Postpartum

Question 1

puerperium

Answer 1

after delivery of baby/placenta until 6-8 weeks postpartum

Question 2

how long does it take for the uterus to return to “normal” size

Answer 2

~6 weeks

Question 3

size of uterus immediately after delivery

Answer 3

20 week size

Question 4

afterpains

Answer 4

myometrial contractions during 1st 2-3 days and assist in involution
if inadequate –> atony

Question 5

locia rubra

Answer 5

normal postpartum d/c with blood, shreds of tissue, decidua

rapidly tapers to reddish-brown over 3-4 days

Question 6

locia serosa

Answer 6

serous to mucopurulent, paler, malodorous discharge

Question 7

locia alba

Answer 7

thick, mucoid, yellowish-white discharge beginning in 2nd/3rd weeks

Question 8

when should lochial secretions stop

Answer 8

5-6th weeks postpartum

Question 9

cervix changes after delivery

Answer 9

dilated 2-3 cm for first few days

<1 cm after a week

Question 10

vaginal walls back to “normal” by

Answer 10

3rd week

Question 11

pelvic floor back to “normal” by

Answer 11

6-7 week

Question 12

when does ovulation return (lactating and non-lactating)

Answer 12

27 days in non-lactating

6 months in lactating

Question 13

weight loss immediately after delivery

Answer 13

10-13 lbs

Question 14

weight loss over next 6th months

Answer 14

5-15 lbs

Question 15

when are blood glucose levels the lowest

Answer 15

day 2/3

insulin requirements are lower

Question 16

CO and SV changes after delivery

Answer 16

increase by 60-70%

Question 17

when do pregnancy-related hematologic changes return to baseline

Answer 17

6-12 weeks post-delivery

Question 18

what to do before discharge

Answer 18

physical exam (no vaginal exam)
pt capable of voiding and having BMs
call office with fevers, vaginal bleeding, un-resolving back pain

Question 19

when is it safe to resume sex

Answer 19

~ 3 weeks when perineum is comfortable, bleeding has stopped

Question 20

when does normal sex response return

Answer 20

12 weeks

Question 21

lactation amenorrhea can be used as a contraceptive for how long

Answer 21

1st 6 months

Question 22

other contraceptive methods acceptable after pregnancy

Answer 22

barriers
intrauterine - inserted 6 weeks postpartum
progestin-only contraception - started 6 weeks postpartum
diaphragms/cervical caps refitted 6 weeks after delivery

Question 23

postpartum visit after a vaginal delivery

Answer 23

4-6 weeks

Question 24

postpartum visit after C-section

Answer 24

2 weeks postpartum and again at 6 weeks

Question 25

possible labs to get in postpartum visit

Answer 25

CBC - if h/o hemorrhage postpartum, anemia, ongoing vaginal bleeding
2 hr glucose tolerance test - if gestational DM
TSH for pts with thyroid dz during pregnancy (adjust levothyroxine)

Question 26

how long will breast engorgement last if patients do not want to breastfeed

Answer 26

3-4 days

Question 27

when should breastfeeding be initiated

Answer 27

in 1st hr after delivery

pump, breastfeed every 2-4 hrs

Question 28

endometritis

Answer 28

polymicrobial infection of the endometrium

Question 29

pathogenesis of endometritis

Answer 29

indigenous cervico-vaginal flora enter uterine cavity during L&D

Question 30

s/s of endometritis

Answer 30

fever + soft/tender uterus, leukocytosis

dx by unexplained postpartum fever

Question 31

tx of endometritis

Answer 31

IV clindamycin + gentamycin until afebrile x24-48 hr

Question 32

prophylaxis of endometritis

Answer 32

ampicillin or 1st gen cephalosporin