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Womens Health > post delivery problems > Flashcards

post delivery problems Flashcards

1
Q

postpartum hemorrhage

A

defined as blood loss requiring transfusion or a 10% decrease in hematocrit btw admission and postpartum period

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2
Q

what is the 3rd leading cause of maternal mortalicty in advanced gestational age?

A

postpartum hemorrhage

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3
Q

what are causes of post partum hemorrhage?

A

MC: uterine atony (unable to contract to stop the bleeding

also: Uterine Rupture, Cervical or Vaginal Tears, Placenta Accreta, Congestion, Bleeding Disorder, Disseminated Intravascular Coagulation

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4
Q

what are RF for spontaneous rupture of the uterus

A

grand multiparity, malpresentation, previous uterine surgery, and oxytocin induction of labor (rupture of c sect scar in vag delivery)

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5
Q

what are rf for hemorrhage?

A

rapid or prolonged labor, overdistended uterus, c section

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6
Q

what is early PP hemorrhage?

A

occurs less than 24 hrs after delivery

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7
Q

what problems are associated with early hemor?

A

abnormal involution of placental site, cervical or vaginal lacerations, retained portions of the uterus

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8
Q

what is late postpartum hemo?

A

after 24 hrs to 6 wks postpartume,

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9
Q

what mcommonly causes late pp hemorrhage?

A

subinvolution of uterus, retained products of conception, endometritis

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10
Q

s/sx of pp hemorrhage

A

Hypovolemic Shock → Hypotension, tachycardia, pale/clammy scale, decreased capillary refill

Uterine Atony → Soft, boggy uterus with dilated cervix

may have foul smelling lochia

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11
Q

dx studies for pp hemo

A

CBC to evaluate hemoglobin & hematocrit

US may detect the bleeding source

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12
Q

management of pp hemo

A

initially: uterine massage and compression

Suction & Curettage → May be needed if there is retained products
Antibiotics in some case

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13
Q

what is first line medical management of pp hemo?

A

Oxytocin IV, Methylergonovine, Prostaglandin Agents (IM Carboprost tromethamine, Misoprostol) → These agents enhance uterine contractions & are only used if the uterus is soft & boggy

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14
Q

what does a subinvolution uterus respond to?

A

oral agents like methylergonovine maleate, or ergonovine maleate

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15
Q

what causes almost 20 % of pp hemorrhages?

A

Excessive bleeding from an episiotomy, lacerations, or both

uterus, cervix, vagina, or vulva

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16
Q

what do you need to watch for after perineal lacerations?

A

hematomas → Bleeding is concealed and can be particularly dangerous because it may go unrecognized for several hours and become apparent only when shock occurs

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17
Q

what sx may suggest a laceration or bleeding from epsiotomy

A

Persistent bleeding (especially bright red) and a well-contracted, firm uterus

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18
Q

episiotomy infection s/sx

A

Pain at episiotomy site = Most common symptom → Spontaneous drainage frequent so a mass rarely forms

Incontinence of flatus & stool may be presenting sx of episiotomy that breaks down & heals spontaneously
Inspection of the episiotomy site shows disruption of wound & gaping of incision → Necrotic membrane may cover wound → Should be debrided if possible

rectovaginal fistula has formed
Integrity of the anal sphincter should be evaluated

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19
Q

tx of perineal lacerations

A

Warm sitz baths or Hubbard tank treatments help debridement process.

Attempts to close an infected, disrupted episiotomy are likely to fail and may make ultimate closure more difficult

Surgical closure by perineorrhaphy should be undertaken only after granulation tissue has thoroughly covered the wound site

20
Q

endometritis

A

infxn of uterine endometrium

21
Q

what is chorioamnionitis

A

fetal membrane infxt

22
Q

when is endometritis most common

A

after c section or when membranes ruptured more than 24 hrs before delivery

23
Q

etiology of endometritis?

A

polymicrobial

mc: anaerobic streptococci

24
Q

when do s/sx of endometritis most commonly occur

A

2-3 days postpartum

25
Q

s/sx of endometritis

A 
\+ever (>38°C/100.4°F), tachycardia, abdominal pain & uterine tenderness after C-section, 2-3 days postpartum or postabortal (may present later)
\+adnexal tnderness
\+Mainly clinical diagnosis
\+May have vaginal bleeding/discharge
\+May have foul smelling lochia
26
Q

dx studies of endometritis

A

WBC >20000

UA

27
Q

tx of endometritis post c-section

A

Clindamycin + Gentamicin → May add Ampicillin for additional GBS coverage → Ampicillin/Sulbactam = Alternative

28
Q

tx of endometritis ppoast vag delivery or chorioamniontis

A

amp + genta

29
Q

what can be used for endometritis prophylaxis

A

1st Generation Cephalosporin x 1 dose during C-section to reduce the incidence

30
Q

post-partum depression

A

major depression 2 wks-12 mnhts PP

31
Q

pp blues onset

A

2-4 days

32
Q

duration of pp bludes

A

resolves w/in 10 days

33
Q

s/sx of pp blues

A

Mild insomnia, anhedonia, fatigue, depressed mood, irritability
No thoughts of harming baby

34
Q

tx of pp blues

A

non, self limited

35
Q

pp depression

A

2 wks to 2 mnths pp

36
Q

duration of pp depression

A

3-14 mnths

37
Q

s/sx of pp depresion

A

Irritability, sleep & mood disturbances, eating changes, anxiety
May have thoughts of harming baby

38
Q

tx for pp depression

A

+/- antidepresants

39
Q

PP of endometritis

A

Prolonged rupture of membranes (> 24 hrs), chorioamniotis, too many digital vag exams, prolonged labor, toxemia, c section esp if he of BV, anemia, poor nutrition, low socioeconomic status, coitus near term

40
Q

S/Sx of endometritis

A

Fever, soft tender ut,

Lochia +/- foul odor, WBC

More severe: high fever, malaise, abd tenderness. Ileus, hypotension, generalized sepsis

Diminished bowel sounds, +/- abd distentionbe

41
Q

What is early fever (w/in hours of deliver) and hypotension pathognomic for infxn?

A

With B hemolytic streptococci

42
Q

Complications of endometritis

A

Tubo-ovarian abscess

43
Q

Labs for endometritis

A

CBC
Bacteremia- mycoplasma and bactericides predominant
UA
Lochia cultures

44
Q

Tx of endometritis

A

IV abx

Clinda+ amino (genta)

Ampicillin

IV abx continued until or afebrile for 24 hours

45
Q

Ddx endometritis

A

Uti, pna,

46
Q

What if fever continues w/ endometritis after tx?

A

Further eval for abscess, hematomas, wound infxn, septic pelvic thrombophlebitis

Womens Health (24 decks)

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