Postpartum Flashcards
true CI to breastfeeding
HIV and HBV
what OCPs can be used when breastfeeding?
progesterone only
COC can be used 4-6 wks postpartum
how many mls of blood is lost in a typical SVD and C/S
SVD = >500ml C/S = >1000
what are the common causes of postpartum hemorrhage?
consider placenta accreta and 4 Ts:
- Tone (uterine atony, MCC)
- Tissue (retained POCs)
- Trauma (cervical or vaginal lacerations, uterine rupture, uterine inversion)
- Thrombin (bleeding d/o)
treatment for uterine atony
Tx IV oxytocin + bimanual uterine massage (1st line), methylergonovine (c/i with HTN), carboprost (c/i with asthma)
what are RF for uterine atony
tocolytics, increased uterine size (multifetal gestation, polyhydramnios, macrosomia)
usually w/ PP hypovolemia; presents as acute cessation of lactation
sheehan syndrome
pituitary infarction
causes of postpartum fever
consider endometriitis, acute mastitis, and the 5 Ws: Wind (atelectasis POD #1) Water (UTI POD #3) Walking (DVT POD #5) Wound infx (POD #7+) Wonder drug (drug-induced fever)
polymicrobial infx → fever, uterine tenderness,
foul-smelling lochia
dx and tx
endometritis
clinda+ gentamicin
breastfeeding women get Staph/Strep infection
through cracks in nipple w/ yellowish discharge
dx and tx
acute mastitis
dicloxacillin, do NOT stop breast feeding
abx for postpartum UTI
cipro or bactrim
pain, swelling, erythema, heat at incision site
dx + tx
wound cellulitis
bactrim or keflex (cephalexin)
separation of incision site → salmon-colored fluid
soaking dressings
wound dehiscence
3 types of postpartum mood disorders
blues (30-70%), depression (10-20%), psychosis (0.1%)
DOC for postpartum depression
sertraline
