Pre + Postpartum care Flashcards
preconception care promotes healthy lifestyles in men and women of ____ age
18-44
what nutritional supplements may be recommended in the peripartum time frame
folic acid
calcium
how should you take folic acid when trying to get pregnant
start taking 2-3mths before pregnancy + continue for 4-6wks after or as long as breastfeeding
how much folic acid is recommended for a patient with no RFs
0.4mgd
how much folic acid is recommended for a patient with FHx of neural tube defects
1mg
how much folic acid is recommended for a patient that takes medication increasing their risk for neural tube defects
1mg
how much folic acid is recommended for a patient that has had a previous neural tube defect in pregnancy or either them/ their partner has a neural tube defect
4mg/d
how much calcium should one be taking why trying for pregnancy
1000mg elemental calcium - usually in diet but can add supplements
what is the recommendation for immunizations in pregnancy
get all live/ live attenuated before, then avoid in pregnancy
what is normal weight gain in pregnancy
5lb in first 10wks, then 1lb/ wk after
how many lb do women usually gain a pregnancy
25-35lb
hypertension in pregnancy is defined as
BP =>140/90
what is nonsevere HPTN in preg/ what about severe?
> 160/110 = severe
why might BP decrease in first trimester
decreased peripheral vascular resistance
what is the target BP in pregnancy
<85mmHg
what is preeclampsia
pregnancy spec onset of HPTN that involves new onset proteinuria
Multisystem, occurs after 20wks of gestation + resolves after delivery + no seizure yet
preeclampsia occurs after _______ of gestation and _____ seizures
20wks
does not include seizures
what is eclampsia
HPTN + proteinuria + seizure has occured
what is HPTN in pregnancy with new onset proteinuria
preeclampsia
how to treat eclampsia
IV antiHPTN tx with hydralazine or labetalol
seizure prophylaxis with magnesium sulfate
what is HELLP syndrome
severe form of preeclampsia that includes hemolysis, elevated liver enzymes, low platelets
DBP >90 mmHg <20 wks gestation is probably
chronic/ prepreg HPTN (at risk of developing superimposed preeclampsia)
DBP >90 mmHg >20 wks gestation with no target organ involvement is probably
gestational hypertension
DBP >90 mmHg >20 wks gestation with target organ involvement is probably
preeclampsia
1st line antihypertensive meds in pregnancy
labetalol, methyldopa, long acting oral nifedipine, other BB
2nd line AHA in pregnancy
clonidine, hydralazine, thiazide diuretics
when should prophylaxis for thromboembolism be considered for pregnant women
prior VTE, inherited thrombophilia
what is the drug of choice for thromboembolism prophylaxis in pregnant women
LMWH
what meds are used for cervix ripening
PGE2 like dinoprostone
misoprostol (PGE1)
what med is used to stimulate uterine contractions
oxytocin IV
what treatments may be used to prevent preterm labour
progesterone
17-hydroxyprogesterone caproate
if the pt has a short cervix, _____ may be given to prevent preterm labour
vaginal progesterone
if a pt has a hx of preterm labour _____ may be given
IM or vaginal progesterone
postpartum care is a period of _____ after delivery
6wks
perineal pain usually resolves by
6wks
typically a ____ will be done to prevent tearing to the anus
mediolateral
tx for perineal pain from vaginal deliveries
sitz baths, rinse area with warm water, kegel exercises to prevent, hamamelis (witch hazel), acetaminophen/ NSAIDs
treatments for cracked nipples
ensure correct latching
warm compress before feeding
lanolin to nipple
acetaminophen/ NSAIDs
applying few drops of breast milk on nipple before/ after
oi massage
how to treat painful engorged breasts
warm showers just before feeding, cold compress in between feeds
how to treat mastitis from blocked milk duct
Warm wet towels/ massage before feeding
Increase fluids
More BF on affected side
Acetaminophen and NSAIDs for pain
If no improvement in 24hrs or fever develops see HCP
how to treat mastitis from infection
Sim sx to blocked milk duct + sx like fever and flu like sx
Encourage milk flow from affected breast either BF or pump + continue while on tx
Hot compresses
Usual pathogen: staph aureus
Oral abx: cloxacillin, cephalexin, (clindamycin if beta lactam allergy or MRSA), IV abx if severe
what antibiotics are used for mastitis from infection
cloxacillin, cephalexin, (clindamycin if beta lactam allergy or MRSA), IV abx if severe
PPD is sx of depressed mood/ loss of interest for a minimum of ____
2wks
list 2 RF of PPD
hx prev PDD (40%), dep/anx during pregnancy, hx/FHx prev MDD, poor social supports, poor marital relationship, stressful life events, OB complications- almost like PTSD
postpartum blues onset + lasts
onset 3-4d
lasts 2-4wks
sx of postpartum blues
mood changes- from happy to feeling uncontrollably sad, and may have inexplicable spells of irritability, weepiness, and anxiety
postpartum depression onset
4-12wks after delivery
what syndrome has the following symptoms: Nonpsychotic depression that occurs shortly after birth- depressed mood, anxiety, not sleeping well (not able to sleep the entire time baby sleeps), fatigue, lower concentration and inability to think recurrent thoughts of death/ suicide
post partum depression
in postpartum depression
1. some pts are primarily anxious
2. may have rapidly fluctuating mood
3. typically resolves in 2-4wks after delivery
4. requires immediate intervention
1
how long should SSRI/SNRIs be continued in PPD
at least 6mths after remission to prevent relapse
how to start SSRI/SNRI dosing in PPD
Some start at ½ dose, then ↑ in 2-3wks as those who just gave birth may be more sensitive
which AD has the most passage into breast milk
fluoxetine, citalopram
which AD has lower release into breast milk
sertraline, fluvoxamine, paroxetine
most studied AD in BF
sertraline, paroxetine
monitoring pts with PPD - AD should be reassessed in ___
2-4wks
what to monitor for in infants once mother starts AD
colic, fussiness, changes in sleep, difficulty feeding- LT effects on children exposed to AD in breast milk remain unknown
if a pt was on fluoxetine during pregnancy for MDD, should we switch her AD during BF?
no- if it were a new dx in BF, would not choose fluvoxamine but since she’s already on it, it’s fine
