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DMST 285 OBGYN 2 > Postpartum > Flashcards

Postpartum Flashcards

1
Q

What is the postpartum period?

A

Placental expulsion&raquo_space;> restoration of uterus to pre pregnant state

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2
Q

How long is the postpartum period?

A

About 6-8 weeks

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3
Q

What happens during the postpartum period?

A

Biochemical and physiological changes occurring from the withdrawal of hormones from pregnancy

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4
Q

Where is the uterine fundus 1 week postpartum? How big is it?

A

The uterine fundus is just inferior to the umbilicus. About 1/2 the size it was immediately after delivery

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5
Q

Besides the Uterine fundus position, what are some things we will look at postpartum? 6

A
  1. Postpartum hemorrhage
  2. Retained products of conceptions
  3. Infection
  4. C-section
  5. Thrombophlebitis
  6. AVMs
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6
Q

What is the normal postpartum uterus size?

A

Length 15-25 cm

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7
Q

What will we see with the normal postpartum uterus? 2

A
  1. The uterus up to the maternal umbilicus
  2. Prominent vessels
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8
Q

What is the endometrium size postpartum?

A

5-13 mm

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9
Q

What does the adnexa look like postpartum? (what should we easily identify)

A

Broad ligaments identified

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10
Q

Should we see the ovaries postpartum?

A

Try to identify

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11
Q

What will the ovaries look like for mothers that are breast feeding?

A

Large due to hormones

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12
Q

What are the causes of postpartum hemorrhage? 2

A
  1. Acute- atony
  2. Lochia
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13
Q

What is acute atony?

A

Lack of uterine muscle tone

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14
Q

Why would we have acute Atony with postpartum hemorrhage?

A

Bleeding is controlled by uterine contractions. If the uterus has been stretched beyond its capabilities atony may occur resulting in hemorrhage

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15
Q

What is lochia?

A

Vaginal discharge of mucous, blood and tissue

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16
Q

Is lochia normal?

A

Yes

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17
Q

When a uterus is flaccid, and fails to return to pre-gravid tone what is the term?

A

Uterine atony

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18
Q

What is associated with uterine atony? 7 (what causes it)

A
  1. Multi fetal pregnancy
  2. More than 5 full term births
  3. Macrosomia
  4. Prolonged labour
  5. Rapid labour
  6. Polyhydraminos
  7. Chorioamnionitis
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19
Q

What raises the risk of postpartum hemorrhage risks? 6

A
  1. Prior C-section
  2. Prior placental abnormality
  3. Maternal age >35
  4. Prior myomectomy
  5. Endometrial defects
  6. Anterior placental previa with C-section
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20
Q

What does this image demonstrate?

A

Normal postpartum uterus

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21
Q

What does this image demonstrate?

A

Morbidly adherent placenta

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22
Q

What is morbidly adherent placenta (MAP)?

A

Abnormal placental implantation into uterine wall

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23
Q

What is MAP used to describe? 3

A
  1. Placenta accrete
  2. Increta
  3. Precreta
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24
Q

How much blood is lost at delivery when there is MAP?

A

3-5 liters

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25
Q

What is the mortality rate of MAP?

A

7%

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26
Q

How would we assist in a mom with MAP post delivery?

A

C-section followed by hysterectomy after delivery

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27
Q

What significantly decreases the mortality and morbidity for both mother and baby for MAP?

A

Diagnosis prior to delivery

28
Q

How often does Placenta accrete occur?

A

~3 per 1000 deliveries

29
Q

What is the placenta accreta spectrum?

A
  1. Placenta accreta
  2. Increta
  3. Precreta
30
Q

Placenta accreta is caused by what?

A

Damage to the endometrium myometrium interface

31
Q

What increases the changes of placenta accreta? 2

A
  1. Uterine scaring
  2. Uterine pathologies
32
Q

What are some uterine pathogens/patholgy that may lead to placenta accreata? 4 (what causes it)

A
  1. Bicornuate uterus
  2. Adenoma oasis
  3. Submucssal fibroids
  4. Myotonic dystrophy
33
Q

With ultrasound what is the sensitivity rate for detecting placenta accreta spectrum?

