Prenatal, Labor, delivery and Post-delivery care Flashcards
1
Q
Impt preconception hx to ask about?
A
- chronic diseases**
- meds known to be teratogens
- reproductive hx
- genetic conditions in the family
- substance use
- infectious disease and vaccinations
- folic acid intake and nutrition
- enviro hazards and toxins
- mental health and social health concerns
2
Q
Goals of prenatal (antepartum) care?
A
- ensure birth of a healthy baby w/ minimal risk to the mother
- early, accurate estimation of gestational age
- ID of pt at risk for complications and continuing risk assessment
- ongoing eval of health status of both mother and fetus
- pt education and communication
3
Q
What are impt preconception interventions?
A
- folic acid supplementation
- glycemic control in women with diabetes
- abstinence from alcohol and illicit and Rx drugs
- smoking cessation
- up to date vaccinations - live vaccines should be admin 1 month or more prior to pregnancy (MMRV)
- wt management (BMI greater than 18 ad less than 30)
- absence from depression
- teratogen avoidance
- absence of STIs
- planned pregnancy with an early prenatal visit
4
Q
What does antepartum care include?
A
- dx pregnancy and determining gestational age
- monitoring ongoing pregnancy w/ periodic exams and appropriate screening tests
- providing pt education that addresses all aspects of pregnancy
- preparing pt and her family for her management during labor, delivery, and postpartum period
- detecting medical and psychosocial complications and instituting indicated interventions
5
Q
First trimester length?
A
- weeks 1-12
6
Q
When should prenatal care be initiated?
A
- ideally prenatal care will be initiated in 1st trimester
- 2011 71% of women received prenatal care in 1st trimester
- 7% received no care or initiated care in 3rd trimester
- with early care there is better estimation of gestational age and problems can be ID and dealt with early
7
Q
Why is gestational age determined? How is this done?
A
- necessary to determine estimated date of confinement (EDC)
- add 7 days to LMP than subtract 3 months - Naegele’s rule
- methods:
hx: using date of LMP
uterine size
US - transvaginal - measure crown rump length, biparietal diameter, and femur length
8
Q
When can biparietal diameter and femur length be used to determine EDC?
A
- 13-25 weeks
9
Q
What needs to be discussed at first prenatal visit?
A
- medical hx
- reproductive hx
- family hx - include dad and genetic hx!! - congenital abnormalities, x’somal abnormalities, advanced maternal and paternal age, ethnicity influenced diseases
- genetic hx
- nutritional hx
- psychosocial hx: critical to screen for domestic violence (20% of women are physically abused when pregnant) and sexual abuse hx
- ob hx: date of delivery, gestational age, location, sex, birth wt, mode, anesthesia, length of labor, outcome, abortions, complications
- prenatal menstrual hx: recent hormonal contraceptive, hx of IUD use and date removed
- meds and allergy hx
- ## usual substance use, exercise, diet
10
Q
What factors ikelihood of having twins?
A
- dizygotic (fraternal)/monozygotic (identical)
- 96% of multiple births
factors that increase likelihood:
- advancing age
- increasing parity
- family hx from either parent
- obese and tall women greater chance
- fertility drugs
- increased calories needed for pregnant mother with multiple babies
11
Q
What are risks of multiple gestations?
A
- preterm birth can lead to bed rest early in pregnancy
- intrauterine growth retardation or unequal growth
12
Q
PE - 1st perinatal checkup?
A
- baseline BP
- ht and wt - baseline BMI
- general PE
- pay attention to oral hygiene (can lead to amniotic infection)
- cardiac exam
- DTRs
- breast exam
- pelvic exam
13
Q
What labs should be checked for 1st perinatal check up?
A
- urine specimen for pregnancy test
- urine is checked each visit for glucose and protein
- 1st visit UA and urine culture are done
- CBC: to detect anemia and screen for thalassemia
- rubella immunity (if nonimmune counselled and immunized postpartum)
- varicella immunity (if nonimmune varicella vaccine PP)
- syphilis test
- hep B ag test - HepBsAg - screening for chronic infection
14
Q
Why is it impt to get urine cultures during pregnancy?
A
- b/c asx bacteriuria occurs in 2-7% pregnant women
- if untx: 30-40% will get UTI
- assoc with increased risk of preterm birth, low birth wt, and perinatal mortality
- 2 consecutive voided specimens w/ same bacterial strain or 1 cath specimen w/ isolated bacterial species - is considered positive and reqrs tx
- need to repeat culture to know it is sterile after tx, osme repeat urine culture each month of pregnancy
- some providers choose to give suppressive therapy throughout pregnancy
15
Q
Tx of Asx bacteriuria?
