Postpartum Care

Question 1

What hormones are decreased by Sheehan Syndrome?

Answer 1

Anterior pituitary: Gonadotropins, TSH, ACTH, prolactin

Question 2

What is the most common cause of postpartum fever?

Answer 2

Endometritis

Question 3

What bacteria tend to make up postpartum endometritis?

Answer 3

Staph, Strep, polymicrobial mix of aerobes and anaerobes in genital tract

Treat with clindamycin and gentamicin

Question 4

What is difference between postpartum depression and blues?

Answer 4

Blues occurs for <2 wks, mild and self-limited

Question 5

What factor most increases risk of surgical site infection?

Answer 5

Obesity confers greatest risk

Question 6

What typically causes dyspareunia in postpartum women?

Answer 6

Atrophic vaginitis - normally + breastfeeding –> lower estrogen levels in vagina

Question 7

What is the safest method to suppress lactation?

Answer 7

Breast binding, ice packs, analgesics

Question 8

What Ig is in breast milk?

Answer 8

IgA - decreases newborn’s GI infections

Question 9

What cancer risk does breastfeeding decrease?

Answer 9

Ovarian cancer

Question 10

How does breastfeeding affect uterine contraction?

Answer 10

Increases it due to oxytocin release, resulting in decreased blood loss

Question 11

Which types of contraceptives should be avoided postpartum?

Answer 11

Estrogen-containing, especially in first 30 days, since they increase risk of thromboembolic disease and diminish lactation

Question 12

What serious infection can happen from postpartum wound or surgical infection?

Answer 12

Staph toxic shock syndrome - Exotoxin binds directly to MHC class II, causing indiscriminate T cell activation and inflammation

Presents with diffuse macular rash and mutiorgan involvement

Question 13

What antibiotics if toxic shock syndrome is suspected?

Answer 13

Vancomycin
Clindamycin - blocks exotoxin production by blocking ribosome
Zosyn, cefepime, or carbapenem

Question 14

Iliohypogastric nerve injury can occur in what setting?

Answer 14

C/S via Pfannenstiel skin incision –> decreased sensation or burning pain at suprapubic region

Question 15

Pudendal nerve injury can occur in what setting?

Answer 15

Prolonged second stage of labor or forceps-assisted delivery

Increased vulvar pain and possible decreased anal sphincter tone (fecal incontinence)

Question 16

Common fibular/peroneal nerve compression during lithotomy position procedures cause what signs?

Answer 16

Unilateral foot drop and loss of sensation over lateral lower leg and top of foot

Question 17

Ilioinguinal nerve entrapment can occur in what setting?

Answer 17

Midurethral sling entrapment —> suprapubic burning pain

Question 18

Raised, red granulation tissue on vaginal wall several weeks after birth

Answer 18

Vesicovaginal fistula

Use bladder dye testing

Question 19

What is pubic symphasis diastasis?

Answer 19

Widening caused by progesterone and relaxin

Suprapubic pain radiating to back, hips, thighs or legs, exacerbated by walking
Point tenderness to pubic symphasis

Question 20

What contraception is commonly used postpartum during breastfeeding?

Answer 20

Progestin-only pills

Note: They do not consistently inhibit ovulation (6% failure rate) and requiring to take within 3 hr of daily time

Question 21

Dark red, velvety lesion with brown discharge on posterior vaginal wall

Answer 21

Rectovaginal fistula

Question 22

Signs of external anal sphincter breakdown

Answer 22

Weakened anal sphincter tone (vs normal)
Asymmetric contraction
Palpable defect

Requires endoanal US

Barium enema is administered to assess anorectal anatomy only for those with refractory fecal incontinence (more invasive)