Post Partum Care and Complications Lecture Powerpoint

Question 1

After pains

Answer 1

Tonic contractions worsened with breastfeeding (oxytocin release), easily relieved with NSAIDS and typically resolves by day 3

Question 2

Lochia

Answer 2

Discharge from sloughing of decidua (leftover material in uterus) for up to 6 weeks after pregnancy, can be either rubra (red), serosa (pink/clear), or alba (white)

Question 3

Subinvolution/prolongation of lochial discharge and treatment (3)

Answer 3

Arrest of involution of the uterus following delivery, can be due to part of placenta fragments left behind or infectious cause

Treatment is oxytocic agents, oral antibiotics, and sometimes D&C

Question 4

Cervical changes after delivery

Answer 4

After first delivery onward, transverse slit like external os persists due to laceration, marking there has been a delivery forever

Question 5

Time for a normal postpartum visit

Answer 5

6 weeks (by this point cervix has typically returned to normal, as has uterus size, and vagina)

Question 6

Breast feeding suppresses…

Answer 6

….ovulation, to the point of sometimes being hypestrogenic (dryness and friction dysparunia)

Question 7

Dilation ureters and renal pelvis postpartum

Answer 7

Normal occurrence, returns to normal 2-8 weeks later often, can cause increased urinary retention and increased UTI concern

Question 8

Decline in estrogen and progesterone result in ____ by day 3 postpartum

Answer 8

breast engorgement

Question 9

Puerperium

Answer 9

Period up to 6 weeks after delivery where the mothers reproductive organs return to the prepregnant state

Question 10

Complications of puerperium and how are they each treated? (blood loss, uterine atony, retention of products of conception, laceration, uterine rupture, infection)

Answer 10

• blood loss (can be limited with weight pads to measure blood loss)
• uterine atony (treated with oxytocics)
• retained products of conception (requires manual exploration of uterus)
• laceration (repair immediately)
• uterine rupture (exploration and repair)
• infection (endomyometritis most common, has foul smelling lochia and tender uterus within first few days postpartum, treated with gentamycin/clindomycin)

Question 11

Milk fever

Answer 11

Elevation in temp lasting <24 hours during milk production in the newborn mother, rarely above 101 degrees and a normal finding without concern

Question 12

Sheehan’s syndrome

Answer 12

Postpartum necrosis of the anterior pituitary followed from blood loss during pregnancy followed by circulatory collapse of the pituitary causing an array of multiglandular disorders, agitation, hallucinations, delusoins, and depression, sees failure of lactation, amenorrhea, breast atrophy, loss of pubic and axillary hair, hypothyroidism, and adrenal cortical insufficiency

Question 13

Immunizations puerperium

Answer 13

Ideal time to administer vaccine for those not found immune (such as rubella), Rh- women with Rh+ baby should receive appropriate amounts of Rh immune globin

Question 14

Contraception puerperium

Answer 14

Ovulation may occur as soon as week 6, sexual intercourse often resumed by week 2-3, oral contraceptives may be started 4 weeks post partum in nonlactating mothers (to avoid increase risk of dvt), injected depo provera can be given before hospital discharge, immediate IUD’s are safe and effective with few contraindications but must be careful cause higher expulsion rates, nexplanon being given more commonly and it also does not interrupt breastfeeding

Question 15

Bromocriptine suppresses what relating to obstetrics?

Answer 15

Breast feeding (dopamine agonist)

Question 16

Drugs absolutely contraindicated in breastfeeding (3)

Answer 16

• tobacco and alcohol
• chemotherapeutic or cytotoxic
• chloramphenicol

Question 17

Menses return in ___ weeks in nonlactating women

Answer 17

6-8 weeks, may not return until lactation ceases

Question 18

Immediately after expulsion of the fetus the fundus of the uterus is located at the…

Answer 18

…umbilicus

Question 19

Other changes of puerperium (2)

Answer 19

• increase in cardiac output (compensate for bleeding)
• Leukocytosis
• return of GFR to prepregnant state

Question 20

Perineal laceration degrees (4)

Answer 20

1st degree just tears mucosa
2nd tears superficial muscles
3rd tears anal sphincter
4th enters directly into the rectum

Question 21

Best indicator of post partum infection

Answer 21

Maternal temp