Maternal Midterm 2nd sem Flashcards by JARED CROIX LEDESMA

6-week period after birth

Puerperium

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Involution of the uterus and vagina

Retrogressive maternal changes

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Production of milk

Restoration of the menstrual cycle

Progressive maternal changes

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the leading cause of mortality and
maternal morbidity.

Postpartum hemorrhage (PPH)

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occurs within 24 hours of birth hemmorhage

Early(acute or primary)

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occurs more than 24 hours but less
than 6 weeks postpartum hemmorhage

Late (secondary)

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Most Common Causes of PPH

Uterine Atony

Lacerations/hematomas

Retained placental fragments

Disseminated Intravascular Coagulations

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deep attachment of the placenta

Placenta accreta

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What does it suggest if…

it Spurts of blood with clots?

It may indicate partial placental
separation.

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What does it suggest if…

Failure of blood to clot or remain
clotted?

It indicates coagulopathy

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Marked hypotonia of the uterus

Uterine Atony

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Causes of Uterine Atony

High parity

Hydramnios

Macrosomic fetus

Multifetal
gestation

Traumatic birth

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Causes of Uterine Atony

Rapid or prolonged
labor

Chorioamnionitis

Use of halogenated
anesthesia

Use of oxytocin for
labor induction and
augmentation

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What does it suggest if…
Dark blood

venous origin

varices

superficial lacerations of the birth canal.

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What does it suggest if…
Bright blood

arterial

indicates deep lacerations of
the cervix

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Risk factors/Causes of Lacerations

Primigravidas

Large infant (>9lbs)

Use of lithotomy position and instruments

Lacerations of the perineum (the most common)

Classification

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vaginal mucous membrane and skin of
the perineum to the fourchette laceration

First degree

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vagina, perineal skin, fascia, levator
ani muscle, perineal body laceration

Second degree

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entire perineum, external sphincter of
the rectum laceration

Third degree

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entire perineum, rectal sphincter,
mucous membrane of the rectum laceration

Fourth degree

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ligation of bleeding vessels

Episiorrhapy

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Stool softeners examples

Dulcolax

Colase

Docusate

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Retained Placenta
Why bleed?

The retained parts keep the
uterus from contracting
fully.!

Uterine fundus is not firm.

Can be detected through
UTZ and serum HCG levels.

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In Retained Placenta
interventions
?

Manual separation and
removal

Administration of
anesthesia

Blood transfusion

Hysterectomy (may be
indicated)

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Coagulopathies assessed when laboratory results:

o Increased prothrombin time & partial thromboplastin time o Decreased platelet o Decreased fibrinogen o Prolonged bleeding time

Coagulopathies Causes

o Idiopathic or Immune Thrombocytopenic purpura (ITP) o autoimmune disorder, in which platelet antibodies decrease the lifespan of platelets. o Tx: Corticosteroids, IV immunoglobulins, Platelet transfusion

formation of a blood clot or clots inside a blood vessel

Thrombosis

Type of Thrombosis

o Arterial thrombosis o Venous thrombosis

o blood clots form in an artery o arteries carry blood from your heart to the rest of your body. o the most common cause of heart attacks and strokes.

o Arterial thrombosis

o blood clots form in a vein o veins carry blood back to your heart from your body o the most common cause of a pulmonary embolism (blood clot in your lung).

o Venous thrombosis

Complications of Thrombosis Lungs:

Pulmonary embolism

complications of Thrombosis brain

Transient ischemic attack (TIA) or stroke

complications of Thrombosis heart

(coronary artery): Myocardial Infarction (MI)

complications of Thrombosis neck

(coronary artery): TIA or stroke.

complications of Thrombosis belly

(superior mesenteric artery or one of its branches): Mesenteric ischemia

Antiplatelet & anticoagulant (blood-thinners). EXAMPLES

Aspirin, Warfarin, Heparin, & Enoxaparin

o uses medications to dissolve blood clots . o serve as an emergency treatment for MI, strokes, and other thrombosis complications. o e.g., Tissue plasminogen activator (tPA), Streptokinase

Thrombolytic therapy

the most direct way to remove a clot is for a surgeon to access it & remove it.