A
- amoxicillin
- augmentin
- sulfisoxazole (don’t use late in pregnancy)
- nitrofurantoin
- ** don’t use fluoroquinolones or tetracyclines
16
Q
How common is acute cystitis in pregnancy? Dx? Tx?
A
- considered to be a complication - cystitis 1-2%, pyelonephritis 0.5-2%
- UA and midstream urine culture for dx
- tx: empiric
augmentin
amoxicillin
nitrofurantoin
cephalexin
17
Q
Why is a blood type and Rh determination and ab screen needed during 1st perinatal checkup?
A
- know blood type if transfusions are needed
- Rh status is needed if mother Rh neg then anti-D immune globulin (rhogam) is given whenever there is a risk of fetomaternal hemorrhage to prevent alloimmunization
- if mother Rh neg another ab screen needed at 28 wks and if still negative then Rh negative mother is given rhogam at 28 wks
- baby can develop fetalis hydrops if mother has absfrom previous pregnancies
18
Q
What are indications for admin. for rhogam?
A
- at 28 wks of gestation
- spontaneous abortion, threatened abortion, induced abortion
- ectopic pregnancy
- invasive procedures: genetic amniocentesis, chorionic villus sampling, multi-fetal reduction, fetal blood sampling
- hydatidifrom mole
- fetal death in 2nd or 3rd trimester
- blunt trauma to abdomen
- antepartum hemorrhage in 2nd or 3rd trimester (placenta previa or abruption)
- external cephalic version
19
Q
When is HIV tested for?
A
- at first prenatal visit and retesting done at 36 wks gestation in high risk pts or those who refused earlier is recommended
20
Q
What other tests should be done if indicated at first prenatal visit?
A
If indicated:
- lipids
- PPD
- HGb A1C
- thyroid testing
- other infections: Hep C, zika
21
Q
What is purpose of 1st trimester prenatal genetic screening? What can this assess? What is tested?
- What would be an indication for chorionic villous sampling?
A
- purpose is to define risk of genetic disorders in low risk population
- can assess for down syndrome, trisomy 18, and trisomy 13
- combining these markers yields an 82-87% detection of down syndrome:
hCG level
pregnancy assoc plasma protein (PAPP-A)
nuchal transparency (NT) - women found to have increased risk of aneuploidy with these tests should be offered chorionic villous sampling
22
Q
What is chorionic villous sampling?
A
- a procedure to get fetal DNA for testing for down syndrome and other abnormalities
- can be done under US guidance through the vagina or by abdominal US
- shouldn’t be done b/f 10 wks gestation b/c of increased pregnancy loss
(usually done at 15 weeks)
23
Q
What is the quadruple screen? When is it done?
A
- may be an option if woman is seen later in pregnancy
- quadruple screen:
AFP
hCG
unconjugated estrodiol
inhibin A - using this combo improves the detection of down syndrome to 80%
24
Q
What does integrated screening for down syndrome entail?
A
- uses both 1st trimester and 2nd trimester markers to adjust a woman’s age related risk of having a child with down syndrome
- can be more anxiety provoking to wait and lose the chance to do CVS
- early amniocentesis (b/f 14 wks of gestation) has high pregnancy loss and more amniotic fluid culture failures
- indivduals who may be carriers can undergo carrier testing
25
Q
MSAFP levels in down syndrome compared to other birth defects?
A
- maternal serum alpha fetal protein
- in down syndrome: low
- in neural tube defects, anencephaly, and multiple gestation it is high
26
Q
What is nuchal translucency?
A
- the width of the translucent space at the back of the fetal neck determined by US (wider the space more likely baby has abnormality)
27
Q
Indications for amniocentesis?
A
- prenatal genetic studies (MC)
- assessment of fetal lung maturity
- eval of fetus for infection
- degree of hemolytic anemia
- eval of dx neural tube defects
- therapeutic: removal of excess amniotic fluid
28
Q
Risks with amniocentesis?
A
- leakage of amniotic fluid
- fetal injury (rare)
- fetal loss: 1/300 to 1/500
29
Q
Education at 1st prenatal visit?
