Post Partum Care Flashcards
The period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition
Puerperium
When does the involution of the uterus happen?
Immediately after delivery – below umbilicus and firm
Back into pelvis in 2 weeks
How long does it take for the uterus to return back to it’s normal size?
6 weeks
Blood clots and thrombi expelled, decidue necrotic and sloughs
Fairly heavy at first then rapidly decreases over first 2-3 days, but can
last several weeks
Lochia
Which type of lochia is described below?
menses-like, first several days
Lochia rubia
Which type of lochia is described below?
next few days lighter color, considerably less blood
Lochia serosa
Which type of lochia is described below?
whitish discharge that may persist several weeks
Lochia alba
Lochia resolves more quickly in women who do what?
breastfeed = uterine contractions
Post delivery, how long does it take for the cervix to return to down to 1 cm?
1 week
Post delivery, what shape does the os of the cervix take?
Round os becomes transverse
When is the return of ovarian functioning in a lactating and non-lactating patient?
45 days non-lactating
189 days lactating
At a patient’s 6 weeks post partum checkup, inflammatory changes because of a healing cervix may result in what on the pap smear?
inflammatory changes because of healing of the cervix may result in minor atypia on a pap smear performed at this time
Which elevated hormone suppresses function and acts as a natural birth control?
Prolactin
What hormone levels fall immediately after delivery, back to normal in 2 weeks if breastfeeding not initiated?
Estrogen
A woman’s cardiovascular system takes how long to return to normal after delivery?
2-3 weeks back to normal
Ureter and renal pelvis dilation persists how long post delivery?
6-8 weeks
Galactocele
plugged duct
What is produced first 5 days then replaced with mother’s milk?
Colostrum
Colostrum contains what important substance?
immunoglobin A
What medication is prescribed to help with breastmilk production?
Regland
> 500mL of blood after vaginal delivery
4% of vaginal deliveries
Criteria: 10% drop in hematocrit, need for transfusion, tachycardia/tachypnea, orthostatic changes, delayed cap refill, narrowed pulse pressures
Postpartum Hemorrhage
What is the most common cause of postpartum hemorrhage?
uterine atony
Describe the difference between primary and secondary postpartum hemorrhage
Primary - Within 24 hours of delivery, much more serious
Secondary - 24 hours to 12 weeks
List some complications/sequalae of a postpartum hemorrhage?
ARDS
coagulopathy
shock
loss of fertility
Sheehan syndrome (pit necrosis)
What are some risk factors for a postpartum hemorrhage?
Prolonged third stage of labor
Multiple deliveries
Episiotomy
History of post-partum hemorrhage
Fetal macrosomia
What treatment alone is often successful in causing uterine contraction, and this should be done while preparations for other treatments underway?
Bimanual uterine massage
List some medications that are used in the treatment of uterine atony that cause uterine contractions
IV oxytoxin
methylergonovine maleate (Methogen) – ergot derivative
Prostaglandins
possibly packed RBCs
Cytotec and hemabeta – given for uterine bleed post-delivery
List some causes of a a postpartum hemorrhage
Uterine atony
Retained Placenta
Uterine Rupture
Abnormal placenta separation
Lacerations
Coagulopathies
Hematoma
Amniotic fluid embolism
Why is it VERY IMPORTANT to assess delivered placenta and make sure intact?
Placental tissue remaining can interfere with uterine contractions, which can lead to atony and post partum hemorrhaging
Frank opening between uterine cavity and abdominal cavity
Can be at site of previous C-section
Surgical repair required 🡪 medical emergency!!
Uterine Rupture
What medical emergency has significantly high mortality rates in mother and fetus?
Uterine Rupture
Rare, sudden, and can be fatal
Often results in severe coagulopathy
Hemorrhage with uterine inversion is characteristically drastic and sudden
Amniotic fluid embolism
An inflammation or irritation of the lining of the uterus
Higher risk in C-section than vaginal birth
Onset is often sudden and within 24 hours of delivery
Endometritis
In mother, significant postpartum fever may indicate what condition? And what is the most common organism?
postpartum endometritis 🡪 may be caused by infection with GBS
What is the single largest risk factor for endometritis?
Caesarean section
List some risk factors for endometritis
Caesarean section
Prolonged rupture of membranes
Severe meconium staining in liquor
Long labor with multiple examinations
Manual removal of placenta
Obesity
Diabetes or impaired glucose tolerance
History of pelvic infection
Retained products of conception
Mother’s age at extremes of reproductive span
Low socio-economic status
Maternal anaemia
Prolonged surgery
Internal fetal monitoring
General anaesthetic
What is the most common cause for chronic endometritis?
Retained products of conception
List the most common signs and symptoms of endometritis?
Significant fever and tachycardia
Onset sudden and within 24 hours of delivery
What testing is done prior to birth to help prevent the incidence of endometritis?
Test for group B strep 35-37 weeks
All women who are GBS positive by rectovaginal culture should
receive antibiotic prophylaxis in labor or with rupture of membranes
(or if status unknown when going to delivery)
