Pregnancy - Postpartum Care

Question 1

Name: Topics to discuss at Postpartum Check (6)

Answer 1

• Amount of vaginal bleeding
• Pain resolution
• Bowel/bladder function
• Mood/support
• Contraception plans
• Breast-feeding/bottle-feeding

Question 2

Describe: Postpartum (Puerperium) care (3)

Answer 2

• is the care of the mother and fetus during the 6-wk period following birth. During this period, the reproductive tract returns to its normal nonpregnant state.
• Early postpartum care involves monitoring of maternal vital signs, pain management, and surveillance for complications.
• Education regarding maternal self-care and appropriate activities is key during this time period.

Question 3

Name: Common postpartum complications (4)

Answer 3

• PPH
• Postpartum fever
• Postpartum blues
• Postpartum depression

Question 4

Define: PPH (3)

Answer 4

• Excessive blood loss in the postpartum period
• Can be seen as:
  
  • Estimated blood loss > 500 mL for vaginal delivery or > 1,000 mL for C/S, or
  • Any amount of blood loss that threatens a woman’s hemodynamic stability, or
  • A 10% ↓ in Hct between admission and last period
• Types
  
  • 1°/early PPH occurs within the rst 24 h after delivery.
  • 2°/late PPHoccurs > 24 h after delivery.

Question 5

Describe initial management: PPH (4)

Answer 5

• Resuscitation: large-bore IVs ± IVFs, O2 using mask, cross and type 4 units PRBC, monitor vital signs (BP, HR, Sao 2, RR)
• Assess etiology: “4 Ts”
• Investigations: CBC, coagulation pro le
• Directed Rx: based on finndings of assessment

Question 6

Name etiologies: PPH (4)

Answer 6

“4 Ts”

• Tone—assess uterine atony
• Tissue—explore uterus for retained placental tissue or blood clots
• Trauma—explore the lower genital tract for lacerations
• Thrombin—review if patient has Hx of coagulopathy (Von Willebrand disease (VWD), ASA use, Disseminated intravascular coagulation (DIC), Immune thrombocytopenia (ITP), etc.)

Question 7

Describe: Postpartum fever (1)

Answer 7

Fever > 38°C on > 2 occasions at least 4 h apart, after the rst 24-h postpartum

Question 8

Name DDX: Postpartum fever (6)

Answer 8

• Breast engorgement, mastitis (S. aureus)
• Atelectasis, pneumonia
• Wound infection—–C/S or episiotomy site (polymicrobial)
• Endomyometritis
• Thrombophlebitis, DVT
• UTI/pyelonephritis

Question 9

Define: Postpartum blues (3)

Answer 9

• Commonly occurs in > 80% of new mothers
• Usually begins between postpartum day 3 and 10
• Due to adjustment to baby and hormonal Ds

Question 10

Describe initial management: Postpartum blues (3)

Answer 10

• Self-kimited
• No need for psychiatric medications
• Supportive care

Question 11

Define: Postpartum depression (1)

Answer 11

Depression occurring in a woman within 1 y of childbirth

Question 12

Name RFs: Postpartum depression (5)

Answer 12

• Stressful life circumstances
• Personal or FHx depression
• Poor social supports
• Colicky infant
• Unplanned pregnancy

Question 13

Describe initial management: Postpartum depression (3)

Answer 13

• Antidepressants
• Psychotherapy
• Supportive care