Postpartum Care and Complications

Question 1

What to look for post-vaginal delivery?

Answer 1

Intact perineal repair and no hematoma formation

Question 2

What to look for post-C-section?

Answer 2

Wound infection
Wound dehiscence
Stool softeners (if on opiates)

Question 3

What preventative meds are given post-partum?

Answer 3

Tdap
MMR
RhoGAM if Rh- within 72 hoursq

Question 4

Why are combined OCPs not recommended for post-partum contraception?

Answer 4

Estrogen can reduce milk production

Prefer progestin only OCPs

Question 5

What are common post-partum complications?

Answer 5

Postpartum hemorrhage
endymyometritis
wound infection/separation
mastitis
postpartum depression

Question 6

Define PPH and complications

Answer 6

> 500 ml blood loss in vaginal delivery, >1000 in c-section
Causes = atony, retained products, trauma (lacs), coagulopathies
Can form consumptive coagulopathy with >2-3L lost
Can lead to Sheehan’s syndrome (pituitiary apoplexy) with hypovolemia

Question 7

How is PPH treated?

Answer 7

IV oxytocin and fundal massage
Methergine
Misoprostol, hemabate (prostaglandins)
OR for D&C, uterine balloon, uterine artery embolization, ligation, hysterectomy is last option

Question 8

What are the signs and treatment of endomyometritis?

Answer 8

Infection of uterine lining, usually after c-section
fever, elevated WBC, uterine tenderness (r/o retained POC with US)
Broad-spectrum abx until afebrile for 48 hours and WBC normalizes, D&C if POC

Question 9

What is the treatment for mastitis?

Answer 9

Oral dicloxacillin

may need I&D if abscess forms

Question 10

How to diagnose post-partum blues?

Answer 10

Rapid mood swings
changes in appetite, concentration, sleep
anhedonia, anorexia, apathy, extreme sadness
Usually starts around day 2-3, peaks around day 5, and resolves by 2 weeks

Question 11

What is treatment for postpartum depression?

Answer 11

Support and encouragement

SSRIs

Question 12

How is postpartum depression different from postpartum blues?

Answer 12

Same symptoms except > 2 weeks

Severe symptoms include ambivalence towards newborn or inability to love family

Question 13

What is the most significant risk factor for postpartum depression?

Answer 13

Personal history of depression

Question 14

Breastfeeding is associated with a decreased risk of what?

Answer 14

Ovarian cancer
GI infection
?breast cancer