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Dr. Omar's Deck of Secret Knowledge > OB Proper (Normal) > Flashcards

OB Proper (Normal) Flashcards

1
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Cessation of menses

A

Presumptive

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2
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Physical outlining of fetus within the uterus

A

Probable

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3
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Positve pregnancy test

A

Probable

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4
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Perception of Quickening by the mother

A

Probable

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5
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Perception of fetal movement by an examiner

A

Definitive

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6
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Ballottement

A

Probable

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7
Q

Diagnosis of Pregnancy: Presumptive, Probable or Definitive

Fetal heart action, recognition of embryo on UTZ

A

Definitive

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8
Q

HCG measuring, when can it be detected? when does it peak? when is the nadir?

A

Detected: 8-9 days after ovulation
Peak: 8-10 weeks
Nadir: 14-16 weeks (Williams), 18-20 weeks (topnotch)

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9
Q

Diagnosis of Pregnancy: FHTs

A

TV-UTZ: 5 weeks
Doppler: 10 weeks
Stethoscope: 17 weeks, almost all by 19 weeks

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10
Q

Complaints in Pregnancy:

Cause & Tx of varicosities

A

Increased venous pressure in the LE
Relaxing effect of progesterone
Tx: stockings, elevate legs

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11
Q

Complaints in Pregnancy:

Cause & Tx of Hemorrhoids

A

Increased water absorption -> constipation

Tx: warm soaks, stool softeners

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12
Q

Complaints in Pregnancy:

Cause & Tx of Stress incontinence

A

Pressure on bladder

Tx: Kegel exercises

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13
Q

Complaints in Pregnancy:

Cause & Tx of Headache

A

Due to increased estrogen

Tx: massage, ice pack

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14
Q

Complaints in Pregnancy:

Cause & Tx of Pica

A

Iron deficiency

tx: Treat the IDA

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15
Q

Complaints in Pregnancy:

Cause & Tx of Leukorrhea

A

Increased secretion of cervical glands, estrogen-induced

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16
Q

Common causes of fundal discrepancy

A 
False discrepancy (more common): measurement error, error in calculation of AOG.
True discrepancy: pathology of the fetus, amniotic fluid, placenta, uterine wall
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17
Q

10 Danger signs of pregnancy

A

Vaginal: Bleeding, fluid leakage
Abdominal: Persistent vomiting, uterine cramping, decreased FM, Epigastric pain
Others: dysuria, edema, headache, BOV
Chills and fever

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18
Q

Obstetric Milestones

NTD and Chromosomal abnormality screening

A

16-18 weeks

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19
Q

Obstetric Milestones

GDM screening & Rhogam administration

A

24-28 weeks

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20
Q

Obstetric Milestones

GBS screening and Leopold’s manuevers

A

35-37 weeks

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21
Q

Obstetric Milestones

FMC q6-q8

A

Start at 28 weeks

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22
Q

Indications for GBS prophylaxis

A 
Previous infant with GBS infection
GBS bacteruria
Postive GBS screening
Unknown GBS status and:
1) Delivery < 37weeks AOG
2) Membrane rupture > 18 hours
3) Intrapartum temp of > 38C
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23
Q

What makes a reactive NST?

A

2 or more accels within 20 minutes, peak at 15 bpm, lasting 15 seconds

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24
Q

What does a CST measure?

A

Uteroplacental function

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25
Q

5 Components of a BPP

A 
FHR / NST
Breathing
Movements
Tone
AFI
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26
Q

BPP 8/10 with normal AFV

A 
Normal
Repeat weekly (2x/week for GDM Pxs)
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27
Q

BPP 8 w/ abnormal AFV

A

Chronic asphyxiated fetus

>37 weeks deliver

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28
Q

BPP 4-6

A

Possible fetal asphyxia
AFV abnormal: deliver
> 36 weeks: deliver
< 36 weeks: repeat after 24 hours

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29
Q

BPP 0-2

A

Almost certain fetal asphyxia

Deliver.

