Postpartum Hemorrhage/Fever

Question 1

What is the leading cause of maternal death?

Answer 1

Postpartum hemorrhage

Question 2

With a vaginal birth, what defines a postpartum hemorrhage?

Answer 2

> 500 cc blood lost

Question 3

With a C-section, what defines a postpartum hemorrhage?

Answer 3

> 1000 cc blood lost

Question 4

Primary Postpartum Hemorrhages occur when?

Answer 4

Within the 1st 24 hours after delivery

Question 5

Secondary Postpartum Hemorrhages occur when?

Answer 5

After 24 hours up to 12 weeks

Question 6

What is the most common cause of Primary Postpartum Hemorrhages?

Answer 6

Uterine Atony

Question 7

What is Uterine Atony?

Answer 7

Uterus fails to contract after the delivery of the baby or placenta in order to compress the severed vessels

Question 8

What is Uterine Atony?

Answer 8

Uterus fails to contract after the delivery of the baby or placenta in order to compress the severed vessels

Question 9

On palpation, what will be felt with Uterine Atony?

Answer 9

Boggy uterus

Question 10

If you feel a boggy uterus after the delivery of the baby/placenta, what is likely the cause?

Answer 10

Uterine Atony

Question 11

What is the treatment of Uterine Atony?

Answer 11

Bimanual massage of the uterus + pharmacologic interventions

Question 12

What is the treatment of Uterine Atony?

Answer 12

Bimanual massage of the uterus + pharmacologic methods

Question 13

A Retained placenta or fragments can also cause Postpartum Hemorrhage. Why is that?

Answer 13

Uterus cannot maintain contraction and involute normally with the retained products

Question 14

If the uterus cannot maintain contraction and involute normally, what is likely in the way?

Answer 14

Retained Placental fragments

Question 15

What is the treatment for a Retained Placenta?

Answer 15

Manual Removal +/- uterine curettage

Question 16

What is a Uterine Inversion?

Answer 16

Uterine fundus descends downward

Question 17

What often can cause Uterine Inversion?

Answer 17

Improper management of the 3rd stage of labor

Question 18

What is the proper management of the 3rd stage of labor in order to avoid a Uterine Inversion?

Answer 18

Counterpressure between the symphysis and fundus!

Question 19

If the Uterine inversion occurs before the placenta is delivered, what should you do first?

Answer 19

Fix the uterine inversion

Question 20

How do you treat a Uterine Inversion?

Answer 20

Manually replace the uterus + start Oxytocin

Question 21

What is Febrile Morbidity?

Answer 21

Fever for 2+ days during the first 10 days after delivery

Question 22

What usually causes Febrile Morbidity?

Answer 22

Endometritis

Question 23

After delivery, what happens to the pH of the vagina that can allow organism growth?

Answer 23

pH becomes more alkaline

Question 24

Puerperal Sepsis occurs after the delivery of the baby What organisms are usually to blame?

Answer 24

Anaerobic Cocci

Question 25

Puerperal Sepsis occurs after the delivery of the baby. What organisms are usually to blame?

Answer 25

Anaerobic Cocci

Question 26

What are the signs of Puerperal Sepsis?

Answer 26

Postpartum FEVER and uterine tenderness 2-3 days after delivery

Question 27

What are the signs of Puerperal Sepsis?

Answer 27

Postpartum FEVER and uterine tenderness 2-3 days after delivery

Question 28

What is the treatment for Puerperal Sepsis?

Answer 28

Antibiotics with Anaerobic coverage

Question 29

What is a pathogen that can be resistant to the broad spectrum antibiotics with Puerperal Sepsis?

Answer 29

Bacteroides Fragilis

Question 30

If the postpartum fever is persistent after the antibiotics, what are 2 causes you must consider?

Answer 30

Ovarian Vein Thrombophlebitis | Deep Septic Pelvic Vein Thrombophlebitis

Question 31

Ovarian Vein and Deep Septic Pelvic Vein Thrombophlebitis' occur a few days after delivery. How does the patient appear with each?

Answer 31

Ovarian Vein = APPEAR ILL | Deep Septic Pelvic Vein = do NOT appear ill

Question 32

If a postpartum mother has a fever a few days after birth and she appears ill, what may be seen on radiographics?

Answer 32

Ovarian Vein Thrombosis may be seen

Question 33

If a postpartum mother has a fever that is not responding to medications a few days after giving birth but she appears fine, what will be seen on radiographs?

Answer 33

NOTHING | -- deep septic pelvic vein thrombophlebitis

Question 34

What is the treatment for both Ovarian Vein and Deep Septic Pelvic Vein Thrombophlebitis'?

Answer 34

Anticoagulate

Question 35

2-3 days postpartum with a fever and uterine tenderness, what should you consider is likely?

Answer 35

Puerperal Sepsis