Postpartum Care Flashcards
2 criteria for the new definition of postpartum hemorrhage
New definition of PPH
- 1000 mL blood loss w/delivery +
- S/s of hypovolemia
Old definition of PPH
- amt of blood loss w/vag delivery
- amt of blood loss w/C section
Old definition of PPH
- 500+ mL blood loss w/vag delivery
- 1000+ blood loss w/C section
MC cause of postpartum hemorrhage
MC cause of postpartum hemorrhage = uterine atony
Definition of uterine atony
Uterine atony = failure of uterus to contract enough to limit blood loss
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?
Next step = uterine massage + oxytocin/pitocin
Dx= Postpartum Hemorrhage d/t Uterine Atony
Name 2 meds given for Uterine Atony in PPH and their CI
Tx of Uterine Atony in PPH
- Methergine (Methylergonovine), CI = HTN
- Carboprost (Hemabate), CI = Asthma
3 surgical Tx for Uterine Atony d/t PPH
- which is definitive Tx but last resort
3 surgical Tx for Uterine Atony d/t PPH
- D+C
- UAE
- Hysterectomy (definitive Tx but last resort)
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?
Dx = PPH d/t retained POC
Tx = D+C
2 other causes of PPH that are a/w well contracted uterus and Tx = sutures
2 other causes of PPH that are a/w well contracted uterus and Tx = sutures
Cervical and Vaginal Lacerations
Fundus of uterus goes thru cervix and into the vagina
Uterine Inversion = Fundus of uterus goes thru cervix and into the vagina
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?
Dx/cause = PPH d/t uterine inversion
Tx = manually replace uterus, uterine relaxants
What is the main sequelae/complication of PPH
main sequelae/complication of PPH = Sheehan’s Syndrome
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?
Dx = Sheehan’s Syndrome
Postpartum ischemic pituitary necrosis –> hypopituitarism
Postpartum ischemic pituitary necrosis –> hypopituitarism = Sheehan’s Syndrome
MC cause of postpartum fever (usu polymicrobial but most commonly involves anaerobes)
MC cause of postpartum fever (usu polymicrobial but most commonly involves anaerobes)
Endometritis
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?
Dx = Endometritis
Tx
- admit
- broad spectrum ABX –> Genta + Clinda
Tx of Endometritis
- How long to continue ABX once pt is afebrile, norm WBCs and no abd pain
- What should be added in 48 hrs if pt doesnt improve w/initial ABX therapy
- If fever still persists after #2 what test should be done next? looking for?
Tx of Endometritis
- continue ABX for 24-48 hrs once pt is afebrile, norm WBCs and no abd pain
- Add Ampicillin in 48 hrs if pt doesnt improve w/initial ABX therapy
- If fever still persists after #2 –> CT/MRI –> look for Septic Thrombophlebitis
Vaginal Lacerations
- what constitutes 1st degree
- 2nd degree
- 3rd degree
- 4th degree
what is the complic a/w 3rd/4th
Vaginal Lacerations
- 1st degree = skin and/or vaginal mucosa
- 2nd degree = above + muscles
- 3rd degree = above + anal sphincter complex
- 4th degree = above + rectal mucosa
complic a/w 3rd/4th = fistula
Type of tear where lac goes thru the vaginal mucosa into the vagina but has intact anal sphincter
what degree
Lac goes thru the vaginal mucosa into the vagina but has intact anal sphincter = buttonhole/ Rectal butthole tear
4th degree
What is the major way to possibly prevent a vaginal laceration
major way to possibly prevent a vaginal laceration = Episiotomy
How are vaginal lacs usually repaired (what type/technique)
Repair of Vaginal lacerations
interrupted sutures
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
What is best tx method (non-pharm) = Sitz bath
What med is helpful and given PPD = stool softener
What can Sitz baths also be used for, other than vaginal lacerations (2)
Use of Sitz baths
- Vaginal/Perineal lacs
- Episiotomy care
- Hemorrhoids
Post laceration/episiotomy care
After vaginal lac or episiotomy what is it important to educate the pt about
Post laceration/episiotomy care
- edu = no anal sex for 6 wks