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30
Q

Doppler Velocimetry Measures

1) Most commonly used
2) Common nonreassuring finding

A

1) UA systolic-diastolic ratio

2) Absent or Reversed End Diastolic Flow

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31
Q

Single most important indicator of an adequately oxygenated fetus

A

Beat-beat variability

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32
Q

Etiology of Acceleration

A

Fetal movement

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33
Q

Etiology of Early deceleration

A

Head compression (vagal compression)

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34
Q

Etiology of Variable deceleration

A

Umbilical cord compression

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35
Q

Etiology of Late deceleration

A

Uteroplacental insufficiency

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36
Q

Cat. I on NST

A

Baseline FHR: 110-160
Mod. Variability
(-) variability / late decel

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37
Q

Cat. III on NST

A

Absent baseline FHR and

  • Recurrent late/var decel
  • Bradycardia

Sinusoidal pattern

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38
Q

Management of Reassuring Tracing

A 
Intrauterine resuscitation: 
Decrease uterine activity
Correct maternal hypotension
Change maternal position
High flow O2

Amnioinfusion: Treatment of variable or prolonged decelerations

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39
Q

Prenatal Diagnosis and Fetal Therapy

Candidates for prenatal diagnosis

A

1) elderly primi
2) >31 yo with mult gestation
3) Previous pregnancy with:
- an autosomal trisomy
- Triple X, or Klinefelter
4) Women with chromosomal abnormalities
5) Repetitive 1st trim abortions
6) Fetus with major structural defects

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40
Q

Most Common isolated fetal structural defect, 2nd

A

1st: Cardiac (VSD)
2nd: NTD (Family hx is most recognized risk factor)

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41
Q

MSAFP screening for NTDs

A

AFP: synthesized in yolk sac then fetal liver
Reported as multiple of median (MoM)
>3.5 MoM = increased fetal risk for NTD

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42
Q

Cranial Signs of NTD

A

1) Small BPD
2) Ventriculomegaly
3) Lemon sign - frontal bone scalloping
4) Banana sign - elongation and downward displacement of the cerebellum
5) Obliteration of the Cisterna Magnus

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43
Q

Components of the Quadruple Serum Marker

A 
ACEI
AFP
Chorioinic gonadotropin
Estriol
Inhibin
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44
Q

Down’s Quadruple Serum Markers

A

Dec AFP
Inc Chorioinic gonadotropin
Dec Estriol
Inc Inhibin

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45
Q

Edward’s Quadruple Serum Markers

A 
All DECREASED
AFP
Chorioinic gonadotropin
Estriol
Inhibin
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46
Q

Prenatal Test of Choice

Fetal Karyotyping in the second trimester

A

Second trimester amniocentesis

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47
Q

Prenatal Test of Choice
Associated with postprocedural pregnancy loss
Associated with talipes equinovarum

A

Early amniocentesis (11-14th weeks)

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48
Q

Prenatal Test of Choice
Need for early karyotyping
Less risks for deformities

A

Chorionic villus sampling (as early as 9th week)

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49
Q

Prenatal Test of Choice

Diagnostic assessment of Red cell anemia or alloimmunization

A

Cord blood sampling

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50
Q

4 Phases of Parturition

A

1) Quiesence
2) Activation
End: Onset of Labor
3) Stimulation
End: Delivery of Conceptus
4) Involution
End: Restoration of fertility

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51
Q

Key Points

Phase 1 Parturition

A 
Myometrial quiesence
PROGESTERONE: mediator
Unyielding cervix
Irregular low intensity contractions
Braxton Hicks contractions
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52
Q

Mechanisms for Uterine Quiesence

A

Calcium sequestration
Inhibition of oxytocin receptor synthesis
Increased enzymatic degradation of uterotonics
Inhibition of contractile signal propagation

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53
Q

Key Points

Phase 2 Parturition

A

Increased uterine responsiveness to uterotonins
ESTROGEN: mediator
Cervical ripening
Increased frequency of painless contractions
6-8 weeks
Formation of the lower uterine segment

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54
Q

Differentiate between physiologic ring and the pathologic ring of Bandl.

A

Physiologic: separates lower and upper uterine segment
Pathologic: abnormal junction with extreme LUS thinning, increased risk for uterine rupture, common cause of obstructed labor.

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55
Q

Phase 3 Key Mediator:

A

Oxytocin (also for phase 4)

Minor: Prostaglandin, serotonin, histamine

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56
Q

Most common fetal lie

A

Longitudinal

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57
Q

Most common fetal presentation

A 
~98% cephalic
~2.7% breech
Transverse
Face
Brow
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58
Q

Characteristic fetal position

A 
Fetus convex
Head flexed, chin on chest
Thighs flexed
Legs bent on knees
Arms crossed over thorax
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59
Q

Most common fetal position

A

Occiput Anterior (L > R)

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60
Q

Station is expressed as plus-minus values at the level of?

