Post Partum Care

Question 1

10 B’s of post partum rounds

Answer 1

B- blues (vs PPD)
B- breasts

B- bum

B- bowel

B- babe

B- bladder

B- belly

B- before conditions

B- blood type

B- bleeding

Question 2

6 W’s of postpartum fever

Answer 2

Wind: pneumonia, pulmonary embolus, atelectasis

Water: UTI

Wound: cellulitis, abscess, infected episiotomy

Walking: DVT

Womb: endometritis

Woobies: mastitis, breast abscess

Question 3

management of post partum fever

Answer 3

1. labs
2. culture
3. empiric antibioitcs
4. CXR?
5. anticoagulation for PE/DVT
   - consider ultrasound to look forretiened products of contraception.

Question 4

Risk factors and pathogens of endometritis

Answer 4

endometritis is the infection of the uterus and the uterine lining

risk factors: C section, retained products of coneception, prev infection, BPS positive, recent URTI, manual removal of placenta, chorioamnionitis, prolonged labour

treatment: IV clindamycin and gentamycin until afebrile, later oral cephlex +/- metronidazole.

Question 5

PE at 6 weeks

Answer 5

PE at 6 weeks:

Vitals

MSE/PP depression

Breast exam

Abdomen

Perineum

Bimanual exam prn

Question 6

what is a secondary post partum hemorrhage

Answer 6

Secondary Post Partum Hemorrhage

Definition: excessive uterine bleeding >24 hours and <6 weeks post partum

DDx: endometritis (tone), retained products of conception, uterine atony, bleeding diathesis, arteriovenous malformation, choriocarcinoma, first trimester bleeding

Management:
• Atony: uterotonics, look for cause (RPOC or infection)
• RPOC: dilatation + curettage
• Infection: Abx
• Bleeding diathesis: heme consult
• AV malformation: DI consult
• Choriocarcinoma: gyne consult