Postpartum Flashcards
What is the postpartum period?
Placental expulsion»_space;> restoration of uterus to pre pregnant state
How long is the postpartum period?
About 6-8 weeks
What happens during the postpartum period?
Biochemical and physiological changes occurring from the withdrawal of hormones from pregnancy
Where is the uterine fundus 1 week postpartum? How big is it?
The uterine fundus is just inferior to the umbilicus. About 1/2 the size it was immediately after delivery
Besides the Uterine fundus position, what are some things we will look at postpartum? 6
- Postpartum hemorrhage
- Retained products of conceptions
- Infection
- C-section
- Thrombophlebitis
- AVMs
What is the normal postpartum uterus size?
Length 15-25 cm
What will we see with the normal postpartum uterus? 2
- The uterus up to the maternal umbilicus
- Prominent vessels
What is the endometrium size postpartum?
5-13 mm
What does the adnexa look like postpartum?
Broad ligaments identified
Should we see the ovaries postpartum?
Try to identify
What will the ovaries look like for mothers that are breast feeding?
Large due to hormones
What are the causes of postpartum hemorrhage? 2
- Acute- atony
- Lochia
What is acute atony?
Lack of uterine muscle tone
Why would we have acute Atony with postpartum hemorrhage?
Bleeding is controlled by uterine contractions. If the uterus has been stretched beyond its capabilities atony may occur resulting in hemorrhage
What is lochia?
Vaginal discharge of mucous, blood and tissue
Is lochia normal?
Yes
When a uterus is flaccid, and fails to return to pre-gravid tone what is the term?
Uterine atony
What is associated with uterine atony? 7
- Multi fetal pregnancy
- More than 5 full term births
- Macrosomia
- Prolonged labour
- Rapid labour
- Polyhydraminos
- Chorioamnionitis
What raises the risk of postpartum hemorrhage risks? 6
- Prior C-section
- Prior placental abnormality
- Maternal age >35
- Prior myomectomy
- Endometrial defects
- Anterior placental previa with C-section
What does this image demonstrate?
Normal postpartum uterus
What does this image demonstrate?
Morbidly adherent placenta
What is morbidly adherent placenta (MAP)?
Abnormal placental implantation into uterine wall
What is MAP used to describe? 3
- Placenta accrete
- Increta
- Precreta
How much blood is lost at delivery when there is MAP?
3-5 liters
What is the mortality rate of MAP?
7%
How would we assist in a mom with MAP?
C-section followed by hysterectomy after delivery