A

The Ischial spine

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61
Q

Key differences between true labor and false labor?

A

True labor: (+) cervical effacement and dilatation

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62
Q

Confirmatory tests for rupture of membranes:

(+) collection fluid in the vagina

A

Pool test

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63
Q

Confirmatory tests for rupture of membranes:

Takes advantage of the alkaline nature of the amniotic fluid

A

Nitrazine test

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64
Q

Confirmatory tests for rupture of membranes:

(+) crystallization under a microscoped

A

Fern test

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65
Q

4 parameters of the cervical exam?

Bishop score?

A 
Effacement
Dilatation
Consistency
Position
Bishop score: add Station
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66
Q

How does one interpret the Bishop score

A

> 8 favorable
6-8 equivocal
<6 unfavorable

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67
Q

What does the Bishop score indicate

A

Cervical status prior to labor induction

68
Q

Obstetric Anesthesia

What are the stage 1 methods?

A 
Natural method (controlled breathing)
IM narcotics: meperidine, morphine (WOF: neonatal resp. depression)
Paracervical block: anesthetic into the vaginal fornices
69
Q

Obstetric Anesthesia

What are the stage 1&2 methods?

A

Epidural block: favorite method of anesthesiologists

SE: maternal hypotension, spinal headache

70
Q

Obstetric Anesthesia

What are the stage 2 methods?

A

Pudendal block: block of pudendal nerve (landmark: ischial spine)
Variable degree of pain relief.

71
Q

3 main forces during Labor

A

1) Maternal intra-abdominal pressure
2) Force of resistance
3) Forces that change the cervix

72
Q

Cardinal movements

Cephalic

A 
EDFIrE ErE
Engagement
Descent
Flexion
Int. Rotation
Extension
Ext. Rotation
Expulsion
73
Q

Cardinal Movements

Breech

A 
(DEIL DR)
Descent
Engagement
Int. Rotation
Lateral flexion
Delivery
Restitution
74
Q

Cardinal Movements

Face

A 
DIF A(ErE)
Descent
Int. Rotation
Flexion
Accessory movements of Ext. Rotation and Expulsion
75
Q

Cardinal Movements

Prerequisite for delivery

76
Q

Cardinal Movements

Demonstrates adequacy of pelvic inlet

A

Engagement

77
Q

Stages of Labor
Divisions?
Phases?

A

3 Divisions: Preparatory, Dilatational, Pelvic

2 Phases: Latent, Active

78
Q

Stages of Labor

Active phase: reflects the fetopelvic relationship

A

Deceleration phase

79
Q

Stages of Labor

Active phase: predictive of labor outcome

A

Acceleration phase

80
Q

Stages of Labor

Active phase: measures efficiency of the “machine”

A

Phase of maximum slope

81
Q

Three stages of Labor?

A

1st: latent and active phase
2nd: 10cm dilatation to delivery of fetus
3rd: delivery of fetus to delivery of placenta

82
Q

Duration: latent phase for a nullipara, multi?

A

Nulli: <14 hours

If greater, Prolonged latent phase

83
Q

Speed of cervical dilatation during active phase?

A

Nulli: ~1.2 cm/hr
Multi: ~1.5 cm/hr
If less than, Protracted active-phase dilatation

84
Q

Maneuver where the OB’s hand exerts forward pressure on the fetus’ chin through the perineum just front of the coccyx, while the other hand exerts pressure posteriorly against the occiput

A

Ritgen’s Manuever

85
Q

Signs of Placental Separation

A

Calkin sign: uterus becomes globular
Gush of blood
Uterus rises in the abdomen
Lengthening of the cord

86
Q

Signs of Fetal Death in Utero

A

Sonographic: Spalding sign (overlapping fetal skull bones)
Radiographic: Roberts sign (+) gas bubbles in the superior sagittal sinus

87
Q

Arrest Disorders (Nullipara)

A

Prolonged deceleration: >3 hours
Secondary arrest of dilatation: >2 hours
Arrest of descent: >1 hour
Failure of descent: No descent in deceleration phase or second stage

88
Q

Arrest Disorders (Multipara)

A

Prolonged deceleration: >1 hours
Secondary arrest of dilatation: >2 hours
Arrest of descent: >1 hour
Failure of descent: No descent in deceleration phase or second stage

89
Q

Management of Arrest Disoders

A

1) Evaluate for CPD, if (+) do CS

2) If (-) CPD, augment labor

90
Q

3 P’s of Abnormal labor

A

Power
Passenger
Passage

91
Q

Prolonged 3rd stage of labor

A

Undelivered placenta >30 minutes

92
Q

2 criteria needed to be met before diagnosis of active phase disorders.

