Major Postpartum Complications: Recognition, Diagnostic Testing, and Treatment Flashcards
What are the main categories of postpartum complications?
Infectious, vascular, genitourinary, musculoskeletal, and behavioral complications.
What is the most common cause of postpartum hemorrhage?
Uterine atony (failure of the uterus to contract after delivery).
What are risk factors for postpartum hemorrhage?
Prolonged labor, multiple gestation, polyhydramnios, chorioamnionitis, retained placenta, uterine atony.
What are the clinical features of postpartum hemorrhage?
Heavy vaginal bleeding, hypotension, tachycardia, dizziness, uterine atony (boggy uterus).
What is the first-line treatment for postpartum hemorrhage?
Uterine massage, IV oxytocin, fluid resuscitation.
When is surgical intervention needed for postpartum hemorrhage?
If bleeding persists despite medical management (uterine artery embolization, hysterectomy).
What is the most common vascular complication of the postpartum period?
Deep vein thrombosis (DVT) and pulmonary embolism (PE).
What are risk factors for postpartum venous thromboembolism (VTE)?
Cesarean delivery, obesity, prolonged immobility, thrombophilia (e.g., Factor V Leiden mutation).
What are the signs of postpartum deep vein thrombosis (DVT)?
Unilateral leg swelling, pain, erythema, calf tenderness.
What is the initial diagnostic test for suspected postpartum DVT?
Compression ultrasound with Doppler.
What is the treatment for postpartum DVT?
Low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH).
What condition is characterized by inflammation and thrombosis of the pelvic veins postpartum?
Septic pelvic thrombophlebitis.
What are the risk factors for septic pelvic thrombophlebitis?
Cesarean delivery, endometritis, prolonged labor, pelvic infections.
What imaging is used to diagnose septic pelvic thrombophlebitis?
Contrast CT or MRI showing thrombosis of the ovarian vein.
What is the treatment for septic pelvic thrombophlebitis?
IV antibiotics (clindamycin + gentamicin) and anticoagulation (LMWH or UFH).
What is postpartum endometritis?
Infection of the endometrium following delivery.
What are risk factors for postpartum endometritis?
Cesarean delivery, prolonged rupture of membranes, multiple cervical exams, chorioamnionitis.
What are the clinical features of postpartum endometritis?
Fever, uterine tenderness, foul-smelling lochia, abdominal pain.
What is the treatment for postpartum endometritis?
IV clindamycin + gentamicin.
What are the signs of puerperal sepsis?
Fever, tachycardia, hypotension, altered mental status, uterine tenderness.
What is the treatment for puerperal sepsis?
Broad-spectrum IV antibiotics and source control (e.g., evacuation of retained products of conception).
What postpartum infection presents with breast pain, erythema, and fever?
Mastitis.
What is the most common pathogen causing mastitis?
Staphylococcus aureus.
What is the treatment for mastitis?
Oral dicloxacillin or cephalexin, continued breastfeeding.
