Postpartum Care

Question 1

what is inflamation of the endometrium, which is the inner lining of the uterus

Answer 1

endometritis

Question 2

what is the most common cause of infection after childbirth

Answer 2

endometritis

Question 3

what are symptoms of endometritis

Answer 3

fever
lower abdominal pain
abnormal vaginal bleeding or discharge

Question 4

what are risk of endometritis

Answer 4

c-section
PROM
vaginal delivery
D&C
pelvic exams

Question 5

how is endometritis diagnosed

Answer 5

based on clinical findings
endometrial biopsy can help make the dx

Question 6

what is the treatment of endometritis

Answer 6

involves the use of abx
- clindamycin and gentamicin
- dilation and curettage if caused by remaining placental or fetal tissue

Question 7

what is puerperium

Answer 7

postpartum period
usually lasting 6 weeks

Question 8

what is immediate puerperium

Answer 8

first 24 hours after parturation when acute postanesthetic or post-delivery complications may occur

Question 9

what is early puerperium

Answer 9

extends until first week post-partum

Question 10

what is remote puerperium

Answer 10

includes the period of time required for involution of the genital organs and return of menses, usually approximately 6 weeks

Question 11

what is a perineal laceration

Answer 11

tear of the skin and other soft tissue structures which, in women, seperates the vagina from the anus

Question 12

what is an episiotomy

Answer 12

perineum is intentionally incised to facilitate delivery

Question 13

what is a first degree perineal tear

Answer 13

perineal skin and vaginal mucosa

Question 14

what is a second degree perineal tear

Answer 14

injury to perneal body

Question 15

what is a third degree parineal tear

Answer 15

through the external anal sphincter

Question 16

what is a 4th degree perineal tear

Answer 16

injury through the rectal mucosa

Question 17

what is the treatment of perineal tears

Answer 17

3rd and 4th degree tears generally require surgical repair

Question 18

how is postpartum hemorrhage defined

Answer 18

losing >1000ml of blood within first 24 hours after birth
decrease of 10% or more in HCT, changes in mothers HR, BP and O2sat

Question 19

what are the 4Ts of post partum hemorrhage

Answer 19

Tone, Trauma, Tissue and Thromin
- uterine atony (mc)
- gentital tract trauma
- retained placental tissue
- coagulation disorders (thrombin)

Question 20

what is uterine atony

Answer 20

boggy and enlarged uterus - 90% of post partum hemorrhages

Question 21

what is gential tract trauma

Answer 21

precipitious labor, operative vaginal delivery (forcepts, vaccum extraction)

Question 22

what is the treatment of uterine atony

Answer 22

fundal massage and meds to help the uterus contracts (oxytocin IV, misoprostol)