A

Latent phase completed, cervix dilated 4cm or more

Uterine contraction pattern of 200 Montevideo units in 1 minute period w/o cervical change

93
Q

Types and treatment of Uterine Dysfunction

A

Hypertonic: asynchronous uterine contractions, basal hypertonus
Tx: sedation

Hypotonic: inefficient contractions
Tx: oxytocin

94
Q

Oxytocin can only be given when:

A 
Cervix is at least 4cm
CPD is ruled out
No abnormal fetal presentation
Fetus is in good condition
No signs of hyperstimulation

Caution if patient is >35 y.o, Para >5, (+) uterine scars

95
Q

Causes of Uterine Dysfunction

A

Epidural anesth
Chorioamnionitis
Poor maternal positioning during labor

96
Q 
CPD
Pelvic Inlet contraction is diagnosed when,
DC <
AP <
GTD
A

Diagonal conjugate < 11.5cm
Shortest AP diameter < 9cm
Greatest transverse diameter < 12cm

97
Q

CPD
Midpelvis contraction is diagnosed when
Interischial spinous diameter is < ____?

A

<8 cm

Suspect if less than 10 cm

98
Q

CPD

Pelvic Outlet contraction is diagnosed when intertuberous diameter is _____?

99
Q

Abnormal Presentations for Delivery

Face Presentation

A

Face presenting, with chin ant or post to symphysis
Etiology: contracted pelvis, large fetus, anencephaly, associated with anthropoid pelvis
Management: SVD, CS if with pelvic contraction

100
Q

Abnormal Presentations for Delivery

Brow Presentation

A

Area between the orbital ridge and ant. fontanel presents
Etiology: same as face
Transient prognosis, will eventually convert

101
Q

Abnormal Presentations for Delivery

Transverse Lie

A

Aka shoulder presentation
Etiology: lax abdominal wall, preterm, placenta previa, contracted uterus, polyhydramnios
Tx: CS

102
Q

Sepsis noted due to rupture of membranes with extrusion of the fetal arm outside the vagina

A

Neglected transverse lie

103
Q

Abnormal Presentations for Delivery

Compound Presentation

A

Extremity prolapses along with presenting part

Tx: Gently push the limb upward while applying downward pressure to bring the head down

104
Q

Abnormal Presentations for Delivery

Persistent Occiput Posterior

A

Due to transverse narrowing of the midpelvis

Tx: manual rotation to anterior position then forceps OR SVD if pelvic outlet is ample, vagina and perineum are relaxed.

105
Q

Abnormal Presentations for Delivery

Deep Transverse Arrest of the Head

A

Associated with an android or platypelloid pelvis
Etiology: hypotonic dysfunction
Tx: Kielland forceps, oxytocin to improve uterine dysfunction

106
Q

Fetal consequences of Shoulder dystocia

A

Fractured humerus or clavicle

Erb’s palsy

107
Q

Maternal complications of shoulder dystocia

A

Postpartum hemorrhage
- cervical lacerations
- uterine atony
Puerperal infection

108
Q

Management of Shoulder Dystocia

Order of Manuevers

A

1) Call for help! Gentle traction, drain bladder
2) Episiotomy
3) Suprapubic pressure with downward traction of the head
4) Mc Robert’s Maneuver
5) Wood Corkscrew
6) Deliver posterior shoulder
7) Last resort:
- Symphysiotomy
- Cleidotomy
- Zavanelli manuever

109
Q

Dystocia Maneuvers

Fetal shoulders rocked from side to side by applying force on the mother’s abdomen

A

Rubin’s maneuver

110
Q

Dystocia Maneuvers

Cephalic placement into the pelvis, then CS

111
Q

Dystocia Maneuvers

Cutting of clavicle with scissors

A

Cleidotomy

112
Q

Dystocia Maneuvers

Progressive rotation of the posterior shoulder 180 degrees

A

Wood’s corkscrew

113
Q

Dystocia Maneuvers
Sharply flexing thighs over abdomen to straighten the sacrum relative to the lumbar spine so that the angle of inclination decreases which frees the ant. shoulder