A
- need visit q 4 wks until 28 wks then q 2wks until 34-36 wks then q wk
- at each visit - maternal wt, BP, uterine growth, urine dipstick, fetal activity and fetal HR are checked
- how to reach provider after business hours
- warning signs: vaginal bleeding, cramping, fever, passing clots or tissue (save), dizziness, fainting, or abdominal pain
- avoid hot tubs and saunas - exposure during 1st trimester assoc with neural tube defects
- avoid substance abuse
- wear seatbelt
- infection precautions: toxo, flu
- exercise: moderate 30 min, avoid strenous exercise and supine positions after 1st trimeseter and abdominal trauma
- work - ok unless undue lifting and prolonged standing
- sex: ok unless risk of STI or vaginal bleeding/positions
- travel: increased risk of DVT, can fly up to 36 wks if not high risk
- meds: acetaminophen ok, should check on anything else including herb preps
- wt gain: only should be 20-25 lbs
- breastfeeding
- childbirth classes/hospital facilities
diet - eat healthy, no unpasteurized dairy products or fruit/veggie juices, can get listeria from processed deli meats, fish - avoid albacore, shark, mackeral (mercury), increase calories by 340 in 2nd trimester, and 450 in 3rd trimester - breastfeeding: increase by another 300-500 and add 1000 mg Ca2+/d
30
Q
What are common sxs of pregnancy?
A
- HAs: common early
- N/V: hyperemesis gravidum less than 2%
- heartburn: general maneuvers, may use turns
- constipation: can try stool softeners, add bulk, drink fluids
- fatigue
- back pain: later in preg.
- round ligament pain: as uterus grows - sharp groin pain - reassurance
- edema: fluid retention common but can be assoc with HTN so need to eval
- hemorrhoids: sitz baths
- vaginal d/c is increased: check for infection if cahnges or malodorous
- pica: inclination for nonnutritious substances such as clay or dirt is often assoc with anemia
31
Q
Complications of the first trimester - vaginal bleeding - DDx?
A
- ectopic pregnancy
- threatened miscarriage
- inevitable miscarriage: incomplete or complete
- vanishing twin
- vaginal tract bleeding
- implantation bleeding (dx of exclusion)
32
Q
How common is bleeding during the first trimester? What is a threatened abortion?
A
- 30-40% of preg women will have some bleeding during early preg
- about 1/3 have some degree have bleeding during 1st trimester
- when preg is complicated by vaginal bleeding b/f 20th wk it is termed a threatened abortion
- 35-50% of threatened abortions eventually result in loss of pregnancy
33
Q
What do you need to rule out if pt bleeding during first pregnancy? What do you want to assess? What if pt is unstable?
A
- rule out ectopic
- assess pt to make sure she is stable - ABCs, and pay attention to CV status
- if pt unstable - presume ruptured ectopic and start fluids and get to OR ASAP
34
Q
A pt comes in with bleeding during first trimester: H and P, and eval?
A
if pt stable - get H and P:
- get hx of bleeding, if tissue or clots have been passed, any cramping or pain, LMP, any prenatal care, blood type and Rh
- exam: CV,
pelvic: pay attention to whether cervical os is open or closed, is there blood in vagina, tissue, any lesions or trauma, size of uterus consistnet with gestation? consistency of uterus? - firm or boggy? - eval: pelvic US when suspect ectopic to see if free fluid, may follow with transvaginal US, CBC with type and cross and Rh, serum quantitative beta hCG
- management according to findings
35
Q
Second trimester is what weeks?
A
- weeks 13-27
36
Q
Eval in 2nd trimester?
A
- fundal ht: at 20 wks uterus reaches umbilicus and now the fundal ht can be measured at each visit, each wk should equal 1 cm up until 36 wks, after the baby drops down into pelvis and is lower
- fetal movement: mother begins to feel fetus move around 18-20 wks (quickening), subsequent visits ask about fetal movement, decreased fetal movement noticed by mother is a sign to come in for eval and can indicate distress or demise
37
Q
What continued eval need to be done in 2nd trimester?
A
- maternal BP and wt
- urine dip for glucose and protein
- documentation of fetal cardiac activity
- assessment of significant events:
travel, illness, stressors, infections, abuse
38
Q
Complications in the 2nd trimester?
A
- premature labor
- vaginal bleeding: placenta previa or placental abruption
- premature rupture of membranes
- HTN in preg
- preeclampsia (may start in 2nd trimester, usually in 3rd)
39
Q
Education in 2nd trimester?
A
moms are instructed on signs and sxs of preterm labor and PROM:
- uterine contractions, low back pain, cramping, diarrhea
- leakage or gush of fluid from vagina (rupture of membranes)
- low pelvic pressure, or low back pain
- advised on selecting a newborn care provider
- lamaze or similar type class especially for 1st time parents
- tobacco cessation if still smoking
- depression counseling if appropriate
- asked about intimate partner violence
- postpartum family planning/tubal sterilization
- pt to lay on Left lateral not flat on back**
40
Q
length of 3rd trimester?
