Postpartum Care/Complications

Question 1

What is the size of the fundus right after birth

Answer 1

Large grapefruit

Question 2

Where is the fundus located right after birth

Answer 2

Midline midway between symphysis pubis and umbilicus

Question 3

Where is the fundus located 6-12 hours after birth

Answer 3

Level of the umbilicus

Question 4

How much does the fundus decrease in size

Answer 4

1 cm a day

Question 5

When does the fundus descend into the pelvis

Answer 5

10th day

Question 6

At 6-8 weeks how much does the fundus weigh

Answer 6

60 g

Question 7

What is lochia rubra

Answer 7

dark red blood with some clotting less than the size of a nickel

Question 8

When does lochia rubra occur

Answer 8

1st 2-3 days after birth

Question 9

What is lochia serosa

Answer 9

pinkish discharge

Question 10

When does lochia serosa occur

Answer 10

days 3-10

Question 11

What is lochia alba

Answer 11

white/yellow-white discharge

Question 12

What does breastfeeding reduce in the mom

Answer 12

• Breast/ovarian cancer
• HTN
• Type 2 diabetes

Question 13

What does breastfeeding reduce in the baby (8)

Answer 13

• Asthma
• Obesity
• Type 1 diabetes
• Severe lower respiratory disease
• otitis media
• SIDS
• GI infections
• NEC in preterm babies

Question 14

What are the postpartum warning signs (7)

Answer 14

• Bright red bleeding, increased bleeding, soaking more than 1 pad an hour, large clots
• Temperature >100.4, chills
• Increased/excessive pain
• Foul smelling lochia
• Urinary burning, frequency, unable to void
• Calf pain, redness, tenderness, increased edema
• Chest pain, SOB

Question 15

How much blood is considered hemorrhaging after a vaginal birth

Answer 15

> 500 ml

Question 16

How much blood is considered hemorrhaging after a c-section

Answer 16

> 1,000 ml

Question 17

What change in Hg, Hct is considered hemorrhaging

Answer 17

10%

Question 18

What is primary/early postpartum hemorrhage

Answer 18

bleeding during the 1st 24 hours after birth

Question 19

What is secondary/late postpartum hemorrhage

Answer 19

bleeding 24 hours-14 days after birth

Question 20

What are the interventions for postpartum hemorrhage

Answer 20

• Initiate emergency response based on hospital policy
• Massage uterus until firm
• Start large bore IV to replace volume with normal saline or lactated ringers
• Supplemental oxygen
• Vital signs every 15 minutes including I&O
• Foley catheter to empty bladder
• Blood for CBC, crossmatching
• Continuous ECG, pain management, support

Question 21

What are the causes/risk factors for postpartum hemorrhage

Answer 21

• Prolonged/rapid labor
• Retained placenta/placenta products
• Oxytocin, augmentation, induction
• Preeclampsia
• History of postpartum hemorrhage
• Trauma to cervix, vagina, perineal muscles
• Multiple gestation
• Coagulation disorders - thrombocytopenia
• Placental abruption, placenta prevue
• Too frequent/too many pregnancies

Question 22

What are the medications used to treat postpartum hemorrhage

Answer 22

• Oxytocin
• Misoprostol
• Carboprost
• Methergine

Question 23

What is the dose for oxytocin during postpartum hemorrhage

Answer 23

IV 10-40 U/1,000 ml solution

Question 24

What is the dose of Misoprostol during postpartum hemorrhage

Answer 24

800-1000 mcg rectally

Question 25

What is the dose of carboprost during postpartum hemorrhage

Answer 25

0.25 IM every 15-90 minutes

Question 26

What is the dose of methergine during postpartum hemorrhage

Answer 26

IM/PO, not for HTN over 140/90