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OB/GYN > Postpartum care & complc'ns > Flashcards

Postpartum care & complc'ns Flashcards

1
Q

what is the puerperium?

A

first 6 w after delivery

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2
Q

what are common p-p complc’ns of vag deliveries? Mgt of each?

A

pain - NSAIDs & tylenol, maybe low-dose narcs
perineal & labial edema - ice packs
episiotomies or lacs - make sure no hematomas, keep wound clean
hemorrhoids - resolve w/time. Stool softeners, OTC hemorrhoidal creams

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3
Q

what are common p-p complc’ns of c/s? Mgt of each?

A

wound care
pain mgt - NSAIDs, tylenol, low-dose narcs
post-op ileus - stool softeners, maybe laxatives

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4
Q

p-p breast care?

A 
may have low-grade fever
warmth, tenderness, firmness
relief w/breastfeeding.  If not breastfeeding:
ice packs
tight bra
analgesics
anti-inflam
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5
Q

how much pelvic rest is needed p-p?

A

6 w

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6
Q

what forms of hrm’l b.c. are safe during breastfeeding?

A

mini-pill
Norplant
Depo-Provera

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7
Q

why aren’t ES-containing OCPs used p-p?

A

dries up milk supply. Can try them 4-6w after establishing breastfeeding.

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8
Q

other forms of contraception recomm’d p-p?

A

condoms. Avoid cervical cap & diaphragm b/c cervix hasn’t returned to normal shape yet.
IUD is ok but has higher rates of extrusion b/c of dilated cervix

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9
Q

how long are vag deliveries kept in hosp? c/s?

A

1 day for vag, 3 for c/s

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10
Q

what are the primary p-p complications?

A

pph
endomyometritis
mastitis
pp depression

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11
Q

what is pph?

A

> 500mL blood loss in a vag delivery, > 1000mL in c/s.
if w/in first 24h of delivery = early.
if after 24h, = late

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12
Q

causes of pph:

A 
uterine atony
retained POCs
placenta accreta
cervical lacs
vag lacs
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13
Q

mgt of pph:

A

IVF
have blood ready
may need plts & coag factors

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14
Q

what is Sheehan syndrome?

A

pituitary infarction 2/2 hypotension from pph. P/w absence of lactation or amenorrhea due to lack of pit hrms.

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15
Q

how does a vag hematoma dvp?

A

trauma of delivery damages an a. w/o damaging overlying skin

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16
Q

how do vag hematomas present?

A

unexplained drop in hct. Need to do a vag exam to look for hematoma

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17
Q

mgt of vag hematomas?

A

expectant mgt. If it becomes tense or expanding, open it & ligate the bleeding bv.

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18
Q

what is a rare complc’n of vag hematoma?

A

retroperitoneal bleed

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19
Q

dx & mgt of retroperitoneal hematoma?

A

CT or u/s

expectant mgt, maybe surgery if unstable

20
Q

mgt of cervical lacs?

A

anesthesia (epidural, spinal, or pudendal)

repair w/interrupted or running absorbable suture

21
Q

what is the leading cause of pph?

A

uterine atony

22
Q

dx of uterine atony?

A

uterus is enlarged, soft, boggy.

23
Q

mgt of uterine atony:

A

IV pitocin
strong uterine massage
methylergonovine if no response to pitocin & massage
prostin (PGF2alpha) intrauterine injection if still no response
if still no response, D&C to r/o retained POC
if rate of bleeding is not too fast, can have IR do uterine a. embolization.
if this fails, need ex lap to ligate pelvic vessels, maybe hysterectomy.

24
Q

methylergonovine is CI’d in who?

A

HTN’ves

25
Q

prostin is CI’d in who?

A

asthmatics

26
Q

what to do if suspect retained POC?

A

manual exploration of uterus if cervix hasn’t ctr’d down yet, or D&C.

27
Q

If bleeding continues and you’ve r/o retained POC, what should you suspect?

A

placent accreta

28
Q

mgt of placenta accreta

A

ex lap, place hemostatic sutures in placental bed. May need hysterectomy if bleeding persists.

29
Q

CP of placenta accreta?

A

pph that has not responded to oxytocin, uterine massage, ergonovines, prostaglandins. Maybe pt had long 3rd stage and/or placenta came out in pieces.

30
Q

CP of uterine rupture:

A

most likely a pt w/previous uterine scar, but can be a pt w/no scar (rare in nullips).
“popping” sensation

31
Q

mgt of uterine rupture

A

ex lap, hysterectomy if can’t control bleeding

32
Q

RF’s for uterine inversion:

A

fundal implantation of placenta
uterine atony
placenta accreta
excessive traction on cord during 3rd stage

33
Q

mgt of uterine inversion:

A

manual replacement. NTG may help.

pts may have a vasovagal response and become unstable - need anesthesiologist stat. Ex lap.

34
Q

operative mgt of pph:

A

1) r/o vag & cervical lacs with exam
2) if bleeding still doesn’t stop, do D&C
3) if bleeding still doesn’t stop, do ex lap. If blood in abdomen, dx is uterine rupture. Need to tie off uterine a’s.

35
Q

what is an alternative to ex lap w/hysterectomy in stable pts?

A

IR uterine a. embolization

36
Q

what is endomyometritis?

A

polymicrobial infection of uterine lining that often invades the underlying wall.

37
Q

RFs for endomyometritis?

A

meconium
chorioamnionitis
PROM

38
Q

CP of endomyometritis?

A

fever
elevated WBC
uterine tenderness
about 5-10d after delivery

39
Q

dx of endomyometritis

A

u/s to look for retained POCs as nidus of inf’n

40
Q

tx of endomyometritis?

A

broad-spec abx, continued until pt is afebrile for 48h and WBc is normal.
D&C if POCs were seen on u/s - use blunt, not sharp currette, post-partum to avoid rupture.

41
Q

CP of mastitis:

A

focal tenderness, erythema & warmth over one region of breast. Fever, WBC.
(diff from diffusely tender, warm, firm breasts - common w/milk letdown)

42
Q

tx of mastitis

A

dicloxacillin
I&D abscess if present
continue to breastfeed or pump (prevents intraductal accuml’n of infected stuff)

43
Q

why does p-p deps’n occur?

A

rapid changes in ES, PG, Prl, lack of sleep, psychosocial stress of being a new mom.

44
Q

RFs for pp deps’n

A

PMHx of depression or mental illness, poor social support

45
Q

CP of p-p deps’n:

A 
low E level
anorexia
insomnia
hypersomnolence
extreme sadness
for > a few weeks
feel like can't care for baby
SI
46
Q

mgt of p-p deps’n

A

reassurance most of the time.

if SI or psychosis, get counselor, SW, rx SSRI

OB/GYN (29 decks)

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