A
- 28 wks to birth
41
Q
Visits during 3rd trimester?
A
- now q 2wks and then at 36 wks visits are weekly
- at each visist - abdomen is examined to determine the position/presentation of fetus using maneuvers of leopold
- usually by 36 wks - fetus is in position its going to stay in
- sometimes if baby is breech - OB doc attempts to maneuver the fetus into cephalic position: external version
42
Q
When is pt screened for gestational diabetes? What does the test include?
A
- 28 weeks dx: - random serum glucose: over 200mg/dl - fasting serum glucose: over 126 mg/dl - glucose challenge test: 50 g oral glucose load given: 1 hr later serum glucose measured, abnormal is over 130, to confirm gestational diabetes - do 3 hr oral GTT
43
Q
What are the adverse outcomes assoc with gestational DM?
A
- preeclampsia
- polyhydramnios
- fetal macrosomia
- birth trauma
- operative delivery
- perinatal mortality
- neonatal metabolic complications: hypoglycemia, hyperbilirubinemia, hypocalcemia, erythemia
44
Q
Initial tx for gestational diabetes?
A
- diet and exercise
- if not effective - insulin
45
Q
What other test needs to be done at 28 wks if mother is Rh -?
A
- Rh ab screen
- rhogam is given at this time
46
Q
Screening labs for 32-36 wks?
A
- CBC
- US when indicated
- HIV when indicated
- depression screening when indicated
47
Q
How do we screen for Group B strep?
A
- CDC recommends universal screening for group B strep at 35-37 wks
- swabs are done of vagina and rectume, if positive - woman tx prophylactically at time of labor and delivery
- tx with PCN, ampicillin, erythromycin or clindamycin
- women with GBS bacteriuria during current preg and women who have given birth to an infant w/ invasive GBS are not screened they are given intrapartum abx prophylaxis
48
Q
3rd trimester education and planning?
A
- anesthesia/birth plans
- labor signs
- vaginal bleeding - sign of early labor or abruption
- signs and sxs of preeclampsia (HA, visual sxs, edema)
- post term counselling
- circumcision
- breastfeeding**
- PPD
- intimate partner violence
- newborn education
- family medical leave or disability forms
49
Q
35-37 wk labs?
A
- group B strep
- resistance testing if PCN allergic
50
Q
What are braxton hicks contractions?
A
- commonly occur in last 2-3 wks of pregnancy - also called false labor
- may be regular and strong
- Don’t result in change in cervix
- therefore not active labor
- encourage mother, don’t tx carelessly or brush it off
51
Q
When should your pt come in (timing of contractions, signs and sxs)?
A
- contractions q 5 min for 1 hr or very intense contractions
- mother getting very uncomfortable or feeling pressure in pelvis
- sudden gush or leaking of fluid from vagina
- significant vaginal bleeding
- decreased fetal movement
52
Q
When is a nonstress test used?
A
- to assess fetal well-being
- if woman presents with decreased fetal movement and fetal heart tones are heard then well-being of fetus is eval with nonstress test (usually after 28 wks)
- while mother reclines in L lateral position - fetal heart tones are recorded by heart monitor
- recorded for 20-30 min
- mother presses button when she detects fetal movement
- if FHR accelerates after movement for at least 3 episodes and there are no concerning decreased in HR the test is reassuring and no intervention is needed at that time
53
Q
What is a reassuring good tracing nonstress test?
A
- seeing the baby’s HR react to mom’s contractions
- has good variability and accelerations (can withstand more labor)
54
Q
Complications that can occur during 3rd trimester?
A
- preeclampsia/eclampsia
- HELPP syndrome
- vaginal bleeding
- premature labor
- PROM
55
Q
What is included in the biphysical profile?
A
- nonstress test
- fetal breathing movements (US)
- fetal movement (US)
- fetal tone (US)
- amniotic fluid volume (US)
56
Q
What is included in the birth plan? Purpose?
A
- helps woman to become actively involved in making decisions about birth of her and her partner’s child
- it provides an opportunity for discussion b/t the woman and her partner or support team, as well as with her health care provider
common topics: - mobility, massage, music
- pain relief, medical procedures (monitoring IV fluids, AROM)
- positioning for pushing
- mother and baby together - breastfeeding w/in 1st hr, rooming in
57
Q
What is labor? What is helping induce this?