A

Mc Roberts Maneuver

114
Q

Dystocia Maneuvers

Pressure is applied to the fetal jaw and neck with strong suprapubic pressure from an assistant

A

Hibbard’s maneuver

115
Q

Fetal macrosomia

A

BW > 4000g

Elective CS for non-GDM >5000g, GDM >4500g

116
Q

Fetal hydrocephalus

A

Normal head circ: 32-38 cm
Cephalic pres: may do cephalocentesis before CS
Breech: labor can be followed to progress then cephalocentesis

117
Q

Precipitous labor is defined as _________

A

Cervical dilatation
Nulli: 5cm/hr or faster
Multi: 10cm/hr or faster

118
Q

Effects of Precipitous labor (mat and fetal)

A

Maternal: PPH, uterine rupture, extensive lacerations, amniotic fluid embolism
Fetal: hypoxia, trauma

119
Q

Mechanisms of Placental Extrusion

A

Schultze: detachment from center, glistening amnion presents
Duncan: detachment from periphery, maternal side presents

Shiny Schultze and Dirty Duncan

120
Q

Labor Induction

Maternal indications

A 
Fetal demise
Prolonged pregnancy
Chorioamnionitis
Severe Pre-Ec
Other medical conditions
121
Q

Labor Induction

Fetal Indications

A 
IUGR
Abnormal fetal testing
Infection
Oligohydramnios
Post-term
122
Q

Contraindications to Labor Induction

A

Prior uterine incision, contracted pelvis, abnormal presentation, genital herpes, cervical CA

Macrosomia, multifetal gestation, hydrocephalus, malpresentation

123
Q

Differentiate early and late amniotomy

A

Early: 1-2 cm dilatation, shortens labor by 4 hours
SE: inc. chorioamnionitis, cord compression

Late: 4-5 cm dilatation, accelerates labor by 1-2 hours

124
Q

Pharmacologic and Mechanical Inducers of labor

A

1) Oxytocin
2) Prostaglandins (misoprostol)
3) Laminaria

125
Q

Obstetric Anesthesia

Causes of pain due to uterine contraction

A

1: compression of nerve ganglia in the cervix and uterus

2) hypoxia of contracted uterus
3) stretching of cervix
4) stretching of peritoneum

126
Q

Sensory innervation of the genital tract

A

Lower Genital tract: Pudendal nerve (S2-S4)
2nd and 3rd stage pain

Upper Genital tract: Frankenhauser ganglion plexus (T11-T12)
1st stage pain
uterus, cervix, upper vagina

127
Q

Anesthetic contraindicated in pre-eclamptic patients

128
Q

Most commonly used anesthetic

A

meperidine

129
Q

Anesthetic for use in epidurals

A

Bupivacaine, lidocaine

130
Q

4 types of Regional OB anesthesia

A

1) Pudendal
2) Paracervical - 3 and 9 o’clock positions of the cervix, for stage 1
3) SAB - for CS, block at least up to T8
4) Epidural - gold standard, ideal for pre-ec, adequate relief for stage 1 & 2.

131
Q

Indications for GA use

A

Int. podalic version of 2nd twin
Breech decomposition
Replacement of inverted uterus
Severe mat. hemorrhage

132
Q

Complications of Epidural anesth

A 
High spinal block
Hypotension
Urinary retention
Headache
Post puncture seizures
Meningitis
MI
133
Q

Contraindications to epidural anesth

A

Anticipated serious maternal bleeding
Infection near site of anesth
Suspicion of neurologic disorder

134
Q

Forceps delivery

Most important function of forceps?

135
Q

Parts of a forcep?

A

Blade, shank, lock handle

136
Q

Forceps delivery:

For delivery of molded head

A

Simpson

- has ample pelvic curve and fenestrated blade

137
Q

Forceps delivery:

Fetus with rounded head

A

Tucker Mac Lane

Solid blade, narrow shank

138
Q

Forceps delivery:

Deep Transverse arrest of the head

A

Kielland

Sliding lock, minimal curvature

139
Q

Forceps delivery:

Breech

A

Piper forceps

140
Q

Differentiate Mid, Low, and Outlet forceps

A

Mid: Station 0 to +1
Low: Station +2, not yet at pelvic floor, rotation at 45deg
Outlet: scalp visible at introitus, rotation <45 deg

