Postpartum Care Flashcards
mc cause of infxn after childbirth
endometritis
mc source of bacteria that cause endometritis
endogenous
3 external sources of bacteria responsible for endometritis
during childbirth
gynecologic procedures
IUD
STI
2 STI mc responsible for endometritis
chlamydia
gonorrhea
2 types of endometreitis
acute
chronic
which type of endometritis is more likely to be symptomatic
acute
4 sx of endometreitis
fever
low abd pain
abd bleeding
d.c
5 rf for endometreitis
c section
PROM
vaginal delivery
D&C
pelvic exam
complications of endometreitis
-infxn spread:
myometreitis
parametreitis
salpingitis
oophritis
-asherman syndrome
what is asherman syndrome
intrauterine adhesions
dx for endometreitis
clinical
bx (not necessary/commonly done)
histological findings of acute vs chronic endometreitis
acute: neutrophils in endometrium
chronic: plasma cells in endometrium
PE findings of endometreitis
-fever
-tachycardia
-vaginal bleed
-foul smell
abd pain/uterine tenderness
2 post birth pt’s esp at risk for endometreitis
2-3 days post c section
postabortal
tx for endometreitis based on cause
-childbirth: clinda PLUS gentamicin
-remaining placental/fetal tissues: D&C
-STI: doxy PLUS ceftriaxone
-TB: RIPE
postpartum (puerperium) period lasts _ weeks
6
what happens in puerperium period
anatomic/physiologic changes of pregnancy are reversed - body returns to nonpregnant state
3 stages of puerperium
immediate: first 24 hr
early: through first week
remote: ~ 6 weeks
period when acute post anesthetic/post delivery complications may occur
immediate puerperium
what changes occur during normal puerperium
-uterine involution (shrinkage)
-immediate placental contraction -> hemostasis
-postpartum d.c
-cervix closes
-vagina returns to antepartum size
-ovulation
-widening of pubic symphysis/SIJ
-increased bladder capacity
-mild proteinuria
normal postpartum d/c begins as _
lochia rubra
postpartum d.c is usually gone by _ weeks postpartum
5-6
normal size of the cervix by the end of the first week postpartum
~1 cm
the vagina normally turns to antepartum size by _ weeks postpartum
3
ovulation usually returns by _ weeks in non bf’ing women
and _ weeks in bf’ing women
non bf’ing: as early as 27 days, mean 70-75 days
bf’ing: 6 months
anovulation during pregnancy is due to elevated _ levels
prolactin
tearing or overstretching of musculature/fascia during delivery predisposes pt to (3)
genital prolapse
genital hernias
cystocele/rectocele/enterocele
involution of abd musculature to pre pregnancy state may require _ weeks post partum
6-7
pt education until abd musculature is back to normal
no vigorous exercise
2 common postpartum bladder issues
incomplete emptying
residual urine
when does bladder usually return to normal postpartum
by 6 weeks
risk of postpartum UTI is higher in women with
persistent dilation
when does postpartum proteinuria normally resolve
1-2 days postpartum
when does CrCl return to normal postpartum
by 8 weeks
t/f: most patients should be hospitalized for 2-4 days postpartum
t!
4 common postpartum complaints
painful perineum
bf’ing difficulty
UTI
urinary/fecal incontinence
most women can return home _ days after vaginal delivery
2
when can pt get out of bed postpartum
as soon as tolerated
t/f: in uncomplicated delivery, you can start exercising vigorously without delay
t!
just don’t if any rips/tear to abd musculature
bf’ing moms require _ more kcal/day
500
when can postpartum mom get down and dirty again
perineum is comfortable
no bleeding
normal time for sexy time to occur after delivery
-6 weeks
mc form of obstetric injury
perineal laceration
t/f: episiotomies are commonly done
f!
it likely increases tears
4 classes of perineal tears
1st degree: perineal skin and vaginal mucosa
2nd degree: injury to perineal body
3rd degree: through external anal sphincter
4th degree: thru rectal mucosa
tx for perineal tear
-natural healing
-surgical repair
which types of perineal tear usually require surgical repair
3rd
4th
when are episiotomies mc performed
2nd stage of labor
indication for episiotomy
fetal distress
complications of episiotomy
bleeding
pain
infxn
unsatisfactory anatomic results
sexual dysfxn
types of episiotomy
midline
mediolateral (mc)
lateral j shaped
mc cause of maternal morbidity/death around the world
postpartum hemorrhage
definition of postpartum hemorrhage
-loss of > 500 mL blood w.in first 24 hr after vaginal delivery
-loss of 1,000 mL blood after c section
signs of significant blood loss in mom
decrease of 10% Hct
changes in HR, BP, SpO2
4 mc causes of postpartum hemorrhage
tone
trauma
tissue
thrombin
mc cause (90%) of postpartum hemorrhage
uterine anatomy/atony: boggy/enlarged uterus
anatomical rf for potpartum hemorrhage
genital tract trauma
retained placental tissue
coagulation d.o’s
what clotting d.o is associated. w sevrve preeclampsia, amniotic fluid embolism, and placental abruption
DIC
tx for postpartum hemorrhage due to atony
-fundal massage
-oxytocin/misoprostol
-hysterectomy
tx of postpartum hemorrhage due to genital tract trauma
sutures if > 2 cm