A
- physiologic process by which regularly occurring, uncomfortable-to-painful uterine contractions result in progressive effacement and dilation of cervix
- this thinning out and dilation permits passage of fetus from uterus through birth canal, resulting in delivery
- increased synthesis of prostaglandins, which stimulate uterine contractions and which may soften the cervix independent of uterine activity
- an increase in myometrial oxytocin receptors, which amplify biologic effect from a given amt of oxytocin
58
Q
What is included in the exam for delivery?
A
- determine presenting part (head down preferably)
- digital vaginal exam: cervix:
consistency: hard or soft
effacement: shortening of cervical canal from 2 cm to paper thin
dilation- cervix opens from closed to 10 cm (fully dilated) - fetal station: position of fetal head in birth canal in relation to ischial spines
59
Q
Stages of labor?
A
- 1st stage:
latent phase- cervical effacement and early dilatation
active phase- begins when cervix is 3-4 cm dilated
onset of contractions to complete dilatation and effacement of cervix - 2nd stage:
delivery of infant - 3rd stage:
delivery of placenta - 4th stage:
hour immediately after delivery
60
Q
What occurs during first stage of labor?
A
- onset of uterine contractions as perceived by preg woman
- ends with complete dilatation of cervix, which is 10 cm in diameter for full term infant
minimal dilatation during active phase:
- primiparous women: 1cm/hr
- multiparous women: 1.5cm/hr
- if not progressing need to eval
61
Q
What occurs during early labor?
A
- vary in frequency and intensity
- typically, contractions occur q 5-10 min (beginning of contraction to beginning of next contraction)
- last for 30-45 seconds
- 20-30 mmHg in intensity
- contractions then become more frequent - q 2-3 min
- lasting 60-70 sec
- intensity of 40-60 mmHg
- can only measure intensity of contractions accurately with internal uterine monitor, external monitor doesn’t accurately show actual pressure of contractions
62
Q
What is the management for the 1st stage of labor?
A
- ambulation of head engaged and intermittent fetal monitoring is done
- if laying down - supine L lateral position (avoid supine hypotensive sydrome)
- if membranes intact may bathe or shower
- hydration w/ IV fluids if needed
- NPO except for ice chips
63
Q
How is fetal monitoring of FHR done? Normal range for FHR?
A
- continuous or intermittent monitoring of FHR either externally or with scalp electrode
- FHR:
range: 110-160
good variability, accelerations - warning signs: late decelrations, bradycardia, decreased variability
64
Q
What does decreased variability look like of FHR?
A
- no accelerations, no reaction to contractions
65
Q
What are variable decelerations usually assoc with?
A
- with umbilical cord compression (heart rate plunges down with contactions because contractions are compressing cord - temporarily reduces blood supply and O2 to baby)
66
Q
What are late decelerations a sign of?
A
ominous- decreased O2 to fetus
- not a good sign if mother in early labor and this is occurring
- give mom O2, IV fluids, on L lateral side, if didn’t change in 30 min do C section
- if baby crowning - can deliver
67
Q
What does a sinusoidal pattern mean?
A
- VERY bad: means baby is acidotic
- baby needs to come out
68
Q
How is pain controlled during labor?
A
- during first stage of labor pain results from uterine contractions and dilation of cervix
- as fetal head descends there is also distension
methods of anesthesia/analgesia:
- sx narcotics - early in labor
- spinal anesthesia: single injection
- epidural block: infusion of local anesethetics or narcotics through a catheter into the epidural space
- local block of anesthetic into vagina or perineum
- general anesthetic
69
Q
2nd stage management of labor?
A
begins with complete dilatation of cervix and ends with delivery of baby - mother has urge to push:
primgavida: 30 min-2 hrs
multigravida: 5-30 min
- fetal descent needs to be monitored carefully to eval progress of labor:
molding and formation of caput can create flase sense of fetal descent
70
Q
The passage of the fetus through the pelvis is called? This usually takes place in predictable sequence based on what?
A
- called mechanism of labor
- usually takes place in predictable sequene based on mechanics of force from above and resistance from below
- power, passenger, passage
71
Q
components of Stage 2?
A
- continuous
- cardinal movements:
engagement
flexion
descent
internal rotation
extension
external rotation or restitution
expulsion
72
Q
Baby’s pasage through pelvis? Bony pelvis consists of what 4 bones?
