pp complications

Question 1

etiology of pp cramping

Answer 1

rhythmic contractions pp in attempt to involute uterus

Question 2

risk factors for pp cramping

Answer 2

prolonged labor
poor muscle tone
over-distension of uterus
multiparity

Question 3

ssx pp cramping

Answer 3

mild to severe cramps usu beginning in 4th stage
may last hours to days
comes and goes
often accompanies latching and nursing

Question 4

managment of pp cramping

Answer 4

keep bladder empty
massage frequently
nurse baby regularly

Question 5

when is pp cramping abnormal?

Answer 5

pain after 3 days

Question 6

prenatal uterine tonic to prevent cramping

Answer 6

rubus 2 pts, medicago 1 pt, urtica 1 pt
infuse for 15 mins, drink 1 cup 2x/day
start by 36 weeks

Question 7

partus prepator formula

Answer 7

caulophyllum 4dr, cimicifuga 4dr

15gtt/day, start week 37

Question 8

caulopyllum

Answer 8

30gtt/hr, then prn: pains dt debility, fullness and weight in pelvis, pains in legs.

Question 9

cimicifuga

Answer 9

30gtt/hr, then prn: tense, aching pains

Question 10

gelsemium

Answer 10

10-20gtt/2hrs prn; pains dt nervous exhaustion. *DO NOT GIVE IMMEDIATELY POSTPARTUM

Question 11

leonorus

Answer 11

30gtt/hr prn; gentle anti-spasmodic, uterine tonic, laxative

Question 12

viburnum

Answer 12

20gtt/15min, then prn; sever, spasmodic pains

Question 13

arnica 200c

Answer 13

3pellets s.l./hr x 3hr; achey, bruised pain w shocky, dazed sensorium. Does not want to be touched.

Question 14

bellis perennis 200c

Answer 14

intense soreness, bruised feeling dt trauma,

Question 15

mag phos 30c, 200c

Answer 15

cramping, spasmodic pains, intense, can be sharp.

Question 16

etiology of hemorrhoids

Answer 16

increased venous stasis
physical pressure of baby’s weight
valsalva pressure during 2nd stage

Question 17

risk factors for hemorrhoids

Answer 17

existing hemorrhoids
prolonged 2nd stage
poor nutrition
obesity

Question 18

ssx hemorrhoids

Answer 18

pain
protruding, bulging veins
bleeding

Question 19

management of hemorrhoids

Answer 19

counter-pressure during 2nd stage
inflatable donut cushions
sitz bath- achillea, quercus, plantago, symphytum, hammemelis
epsom salts
suppositories
keep stools soft

Question 20

risk factors for hematomas

Answer 20

varicosities
prolonged 2nd stage
excessive use of perineal stretching
instrumentation
macrosomia

Question 21

ssx hematoma

Answer 21

swelling
bruising
pain
displacement of uterus
signs of shock

Question 22

management of hematoma

Answer 22

apply pressure- truss, ice pack, sanitary pad
stop bleeding
prevent infx

Question 23

etiology urinary incontinence

Answer 23

weakened pelvic structures including muscles, ligaments, bladder sphincter

Question 24

risk factors urinary incontinence

Answer 24

prolonged 2nd stage
poor nutrition
intrapartum or PP urinary retention
obesity
multiparity

Question 25

ssx urinary incontinence

Answer 25

incontinence due to stress (valsalva) | cystocele

Question 26

managment of urinary incontinence

Answer 26

pelvic floor exercise

Question 27

botanicals for urinary incontinence

Answer 27

Arnica - 5gtt tid:  Incontinence due to bruising and trauma Achillea - 30gtt qid  :  Incontinence due to tissue laxity. (Astringent) Claviceps - 10gtt tid :  Weakness of the bladder. Caution, toxic botanical. Helonias -  30-60 gtt tid :  Incontinence due to prolapse (tones pelvic tissue) Piper - 20gtt tid:  Tones urinary apparatus *CAUTION: can have sedative effect on nursing newborn.  Thuja - 20gtt qid:  Weak bladder sphincter, dribbling with cough

Question 28

homeopathics for urinary incontinence

Answer 28

Helonias -  Stress incontinence dt prolapse, weak feeling in pelvis Nat mur - Involuntary when walking, coughing.  Good after disappointing birth experience. Pulsatilla - Involuntary urination worse with coughing and passing flatus, < at night
Sepia - Involuntary urination, esp during first sleep, pelvic weakness and uterine prolapse, slow sluggish urination.
Staphysagria - incontinence due to cystocele, feeling pressure on bladder. Causticum- night watching and worry about something bad happening to baby

Question 29

what is the biggest risk of thrombosis?

Answer 29

PE

Question 30

risk factors for thrombosis

Answer 30

``` c-section >35yo high parity obesity suppression of lactation smoking immobility trauma to legs ```

Question 31

ssx thrombosis

Answer 31

superficial thrombophlebitis- tenderness, veins hard/red/warm DVT- pain, homan's sign, swelling

Question 32

management of thrombosis

Answer 32

``` prophylactic tx- prevent trauma, exercise prompt tx of DVT: supportive hoses/bandages, legs elevated Vit E 400-1200IU Bioflavonoids – GSE, pycnogenol, diosmin (Thorne) Immune stimulating herbs Bromelain 1000mg 4x/d (3rd tri only) Heparin/Warfarin ```

Question 33

ssx PE

Answer 33

``` severe CP dyspnea shock slight hemoptysis collapse cyanosis hypotension ```

Question 34

what is an amniotic embolism?

Answer 34

amniotic fluid enters maternal circ, can obstruct pulmonary vessel but MC causes anaphalaxis

Question 35

risk factors for amniotic embolism

Answer 35

precipitous labor multiparity excessive use of oxytocic drugs uterine trauma

Question 36

ssx amniotic embolism

Answer 36

``` sudden onset dyspnea rapid shallow breaths pulmonary edema tachycardia hypotension convulsions/seizures pt often says she is going to die ```