PP-NORMAL

Question 1

Postpartum period, also called the puerperium, last from delivery to placenta until - weeks

Answer 1

6-12 weeks

Question 2

What pregnancy changes remain present for months to years?

Answer 2

Pelvic musculature and cardiac remodeling

Question 3

The pregnant uterus at term–excluding stuff inside–weighs about 1000g, 10-20x heavier than the nonpregnant uterus. Involution back into the pelvis usually occurs around week __ and usually back to it’s size by week ___

Answer 3

Week 2: back into pelvis

Week 6: normal size

Question 4

By day __, the endometrium is fully restored via regeneration

Answer 4

16 (2.5wks)

Question 5

How is hemostasis accomplished right after birth?

Answer 5

Arterial smooth muscle contraction and compression of vessels by the involuting uterus.

Question 6

A sudden but transient increase in bleeding occurs between day _ and _
& should be evaluated if lasts longer than _ and __ hours

Answer 6

7-14 days

1-2 hours.

Question 7

Describe phases of lochia

Answer 7

Lochia rubra–flow of blood last several hours, then rapidly diminishes to a reddish brown d/c through day 3-4.
Lochia serosa: mucopurulent, somewhat malodorous d/c that lasts on avg 22-27days (with bleeding from healing placenta location occurring around day 7-14.)
Lochia alba: yellow-white d/c occurs afterward.

Question 8

T or F: Breastfeeding and use of COCs affect lochia

Answer 8

False;

BF may just help decrease amount of bleeding immediately PP

Question 9

Mgmt plan for abnormal uterine bleeding in the PP period

Answer 9

ultrasound; uterine evacuation and curettage
Meds: Pit, Cytotec, Methergine, Hemabate, Dinoprostone, TXA
Labs: CBC w/diff, coags
Give: extra IV fluids, O2, 2nd IV line for possible transfusion
Cont. to monitor VS
Determine cause: 4 T’s- Tone, Tissue, Trauma, Thrombin

Question 10

Mean-time to ovulation in the breastfeeding and nonlactating mothers?

Answer 10

Lactating: 6 mons
Nonlactating: Day 70-75 (week 9), earliest being 27 d after delivery

Question 11

Thyroid panel should be drawn at week _, month__, and month __ in women who have thyroid disease

Answer 11

6 wks
3 months
6 months
TSH should be 0.4-5mU/L

Question 12

Hyperthyroidism is best treated with…

Answer 12

1st: beta blockers
2nd: Methimazole and propylthiouracil, which are SAFE during BF

Question 13

Hypothyroidism is best treated with…

Answer 13

thyroid supplementation: synthroid

Question 14

Plasma volume decreases by about _____cc after delivery secondary to blood loss, and by the third day PP, is replenished by fluid shift.

Answer 14

1000cc

Question 15

By __ weeks, red cell mass has rebounded and hematocrit is usually normal

Answer 15

8wks

Question 16

Due to cardiac remodeling, this remains higher than prepregnancy values 1 year after delivery

Answer 16

Cardiac output

Question 17

When are PP women most likely to clot?

Answer 17

Greatest level of coagulability: immediately after delivery, up to 48 hours after
up to 6 wks PP

Question 18

By week __, dilation and tone of ureters and renal pelvis decrease back to prepregnancy state

Answer 18

6

Question 19

What is telogen effluvium

Answer 19

Period of diffused, rapid hair turnover, up to 3 mons, returns to normal within a few months

Question 20

When does bone loss usually resolve by?

& what can you do to prevent it?

Answer 20

12-18 mons PP

aerobic exercises in the PP period

Question 21

Management/tx for constipation & to prevent straining?

Answer 21

Stool softeners (colace), high fiber diet, fluid intake, laxatives, suppositories (avoid if 3rd/4th degree lac), limit opioid use if possible.

Question 22

Treatment for hemorrhoids

Answer 22

Witch hazel compresses, hydrocortisone suppository, corticosteroids, stool softeners, cold/warm sitz baths or compresses, anesthetics

Question 23

When does BP return to baseline after delivery

Answer 23

Usually within 24 hrs-4 days

Question 24

T or F: A low-grade fever is not normal in the PP period

Answer 24

False, can have low-grade fever 1-3 days PP

Question 25

When should a woman with GDM be assessed for DM in the PP period?

Answer 25

6-12 wks PP with a 75g 2-hour glucose challenge
Should check annually thereafter
75g 2-hr <140mg/dL
Fasting <100mg/dL

Question 26

What does BUBBLE PLEB stand for?

Answer 26

Breasts Pain
Uterus Legs/lacs
Bladder Emotional status
Bowels Bonding
Lochia
Episotomy/Extremities

Question 27

What causes rapid diuresis in the first 48 hours PP?

Answer 27

Withdrawal of estrogen (return to baseline hematocrit levels)
A decrease in progesterone helps remove excess fluid from tissues (return to baseline CO and BP)

Question 28

Define immediate, early and late PP

Answer 28

Immediate: first 24 hours after placenta expulsion
Early: First 72 hours
Late: 6-8 weeks

Question 29

Describe involution and subinvolution

Answer 29

Involution: uterus contracts to non-pregnant state
Subinvolution: uterus is slow or fails to return to non-pregnant state (size & position)

Question 30

What are the preferred opioids for pain relief in the breastfeeding mother?

Answer 30

morphine, hydromorphone, and butorphanol

Question 31

When does lactogenesis II (seen as engorgement) occur and how long does it last?

Answer 31

48-72 hrs, but sometimes takes up to 7 days

Lasts 24-48 hours

Question 32

What labs should you collect in the PP period?

Answer 32

CBC w/diff (r/o infection and/or anemia)

Rh screen in NB if mom is Rh negative