hemorrhoids ○ Perineal pain ○ Urinary / fecal incontinence ■ Up to 6 months ○ Perineal healing ○ Return of sexual function
Postpartum: PE (includes)?
- Include breast exam, gynecologic exam
● Perineum for normal healing, cervix, lacerations
● Breasts: masses, nipples for evidence of improper latch
Breastfeeding Support:
- colostrum=
- “let down” at ____
- Colostrum 2-3 days
- “Let-down” at 2-3 days
Breastfeeding support:
latching and suckling stimulates the release of ______
prolactin and oxytocin
- note: Nipple pain, cracking, bleeding suggest improper latch
- Utilization lactation support
Describe Baby blues
Tearfulness, anxiety, irritation, restlessness
○ Up to 70%
○ Self limited
Describe Postpartum depression
**Within 12 months of delivery
○ Two weeks persistent symptoms with same diagnostic criteria as MDD
○ Screening: e.g. Edinburgh, PHQ
Patients with GDM, screen for ____
DM 2
PRN follow up maternal disease and morbidity: (list 3 things)
Hypertensive disease
○ Hypo/hyperthyroidism
○ Autoimmune diseases
● Follow up abnormal Pap / Colpo if indicated
Preconceptive Care (describe the components)
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
Key Points:
-puerperium=
**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
Key points:
-Postpartum depression?
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.
Which of the following accurately describes the puerperium?
The time between delivery and approximately 6 weeks postpartum when
maternal physiology gradually returns to baseline
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?
FALSE