141
Q

Prerequisites for Forceps delivery

A 
FORCEPS
Fully dilated cervix
Occiput anterior, Chin anterior
Ruptured membranes
CPD ruled out
Engaged head
Position of head known
Skilled practitioner (PGH addendum)
142
Q

Contraindications for Forceps

A 
I MAUL
Incompletely dilated cervix
Marked CPD
Absence of proper indication
Unengaged fetal head
Lack of experience
143
Q

Complications of Forceps Delivery

A

Maternal: PPH, lacerations
Natal: Cephalhematoma, ICH, Facial Nerve palsy

144
Q

Cesarean Section

Indications

A 
Repeat CS
CPD
Breech
Hemorrhagic complications
Hypertensive disorders
Uterine dysfunction
Fetal distress
145
Q

CS Incisions

Excellent cosmesis, curvilinear incision/”bikini cut”

A

Pfannenstiel aka Transverse suprapubic

146
Q

CS Incisions

Transverse incision made with the rectus muscles being divided with scissors

147
Q

CS Incisions

Infraumbilical midline incision

A

Ummm… yeah… nothing much to say about this.

148
Q

CS Incisions

Uterine incision of choice, easy to repair, least likely to rupture, least adhesions

A

Transverse / Kerr AKA LTCS.

149
Q

CS Incisions

Vertical uterine incision

150
Q

CS Incisions

Vertical uterine incision on the uterine body reaching the fundus

151
Q

Indications for Classical CS

A

1) Non-availability of the Lower uterine segment: myoma, cancer, dense adhesions with bladder
2) Ant. implanted previa
3) Neglected transverse lie
4) Massive maternal obesity
5) LUS is not sufficiently thinned out

152
Q

Indications for Postpartum hysterectomy

A 
Intractable uterine atony
Placenta accreta
Laceration of a major uterine vessel
Large myomas
Severe cervical dysplasia
CA in situ
153
Q

Candidates for VBAC

A

1) prior LTCS
2) Clinically adequate pelvis
3) Double setup

154
Q

Puerperium

Duration?

A

From delivery up to 6 weeks after.

155
Q

Pueperium

Timeline of uterine involution

A

2-3 days: superficial layer of decidua sloughed off
2 weeks: uterus descends to true pelvis
3 weeks: endometrium restored
4 weeks: non-pregnant size of uterus

156
Q

Puerperium

Timeline of Decidual Shedding

A

Rubra: blood, Days 1-3
Serosa: pale colored, Days 4-10
Alba: White to yellow-white due to leukocytes, Day 10 to Week 4-8

157
Q

Common causes of prolonged uterine involution

A

Retained placental fragments
Late onset metritis (usually due to chlamydia)

Tx: Methylergonavine, treat chlamydia

158
Q

Late postpartum hemorrhage

A

1-2 weeks into puerperium

159
Q

Pueperium

Common urinary problems

A

Overdistention, incomplete empyting
2nd-5th day: Diuresis
2nd-8th week: Dilated ureters and renal pelvis return to nonpregnant size
4th-6th week: normal function

160
Q

Puerperium

Blood and fluid

A

1 week post: Volume is back to normal

2 weeks post: CO returns to pre-pregnant state

161
Q

Puerperium

Weight

A

Uterine evacuation and involution: 5-6kg
Diuresis: 2-3 kg
Decrease in “sodium space”: 2kg

162
Q

Puerperium

Breast

A

accelerates uterine involution

contraception from 2-6 months

163
Q

Puerperium

Postpartum depression

A

within 6 weeks, patient is hopeless, anxious, and in despair

Key feature: mother neglects herself and baby

164
Q

Puerperium

Contraception for Lactating women

A

started after 2-3 weeks
progestin only pills

at 6 weeks
DMPA
OCP
IUD

165
Q

Puerperium

Lactational amenorrhea method of contraception

A

98% effective if:

Mother is not menstruating, nursing 2-3x/night, every 4 hours during the day.

166
Q

Puerperium

Postpartum fever

A

Definition: >38C, on any two of the first 10 postpartum days exclusive of the 1st 24 hours.
Most important risk factor: Route of delivery
Most common cause: Endometritis

167
Q

Causes of Postpartum fever

A 
Day 0: Atelectasis (wind)
Day 1: UTI (water)
Days 2-3: Endometritis (womb)
Days 4-5: Wounds (wound)
Days 5-6: DVT (walk)
Days 7-21: Mastitis

Dr. Omar's Deck of Secret Knowledge (57 decks)

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