34
Q

What is the positive and negative predictive value for placenta accreta spectrum?

A

68% positive and 98% negative predictive value

35
Q

Label the image

A
  1. Normal
  2. Accreta
  3. Increta
  4. Precreta
36
Q

What is the ultrasound features of MAPs? 5

A
  1. Loss of hypoechoic plane in the myometrium beneath the placenta bed
  2. Presence of multiple placenta lacunae
  3. Loss of hyperechoic line separating the urinary bladder from the uterus
  4. Thinning of the myometrium to less than 1mm
  5. Buldging of placenta into organs adjacent to the uterus, causing a mass like lesion protruding out from the uterine wall
37
Q

What does retained products of conception look like?

A

Variable amount of echogenic or heterogeneous material within the endometrial cavity

38
Q

What happens if we see echogenic or heterogenous material within the endometrial cavity?

A
  1. Echogenic = Tissue (placenta)
  2. Heterogenous = Blood or infection
39
Q

What may retained products of conceptions present as?

A

Endometrial or intrauterine mass

40
Q

What supports the diagnosis of retained products of conception? Why?

A
  1. Vascularity within the endometrial material
  2. Absence of colour doppler flow has a low negative predictive value because retained products of conception may be avascualar
41
Q

Can we see calcifications as a retained products of conceptions?

A

They may be present

42
Q

What might we see with infections? 3

A
  1. Temperature >38 degrees Celsius
  2. Pain
  3. Endometriosis
43
Q

When would the mother contract an infection?

A

After rupture of membranes the vagina becomes alkaline, this encourages bacterial growth

44
Q

How are infections combated?

A

Antibiotics or D and C

45
Q

What is more typically associated with post C-Section?

A

Endometritis

46
Q

What does this image demonstrate?

A

Gas in the endometrium

47
Q

What are some C-section complication? 3

A
  1. Uterine incision scarring
  2. Infection at incision site
  3. Hematoma
48
Q

What does this image demonstrate?

A

C section scar

49
Q

What does this image demonstrate?

A

A women with G20 P18 with 6 C-section

50
Q

What does infections look similar to?

A

There is an overlapping appearance of endometritis and retained products of conception

51
Q

What is the sonographic appearance of infections? 4

A
  1. Completely normal endometrium and uterus
  2. Dilated uterine cavity filled with fluid
  3. Gas in the endometrium
  4. Both fluid and gas in the endometrium
52
Q

Where might hematomas present?

A
  1. Potential space between the bladder and uterus
  2. > 2cm adjacent to scar
53
Q

What will hematomas look like in the potential space?

A

Complex or anechoic mass

54
Q

How will we find hematomas?

A

Search along the skin incision site

55
Q

What does this image demonstrate?

56
Q

What are abscesses?

A

Wound infections

57
Q

What has a similar appearance to Abscesses?

58
Q

What might we see in a abscess?

A

Gas bubbles

59
Q

What would point to the idea of abscess vs a hematoma?

A

Patient febrile and increase white blood cell count

60
Q

What does Thrombophlebitis - POVT occur from? 3

A
  1. Venous stasis
  2. Changes in blood clotting factors
  3. Alteration in vessel walls due to uterine expansion and contraction
61
Q

What does the PVOT stand for in thrombophlebitis -PVOT?

A

Postpartum ovarian vein thrombophlebitis

62
Q

What increases the incidence of thrombophlebitis- PVOT?

63
Q

Most thrombophlebitis - PVOT caused by?

A

Anaerobic streptococcus

64
Q

Where does thrombophlebitis - PVOT start in?

A

Ovarian vein and can extend to pelvic and femoral veins

65
Q

How severe is thrombophlebitis - POVT?

A

Life threatening

66
Q

What are some signs and symptoms of thrombophlebitis? 6

A
  1. Fever
  2. Lower abdominal pain (right sided)
  3. Nausea
  4. Vomiting
  5. Flank or groin pain
  6. Sometimes bowel obstruction
67
Q

What might we see on u/s in terms of thrombophlebitis?

A

Echogenic thrombus in ovarian vein

DMST 285 OBGYN 2 (15 decks)

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