postpartum care Flashcards
What is endometritis?
Poly microbial infection of the endometrium with bacteria from the lower genital tract.
!!! Most common postpartum infection!!!
What are some pathogen known to cause endometritis?
Group A & B streptocci
Chlamydia & gonorrhea can also cause it
What is the presentation of endometritis?
Foul smelling vaginal bleeding or discharge
Fever
uterine tenderness
Tachycardia
What are alarm findings for endometritis?
Fever >103 F
OR
Fever >102 +
-HR >110
-RR >20
WBC with 10% band
BP <90/60
What is the gold standard tx for endometritis?
Clindamycin + Gentamicin (+/- ampicillin or augmentin if GBS +)
How is pernieal laceration different from episiotomy?
perineal laceration is a tear of the skin of the perineum with vaginal child birth.
Episiotomy: intentional incision of the perineum to aid with facilitation of delivery.
1st degree perineal laceration?
lacerations extend to the skin and subcutaneous tissue of the perineum, and the perineal muscles are intact
2nd degree perineal laceration?
lacerations extend through the fascia into the muscle of the perineum but leave the anal sphincter muscles intact.
3rd degree perineal laceration ?
extend through the fascia and perineal muscles and into the anal sphincter.
4th degree perineal laceration
extend through the perineal muscles, external and internal anal sphincters, and the rectal mucosa
what is the most common type of episiotomy?
midline and mediolateral
What is puerperium and how long does it last?
period after birth in which the reproductive tract and body returns to its non pregnant state.
generally lasts 6 weeks
What is the course of normal postpartum discharge?
Lochia rubra: mense like bleeding with blood & necrotic decidual tissue
Lochia serosa: lighter discharge with less blood (mucopurulent and may have a mild odor)
Lochia Alba: yellow-whitish discharge (may persist for 7wks)
What is the size of the cervix by wk1 of the pueperium?
at the end of the first week, it is little more than 1 cm dilated
How long does it take for the uterus to involute completely?
Within 2 weeks of delivery the uterus should be approximately at the level of the pelvis. By 6 weeks post partum, it should be normal size.
How long are patients amenorrheic after delivery?
Lactating women = increase prolactin levels = ovulation suppression.
nonlactating: 70-75 days (2 months)
Lactating: 6 months
Why does postpartum ovulation suppression occur?
Ovulation suppression is related to elevated prolactin and decreased estrogen levels.
Lactating women: increased prolactin lasts 6 weeks & estrogen levels remain low.
Nonlactating women: prolactin normalizes by postpartum week 3 and estrogen rises
What is the definition of a postpartum fever?
A temperature of 100.4° F x2 separate occasions, more than 24 hours after delivery.
What is septic pelvic thrombophlebitis?
A complication of endometritis of when a thrombus in the pelvic vein gets infected.
Postpartum endometritis not improved with abx
Will need heparin added to gentamicin & clindamycin
What is postpartum hemorrhage?
bleeding >500 ml vaginal
>1000ml c-section
What are the 4 T’s of postpartum hemorrhage?
Tone: Atony “soft & boggy” uterus (MCC)
Trauma: laceration to cervix & vagina
Thrombin: underlying coagulation disorder
Tissue: retained placenta
What is the treatment of atony?
uterine massage & oxytocin
What is a common lab finding of von willebrand disease?
increase PTT
normal PT
normal platelets
abnormal ristocetin
What is a complication of postpartum hemorrhage ?
the pituitary gland enlarge during pregnancy -> prone to infraction with hypovolemia
What is the presentation of sheehan syndrome?
failure to lactate + ameorrhea
The uterus involutes progressively after 5-7 days and should be firm, nontender & located between
symphysis & umbilicus
Postpartum blues is common during the first__________ hours after delivery but is transient.
ostpartum blues is common during the first 24–72 hours after delivery but is transient.
When can a patient with vaginal delivery return to sexual activity?
As soon as the woman feels ready after a minimum of 2 weeks
What are the three components of the levator ani muscle?
The puborectalis, pubococcygeus, and iliococcygeus. These form the pelvic floor.
What are the components ofcolostrum?
immunoglobulin (IgA)
leukocytes, marcophages
high protein -> high lactoferrin