A
- sacrum, coccyx, 2 innominate bones - each made of fused pubis, ischium and ilium
- baby’s head must go in an inferoposterior direction and then in an inferoanterior direction
73
Q
What occurs during engagement?
A
- biparietal diameter - widest transverse diameter of fetal head, has passed the plane of the pelvic inlet
- presenting part is palpated below the level of ischial spines
74
Q
What occurs during flexion?
A
- as forces cause descent of fetus through pelvis, soft tissue and bony resistance is encountered
- allows the smaller diameters of the fetal head to present to maternal pelvis
75
Q
What occurs during descent?
A
- successful passage of presenting part through birth canal
- greatest rate of descent occurs during latter portions of first stage of labor and during 2nd stage of labor
76
Q
What occurs during internal rotation?
A
- facilitates optimal diameters of fetal head to bony pelvis
- most commonly from transverse to either anterior or posterior
77
Q
What occurs during extension?
A
- after further descent, fetal head reaches the introitus
- to accomodate the upward curve of the birth canal - the flexed head now extends
78
Q
What occurs during external rotation?
A
- occurs after delivery of the head
- the head rotates “face forward” relative to the shoulders
- known as “restitution” then there is rapid delivery of body: expulsion
79
Q
What should be done to baby once head is delivered?
A
- oral cavity and nares are suctioned (uptodate doesn’t recommend this)
- check for nuchal umbilical cord
- deliver shoulder trunk and legs
- clamp and cut cord w/in 15-20 seconds
- place infant on mother’s chest, if not in distress, then to warmer
80
Q
What happens in the 3rd stage of labor?
A
- begins with delivery of baby and ends with delivery of placenta and membranes
- obtain cord blood while waiting
- while waiting for placenta to deliver - check for lacerations (can take 2-30 min to deliver)
- don’t pull on umbilical cord
- once placenta separates you can gently put traction on cord, sometimes the mother will need to push - check cord and placenta - usually give oxytocin (pitocin) IV after delivery of placenta
81
Q
What should be closely observed during stage 4 of labor?
A
- closely observation for PPH: uterine relaxation: MC cause of PPH retained placental fragments cervical or vaginal lacerations - monitor pulse, BP, uterine blood loss (RR and pulse will go up first w/ blood loss, by time BP goes down - in trouble - shock!)
82
Q
APGAR assessment?
A
- color
- heart rate
- reflex activitiy
- muscle tone
- respirations
83
Q
Milk production after labor? Nipple care?
A
- colostrum (first 5 days): more minerals, protein, and IgG abs, and less fat and sugar
- milk production: adequate insulin, cortisol and thyroid hormone
- nipple care: wash with water and expose to air for 15-20 minutes afer each feeding
- lanolin or A&D ointment may be applied if tender
**need more calories for breastfeeding
84
Q
How can labor be induced? When is this done?
A
- done when benefits to either the mother or fetus outweigh those of continuing the pregnancy
- cervical ripening may need to be done:
misoprostol and prostaglandin E2 can be admin intravaginally and intracervically
laminaria: mechanical dilation of the cervix
pitocin drip to stimulate uterine contractions
85
Q
What is the MC major operation performed in US?
A
- c section
- can have vaginal birth after cesarean (VBAC)
called trial of labor after cesarean (TOLAC)
86
Q
Breech presentation?
A
- bottom first
- generally known ahead of time - do c-section
- if faced with this most likely baby will just deliver or will need expedient OB referral
87
Q
What happens to the uterus postpartum?
A
- postpartum: 6-8 wks following birth
- involuation of uterus - normal size by 6 wks
- lochia: d/c from uterus after birth as the dicidua differentiates into a superficial layer which sloughs off
heavy at first, and rapidly decreases in amt over 1st 2-3 days, may last for several wks, in women who breastfeed - lochia resolves more rapidly
88
Q
What happens to vagina postpartum?
A
- vulvar and vaginal tissue return to normal over first several days
- if a woman had an episiotomy or tear that can take 3-4 wks to heal
- general rule: nothing in the vagina for 4 wks after delivery
89
Q
What happens to ovarian fxn postpartum?
A
- in nonlactating women - avg time to ovulation is 45 days
- in lactating woman: 189 days
- likelihood of ovulation increases as frequency of breastfeeding decreases
- breastfeeding isn’t a reliable contraception
90
Q
How common is PPD?
A
- 70-80% of women get post partum blues
- 10-15% get PPD:
may be more likely if have a h/o personal or family deprssion, predictor if depressed during pregnancy, screening ?s at post-partum visits - 0.1-0.2% get post-partum psychosis
