Postpartum problems Flashcards
Post-partum problems can be what kind ?
Physiologic changes
Post-partum complications
Physiologic changes can be like what ?
Puerperium
Uterus
Cardiovascular system
Endocrine
Breasts
Post-partum complications can be like what
- Endometritis
- UTI’s – most common
- Mastitis
- C-section wound infection
- Thromboembolism
- Thrombophlebitis
- Phlebothrombosis (DVT) - Maternal collapse
Puerperium
period of 6 weeks after birth where maternal reproductive organs go back to nonpregnant conditions.
Uterus
a. After birth weighs 1kg
b. 6 weeks later weighs less than <100g
c. Endometrium regenerates
d. Menstruation occurs (if lactation ceased)
e. Within 10 days uterus is not palpable
f. Uterus discharge appearing after birth – also called lochia
i. Lochia rubra
* Consists blood and fetal membranes
* Lasts for 2-14 days
* Persistence might indicate remaining placental or fetal tissues
ii. Lochia serosa
* Consists serous and mucus
* Lasts for 5 days after lochia rubra
iii. Lochia alba
* Consists leukocytes, fat, mucus and cholesterol
* Lasts for 4 weeks after lochia serosa
Lochia rubra
- Consists blood and fetal membranes
- Lasts for 2-14 days
- Persistence might indicate remaining placental or fetal tissues
Lochia serosa
- Consists serous and mucus
- Lasts for 5 days after lochia rubra
Lochia alba
- Consists leukocytes, fat, mucus and cholesterol
- Lasts for 4 weeks after lochia serosa
Cardiovascular system
a. CO and plasma volume return to normal (~3.5L fluid loss)
b. Increase in serum Na, bicarbonate, clotting factors (increased risk for DVT) and platelets
Endocrine
a. Estrogen and progesterone levels fall
b. Increase serum prolactin (in lactating women)
c. hCG is no longer detectable
Breasts
a. Colostrum - first milk present in breasts
i. Pre-birth - present from 12-16 weeks of pregnancy
ii. Post birth - produced up to 5 days after birth (thick and yellow) → turn to
transitional milk → mature milk from 14 days and onward (
iii. Importance of colostrum:
- Maternal bacterial colonization in the baby
- Promoting antigenic tolerance (reduces allergies)
- Passive immunization
iv. Contraindicated in cases of:
* HIV mother
* Retracted or painful nipples
* Previous breast surgery or implants
* Chemotherapy
* Mother does not want to breast feed
Endometritis
a. Symptoms:
i. Fever
ii. Lower abdominal pain
iii. Tachycardia
iv. Foul vaginal discharge
v. Bleeding
b. Agents:
i. Streptococci
ii. Aerobic gram negative
c. Complications – peritonitis, thrombophlebitis, abscess, TSS, sepsis
d. Diagnosis
i. Blood markers (CRP, leukocytosis)
ii. Vaginal culturing
e. Treatment – antibiotics
UTI’s – most common
a. Risk factors:
i. Previous infection
ii. Polycystic kidneys
iii. Neuropathic bladder
iv. Renal stones
b. Symptoms:
i. Pain
ii. Voiding difficulty
iii. Fever
iv. Dysuria
c. Agents:
i. E. coli
ii. Klebsiella
iii. Staph. Epidermidis
d. Diagnosis:
i. Urine analysis
Mastitis
a. Symptoms:
i. Pain
ii. Fever
iii. Erythema
b. Agents:
i. Staph Aureus and epidermidis
ii. Streptococci
C-section wound infection
a. Agents
i. Staph Aureus and MRSA
b. Complications:
i. Dehiscence
ii. Necrotizing fasciitis
