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Women's Health EOR > Postpartum Care > Flashcards

Postpartum Care Flashcards

1
Q

2 criteria for the new definition of postpartum hemorrhage

A

New definition of PPH

  1. 1000 mL blood loss w/delivery +
  2. S/s of hypovolemia
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2
Q

Old definition of PPH

  1. amt of blood loss w/vag delivery
  2. amt of blood loss w/C section
A

Old definition of PPH

  1. 500+ mL blood loss w/vag delivery
  2. 1000+ blood loss w/C section
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3
Q

MC cause of postpartum hemorrhage

A

MC cause of postpartum hemorrhage = uterine atony

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4
Q

Definition of uterine atony

A

Uterine atony = failure of uterus to contract enough to limit blood loss

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5
Q

Pt is G5P4 who delivered twins at 36 wks. Pt has h/o of chorioamnionitis, was given MgSO4 for PTL 1 wk ago and has experienced prolonged labor. After delivery you notice that the uterus is boggy, soft and enlarged. W/in few hrs of delivering pt c/o significant vaginal bleeding. Pts vitals are: BP 90/50 and HR 120. Pt’s skin feels clammy/cool and she has decr cap refill.

what is the 1st best step in managing this pt (2 things, 1 med to give)
Dx/cause?

A

Next step = uterine massage + oxytocin/pitocin

Dx= Postpartum Hemorrhage d/t Uterine Atony

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6
Q

Name 2 meds given for Uterine Atony in PPH and their CI

A

Tx of Uterine Atony in PPH

  1. Methergine (Methylergonovine), CI = HTN
  2. Carboprost (Hemabate), CI = Asthma
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7
Q

3 surgical Tx for Uterine Atony d/t PPH

- which is definitive Tx but last resort

A

3 surgical Tx for Uterine Atony d/t PPH

  1. D+C
  2. UAE
  3. Hysterectomy (definitive Tx but last resort)
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8
Q

Pt is PPD#0 after NSVD. After delivery pt develops severe cramping and significant bleeding. US fails to reveal a normal uterine stripe. Pt also develops fever of 38.1 C

Dx/cause?
Tx?

A

Dx = PPH d/t retained POC

Tx = D+C

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9
Q

2 other causes of PPH that are a/w well contracted uterus and Tx = sutures

A

2 other causes of PPH that are a/w well contracted uterus and Tx = sutures

Cervical and Vaginal Lacerations

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10
Q

Fundus of uterus goes thru cervix and into the vagina

A

Uterine Inversion = Fundus of uterus goes thru cervix and into the vagina

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11
Q

Pt who is now G7P7 just delivered baby via NSVD. The Dr. attempts to remove the placenta before it is ready to deliver, causing traction and lengthening of the cord. When the placenta is ready to be delivered you notice a shaggy, reddish bulging mass around the placenta. After delivery pt has significant bleeding

Dx/cause?
1st 2 things done to Tx?

A

Dx/cause = PPH d/t uterine inversion

Tx = manually replace uterus, uterine relaxants

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12
Q

What is the main sequelae/complication of PPH

A

main sequelae/complication of PPH = Sheehan’s Syndrome

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13
Q

Pt has non-complicated delivery. After delivery pt experiences significant vaginal bleeding, becomes HoTNsive and tachycardic and difficulty BR feeding. Labs reveal low levels of FSH, TSH, LH

Dx?

A

Dx = Sheehan’s Syndrome

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14
Q

Postpartum ischemic pituitary necrosis –> hypopituitarism

A

Postpartum ischemic pituitary necrosis –> hypopituitarism = Sheehan’s Syndrome

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15
Q

MC cause of postpartum fever (usu polymicrobial but most commonly involves anaerobes)

A

MC cause of postpartum fever (usu polymicrobial but most commonly involves anaerobes)

Endometritis

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16
Q

Pt is POD #4 after C/S after FTP at 36 wks. Pt had prolonged ROM and labor. Pt had IUPC monitoring prior to delivering, multiple cervical exams to monitor dilation. Pt is GBS+ and has h/o DM. Pt presents to clinic c/o lower abd pain and purulent, foul smelling lochia. On PE you notice her temp is 38.3 and pt has uterine tenderness. Labs reveal elevated WBCs w/L shift and incr neutrophils

Dx?
Tx? - admit? what to give?

A

Dx = Endometritis

Tx

  1. admit
  2. broad spectrum ABX –> Genta + Clinda
17
Q

Tx of Endometritis

  1. How long to continue ABX once pt is afebrile, norm WBCs and no abd pain
  2. What should be added in 48 hrs if pt doesnt improve w/initial ABX therapy
  3. If fever still persists after #2 what test should be done next? looking for?
A

Tx of Endometritis

  1. continue ABX for 24-48 hrs once pt is afebrile, norm WBCs and no abd pain
  2. Add Ampicillin in 48 hrs if pt doesnt improve w/initial ABX therapy
  3. If fever still persists after #2 –> CT/MRI –> look for Septic Thrombophlebitis
18
Q

Vaginal Lacerations

  1. what constitutes 1st degree
  2. 2nd degree
  3. 3rd degree
  4. 4th degree

what is the complic a/w 3rd/4th

A

Vaginal Lacerations

  1. 1st degree = skin and/or vaginal mucosa
  2. 2nd degree = above + muscles
  3. 3rd degree = above + anal sphincter complex
  4. 4th degree = above + rectal mucosa

complic a/w 3rd/4th = fistula

19
Q

Type of tear where lac goes thru the vaginal mucosa into the vagina but has intact anal sphincter

what degree

A

Lac goes thru the vaginal mucosa into the vagina but has intact anal sphincter = buttonhole/ Rectal butthole tear

4th degree

20
Q

What is the major way to possibly prevent a vaginal laceration

A

major way to possibly prevent a vaginal laceration = Episiotomy

21
Q

How are vaginal lacs usually repaired (what type/technique)

A

Repair of Vaginal lacerations

interrupted sutures

22
Q

Asian pt who is now G1P1 immediately PPD after a successful vaginal delivery that was assisted with vacuum extraction. Delivery complicated by large EFW, prolonged 2nd stage of labor, OP position and shoulder distocia. Pt noted to have 1st degree vaginal lac.

