Postpartum Conditions/Labor Issues Flashcards
What defines Uterine Tachysystole?
More than 5 contractions in a 10 minute time
What occurs with Uterine Tachysystole?
Too many contractions with not enough time between them causes an interruption in blood flow and oxygen to the fetus which will compromise them
What will be seen on FHR monitoring with Uterine Tachysystole?
Decelerations
What should be done if Uterine Tachysystole is present?
Discontinue the utertonics
How will Postpartum Endometritis present?
Maternal Fever
Malodorous discharge
Uterine tenderness
How will Postpartum Endometritis present?
Maternal Fever
Malodorous discharge
Uterine tenderness
What is the treatment for Postpartum Endometritis?
IV antibiotics (clindamycin/gentamicin) until afebrile for 48 hours
What is a possible complication of Postpartum Endometritis?
Septic Pelvic Thrombophlebitis
How does Septic Pelvic Thrombophlebitis arise?
Pelvic infection that spreads to the pelvic vein and damages the vein wall that will then form a clot/embolus that is infected
What are the signs of Septic Pelvic Thrombophlebitis?
Abdominal pain and HECTIC fevers that are UNRESPONSIVE to antibiotics
What are the signs of Septic Pelvic Thrombophlebitis?
Abdominal pain and HECTIC fevers that are UNRESPONSIVE to antibiotics
What is Sheehan Syndrome?
Pituitary ischemia and necrosis that causes Anterior Pituitary Insufficiency
How may Sheehan Syndrome present?
Failure to lactate due to decreased prolactin from the anterior pituitary
How may Sheehan Syndrome present?
Failure to lactate due to decreased prolactin from the anterior pituitary
Besides failure to lactate, how may Sheehan Syndrome present?
Weakness/lethargy
Cold intolerance
Menstrual irregularities
Genital atrophy
Initial test if you suspect Sheehan Syndrome?
Provocative Hormonal testing
Best test if you suspect Sheehan Syndrome?
MRI of the pituitary
Treatment for Sheehan Syndrome?
Replace deficient hormones
How much blood must be lost to be considered a postpartum hemorrhage?
> 1000 mL of blood
What is the most common cause of postpartum hemorrhage?
Uterine Atony
What are some risk factors for Uterine Atony?
- Uterine stretch like with multiple gestations
- Exhausted uterus from uterotonics/long labor
How will Uterine Atony present?
Postpartum hemorrhage with a soft and boggy uterus ABOVE umbilicus (enlarged)
What is the initial treatment for Uterine Atony?
Uterine massage + Oxytocin
What is the initial treatment for Uterine Atony?
Uterine massage + Oxytocin
Retained placental tissue can also cause a postpartum hemorrhage. What should be done to diagnose?
Inspect placenta and uterus +/- US
What are risk factors for a Retained Placental Tissue causing postpartum hemorrhage?
Placenta accreta/increta/percreta or other anomalies of the placenta
Placenta Accreta
Placenta attaches too firmly to endometrium of the uterus
Placenta Increta
Placenta invades and attaches to the uterine muscle/myometrium
Placenta Percreta
Placenta invades the uterine wall and attaches to nearby organs like the bladder
What is seen with a Uterine Inversion?
Vaginal mass protruding = uterine fundus prolapsed through cervix and vagina
The risk of uterine rupture increases with?
More uterine surgeries
What is the most common sign of uterine rupture?
Loss of fetal station
What is the most common sign of uterine rupture?
Loss of fetal station
What may be felt on abdominal exam with a uterine rupture?
Fetal parts
What is the treatment for a Uterine inversion?
Replace the uterus into a normal position
