Postpartum Care

Question 1

postpartum is the 4th stage of labor but what are the 3 parts of postpartum?

Answer 1

1. initial phase: first 6-12 hrs
2. subactue phase: 2-6 weeks
3. delayed postpartum phase: lasts up to 6 months

Question 2

risks in postpartum phases

Answer 2

1. rapid changes w/ potential for immediate crises
2. still major changes to the body; pt may self ID problems
3. gradual change, pathology is rare

Question 3

changes to the body in the initial (immediate) phase?

Answer 3

uterine involution

Question 4

uterine involution

Answer 4

• chiefly occurs as result of decrease in myometrial cell size
• withdrawal of the steroid sex hormones stimulates increases the activity of uterine collagenase
• helped by manual external massage; “afterpains”
• accentuated by oxytocin release from breast feeding

Question 5

changes of the placental implantation site in the immediate phase

Answer 5

• contraction of the placental site to less than half
• permits occlusion of underlying blood vessels
• accomplishes hemostasis and endometrial necrosis

Question 6

endometrial regeneration

Answer 6

-completed by 3rd week postpartum

Question 7

normal postpartum discharge (lochia)

Answer 7

• lochia rubra (3-4 days): heavy, bright red
• lochia serosa (10-12 days): lighter, pale brownish
• lochia alba: (4-5 weeks): very light, yellowish white

Question 8

postpartum hemorrhage

Answer 8

-excessive bleeding (>500mL) (but remember the nl vaginal deliveries will have about 700 mL of blood loss)

Question 9

major causes of postpartum hemorrhage

Answer 9

1. uterine atony (50%)
2. OB lacerations (20%)
3. retained placental tissue (5-20%)
4. coagulation defects

Question 10

Uterine atony risks/causes

Answer 10

• excessive manipulation of uterus
• general anesthesia
• uterine overdistention
• prolonged labor
• oxytocin induction
• intrinsic myometrial dysfunction
• grand multiparity

Question 11

OB lacerations risks/causes

Answer 11

• episiotomy
• can involve uterus, cervix, vagina or vulva
• uncontrolled delivery or operative delivery
• hematomas

Question 12

retained placental tissue risks/causes

Answer 12

• placenta accreta
• manual removal of placenta
• mismanagement of 3rd stage of labor
• unrecognized succenturiate placenta

Question 13

placenta accreta

Answer 13

general term for when the placenta attaches too deeply into the uterine wall

Question 14

placenta perfreta

Answer 14

through the uterine wall

Question 15

placenta accreta is associated with what?

Answer 15

previous c section

Question 16

diagnosis of placenta accreta

Answer 16

• diagnosed by US

- affirmed/defined by MRI

Question 17

degrees of uterine inversion

Answer 17

1st: dimpling of fundus, remains above internal os
2nd: fundus passes through cervix but remains in vagina
3rd: endometrium visible outside of vulva

Question 18

endometritis

Answer 18

-postpartum infection defined by temp > 38C (100.4F) on 2 separate occasions at least 24 hrs apart following the first 24 hrs after delivery

Question 19

endometritis is associated w/ ?

Answer 19

• prolonged rupture of the membranes
• toxemia
• intrauterine pressure catheters (>8hrs)
• fetal scalp electrode monitoring
• excessive number of digital vaginal exams
• coitus near term

Question 20

pathognomonic for infection (of mom) with group B strep

Answer 20

-early fever (w/i hours of delivery) and hypotension

Question 21

postpartum depression

Answer 21

• beging 12 mo after delivery
• criteria for diagnosis is same as non-pregnancy depression
• sx must be present nearly every day for at least 2 weeks

Question 22

s/s of postpartum eclampsia

Answer 22

• HA

- pitting edem at postpartum phase

Question 23

review . .

Answer 23

long list of RFs and clinical presentation of postpartum eclampsia

Question 24

PE at discharge of the postpartum pt

Answer 24

• breasts and abdomin exam
• degree of uterine involution should be noted
• calves and thighs palpated for thrombophlebitis
• perineum if laceration or episiotomy