What is best tx method (non-pharm) for this
What med is helpful and given PPD

A

What is best tx method (non-pharm) = Sitz bath

What med is helpful and given PPD = stool softener

23
Q

What can Sitz baths also be used for, other than vaginal lacerations (2)

A

Use of Sitz baths

  1. Vaginal/Perineal lacs
  2. Episiotomy care
  3. Hemorrhoids
24
Q

Post laceration/episiotomy care

After vaginal lac or episiotomy what is it important to educate the pt about

A

Post laceration/episiotomy care

  • edu = no anal sex for 6 wks
25
Q

what is puerperium pd range

A

puerperium pd = 6 wks after delivery

26
Q

Normal Changes during Puerperium Pd: Uterus

  1. what happens to the uterus during this pd
  2. when is it expected to be normal size
  3. does elasticity/firmness return to pre-preg state
A

Normal Changes during Puerperium Pd: Uterus

  1. Uterus shrinks/descends back into pelvis
  2. normal size wks PPD
  3. YES elasticity/firmness returns to pre-preg state
27
Q

Normal Changes during Puerperium Pd: Vagina

  1. does firmness of muscles return to pre-preg state
  2. 2 interventions to help w/ #1
  3. pt education
A

Normal Changes during Puerperium Pd: Vagina

  1. firmness of muscles dose NOT return to pre-preg state
  2. 2 interventions to help w/ #1 = Kegel’s, PT
  3. pt education = nothing in vagina x 6 wks
28
Q

Normal Changes during Puerperium Pd: Lochia

  1. name 3 types in order of appearance PPD
  2. which one should not be a/w clots
A

Normal Changes during Puerperium Pd: Lochia

  1. name 3 types = Rubria –> Serosa –> Alba
  2. not a/w clots = lochia alba
29
Q

Normal Changes during Puerperium Pd: Mensturation/BR feeding

  1. can pts who are BR feeding still get preg even though they may not get menses
  2. Safe method of hormonal contraception for BR feeding
  3. NOT BR feeding –> menses return when?
A

Normal Changes during Puerperium Pd: Mensturation/BR feeding

  1. YES - if BR feeding can still get preg even though they may not get menses b/c still ovulating
  2. Safe method of hormonal contraception for BR feeding = Progesterone only options
  3. NOT BR feeding –> menses return 6-8 wks PPD
30
Q

Normal Changes during Puerperium Pd: CV

  1. immediate incr in _____
  2. gradual return to norm ______ + _____
A

Normal Changes during Puerperium Pd: CV

  1. immediate incr in PVR
  2. gradual return to norm CO + plasma vol
31
Q

Normal Changes during Puerperium Pd: Psych - PPD blues vs Depression

  1. which occurs later in PPD pd (w/in 2 wks)
    - other w/in days
  2. Which usu resolves spont + w/in 10 days
  3. Which requires intervention/Tx, what are the 2 options
    - other self limited
A

Normal Changes during Puerperium Pd: Psych - PPD blues vs Depression

  1. occurs later in PPD pd (w/in 2 wks) = Depression
    - other w/in days = Blues
  2. Usu resolves spont + w/in 10 days = Blues
    - Depression lasts months - over 1 yr
  3. Requires intervention/Tx = Depression (cousel, +/- antidepressants)
    - Blues –> no tx (self limited)
32
Q

Normal Changes during Puerperium Pd: Lactation

  1. how long recommended to exclusively BR feed
  2. how often to BR feed
  3. what is the early milk called/what color
A

Normal Changes during Puerperium Pd: Lactation

  1. recommended to exclusively BR feed x 6 mo
  2. how often to BR feed = 8-12x/day (q2-3 hrs)
  3. early milk =colostrum (yellow)
33
Q

Normal Changes during Puerperium Pd: Lactation

  1. why is PRL incr in PPD period (2 things)
  2. suckling –> secretion of ____ + _____ –> milk let down/production
  3. What med can incr lactation, what kind of med is it (why it causes lactation)
A

Normal Changes during Puerperium Pd: Lactation

  1. PRL incr in PPD period d/t decr estrogen + progesterone
  2. suckling –> secretion of oxytocin + PRL–> milk let down/production
  3. incr lactation w/Domperidone
    - DA antagonist –> incr PRL –> milk production
34
Q

Normal Changes during Puerperium Pd: Lactation Benefits

  1. 4 major benefits to mom
  2. 2 major benefits to baby
A

Normal Changes during Puerperium Pd: Lactation Benefits

  1. 4 major benefits to mom
    - decr PPD depression, uterus size, risk of BCA and ovarian CA
    - incr wt loss
  2. 2 major benefits to baby
    - easier to digest
    - passive IgA immunity –> gut protection
35
Q

5 CIs/conditions to BR feeding

A

CIs to BR feeding

  1. HIV
  2. Hep B
  3. TB
  4. Herpes BR lesion
  5. Galactosemia

Women's Health EOR (7 decks)

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