Postpartum Care Flashcards
What causes Sheehan’s syndrome?
When a patient experiences significant blood loss, it can result in anterior pituitary hypoperfusion and ischemic necrosis
What hormones are lost in Sheehan’s syndrome?
gonadotropin, TSH, and ACTH; all produced in anterior pituitary
Signs and symptoms of Sheehans syndrome
slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension and amenorrhea
Treatment for sheehans syndrome
estrogen and progesterone, thyroid and adrenal hormones
Endometritis is postpartum period is most closely related to ____.
Mode of delivery. Can be found in <3% vaginal birthds, 5-10x higher in C sections.
Factors related to increased rates of endometritis in vaginal delivery:
prolonged labor, prolonged rupture of membranes, multiple vaginal exams, internal fetal monitoring, manual removal of placenta, and low socioeconomic status.
Most common cause of postpartum fever
endometritis, uterine fundal tenderness is commonly observed; ddx: uti, lower genital tract infection, wound infections, pulmonary infections, thrombophlebitis, mastitis
What is most likely causative bacterial agent of endometritis?
Usually polymicrobial with mix of aerobes and anaerobes in genital tract; most common are Staph aureus and Streptococcus
Risk factors for postpartum depression
prior history of depression***, marital conflict, lack of social support, having contemplated terminating pregnancy, stressful life events in previous 12 months and sick leave in past 12 months related to hyperemesis, uterine irritability, or psychiatric disorder
What is safest method to suppress lactation?
breast binding, ice packs, analgesics; pt should avoid breast stimulation so natural inhibition of prolactin secretion will result in breast inovulation
Bromocriptine for suppressing lactation is associated with:
hypertension, stroke, and seizures
hormonal interventions for suppressing lactation predispose to:
thromboembolic events and rebound engorgement
Breastfeeding is associated with decreased risk of:
Ovarian cancer; other benefits include uterine contraction due to oxytocin release during milk letdown and decreased blood loss
Breast milk is a major source of _____ for newborns
Immunoglobulin A, which is associated with decrease in newborns GI infections; breastfeeding recommended for first 6 months after birth
Best contraceptives postpartum:
Progesterone-only(non hormonal methods) are more ideal than estrogen containing methods because it has not been shown to impact milk production or volume and no adverse effects for infant; estrogen-progesterone containing methods may diminish lactation and cause issues with breastfeeding, especially in the first 30 days PP
