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