Thrombectomy

vein inflammation: pain and swelling occur when a blood clot forms in one of your veins.

Thrombophlebitis

Predisposing factors Thrombophlebitis

o Cesarean birth o History of venous thrombosis or varicosities o Obesity o Maternal age over 35 o Multiparity o Smoking

Thrombophlebitis o Precipitating factors

o Increased fibrinogen level o Dilation of lower extremity pressure of the fetal head o Inactivity/ prolonged delivery- pooling and stasis

Types of Thrombophlebitis

Deep Vein Thrombosis (DVT) Pelvic

o blood clots happen in major veins, usually in one of the legs. o swelling, pain, redness, warmth, shiny, red, or white (phlegmasia alba dolens) o Homans’ sign (+), unilateral discomfort on dorsiflexion

o Deep Vein Thrombosis (DVT)

Management of Thrombophlebitis Diagnostics

o Physical examination o Blood tests o Venography (X-ray of the veins o Imaging test (USS)

Management of Thrombophlebitis interventions

o Early ambulation o Side-lying or back-lying o Not to squat o Not to use constrictive clothing o Use anti-embolic stockings o Never massage o Rest the affected leg, elevation

Management of Thrombophlebitis

o Pain Medications, e.g., Paracetamol or NSAID o Anticoagulants (blood thinners), e.g., Heparin & Warfarin o Thrombolytic agents (clot-busting drugs), e.g., Streptokinase o Antibiotics

one of the leading causes of morbidity and mortality throughout the world.

Puerperal infection

o Common Postpartum Infections

o Endometritis o Wound infections o Mastitis o Urinary tract infections o Respiratory tract infections

An infection of the lining of the uterus

Endometritis

Endometritis o What are the Typical laboratory findings?

o Leukocytosis (>20,000 mm³) o Anemia o Blood cultures or intracervical or intrauterine bacterial cultures reveal the offending pathogens within 36 to 48 hours.

Treatment of Endometritis

IV Broad spectrum antibiotic therapy (Cephalosporins, Penicillins, or Lincosamides and Macrolides).

When it already spreads through the peritoneal cavity through fallopian tubes

Peritonitis

Mastitis (Breast Infection)

o First-time mothers Staphylococcus aureus (oral/nasal cavity of infant)

Predisposing Factors mastitis

o Inadequate emptying of the breast o Sudden decrease in the # of feedings, abrupt weaning o Wearing underwire bras o Sore, cracked nipples (provides a portal of entry) o Stress and fatigue o Ill family members o Breast trauma o Poor maternal nutrition

Management mastitis

o Proper way of breastfeeding o Hand hygiene o Expose to air-dry o Vit E (to soften nipples daily) o Broad-spectrum antibiotic o Breastfeeding continued o Breast emptying(2-3h interval) o Cold compresses/ warm o Firm-fit bra o Hydration and a balanced diet

STRESS brought about by

Giving birth o Unmet expectations o Low support o Fetal death/ anomalies

some immediate feelings (1 to 10 days postpartum) of sadness almost every woman notices after childbirth.

Postpartal Blues

occurs as a response to the anticlimactic feeling after birth and is probably related to hormonal shifts

Postpartal Blues

– body’s coordinator for stress response

corticotropin-releasing hormone (CRH)

A feeling of extreme sadness

Postpartum Depression

Postpartal Depression Risk factors

o History of depression o A troubled childhood o Stress in the home or at work o Lack of self-esteem or lack of effective support people

An actual separation from reality Woman appeals exceptionally sad. A severe mental illness that requires referral to a professional psychiatric counselor and antipsychotic medication.

Postpartal Psychosis

Onset post partum blues

1 to 10 days after birth

onset Postpartal Depression

1 to 12 months after birth

onset Postpartal Psychosis

within the first month after birth

Signs & Symptoms post partum blues

sadness, tears

Postpartal Depression s/s

anxiety, feelings of loss, & sadness