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
MSAFP levels in down syndrome compared to other birth defects?
- maternal serum alpha fetal protein
- in down syndrome: low
- in neural tube defects, anencephaly, and multiple gestation it is high
26
What is nuchal translucency?
- 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
Indications for amniocentesis?
- 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
Risks with amniocentesis?
- leakage of amniotic fluid
- fetal injury (rare)
- fetal loss: 1/300 to 1/500
29
Education at 1st prenatal visit?
- 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
What are common sxs of pregnancy?
- 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
Complications of the first trimester - vaginal bleeding - DDx?
- ectopic pregnancy
- threatened miscarriage
- inevitable miscarriage: incomplete or complete
- vanishing twin
- vaginal tract bleeding
- implantation bleeding (dx of exclusion)
32
How common is bleeding during the first trimester? What is a threatened abortion?
- 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
What do you need to rule out if pt bleeding during first pregnancy? What do you want to assess? What if pt is unstable?
- 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
A pt comes in with bleeding during first trimester: H and P, and eval?
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
Second trimester is what weeks?
- weeks 13-27
36
Eval in 2nd trimester?
- 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
What continued eval need to be done in 2nd trimester?
- 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
Complications in the 2nd trimester?
- 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
Education in 2nd trimester?
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
length of 3rd trimester?
- 28 wks to birth
41
Visits during 3rd trimester?
- 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
When is pt screened for gestational diabetes? What does the test include?
```
- 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
What are the adverse outcomes assoc with gestational DM?
- preeclampsia
- polyhydramnios
- fetal macrosomia
- birth trauma
- operative delivery
- perinatal mortality
- neonatal metabolic complications: hypoglycemia, hyperbilirubinemia, hypocalcemia, erythemia
44
Initial tx for gestational diabetes?
- diet and exercise
| - if not effective - insulin
45
What other test needs to be done at 28 wks if mother is Rh -?
- Rh ab screen
| - rhogam is given at this time
46
Screening labs for 32-36 wks?
- CBC
- US when indicated
- HIV when indicated
- depression screening when indicated
47
How do we screen for Group B strep?
- 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
3rd trimester education and planning?
- 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
35-37 wk labs?
- group B strep
| - resistance testing if PCN allergic
50
What are braxton hicks contractions?
- 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
When should your pt come in (timing of contractions, signs and sxs)?
- 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
When is a nonstress test used?
- 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
What is a reassuring good tracing nonstress test?
- seeing the baby's HR react to mom's contractions
| - has good variability and accelerations (can withstand more labor)
54
Complications that can occur during 3rd trimester?
- preeclampsia/eclampsia
- HELPP syndrome
- vaginal bleeding
- premature labor
- PROM
55
What is included in the biphysical profile?
- 1. nonstress test
- 2. fetal breathing movements (US)
- 3. fetal movement (US)
- 4. fetal tone (US)
- 5. amniotic fluid volume (US)
56
What is included in the birth plan? Purpose?
- 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
What is labor? What is helping induce this?
- 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
What is included in the exam for delivery?
- 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
Stages of labor?
- 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
What occurs during first stage of labor?
- 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
What occurs during early labor?
- 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
What is the management for the 1st stage of labor?
- 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
How is fetal monitoring of FHR done? Normal range for FHR?
- 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
What does decreased variability look like of FHR?
- no accelerations, no reaction to contractions
65
What are variable decelerations usually assoc with?
- with umbilical cord compression (heart rate plunges down with contactions because contractions are compressing cord - temporarily reduces blood supply and O2 to baby)
66
What are late decelerations a sign of?
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
What does a sinusoidal pattern mean?
- VERY bad: means baby is acidotic
| - baby needs to come out
68
How is pain controlled during labor?
- 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
2nd stage management of labor?
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
The passage of the fetus through the pelvis is called? This usually takes place in predictable sequence based on what?
- 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
components of Stage 2?
- continuous
- cardinal movements:
engagement
flexion
descent
internal rotation
extension
external rotation or restitution
expulsion
72
Baby's pasage through pelvis? Bony pelvis consists of what 4 bones?
- 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
What occurs during engagement?
- 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
What occurs during flexion?
- 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
What occurs during descent?
- 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
What occurs during internal rotation?
- facilitates optimal diameters of fetal head to bony pelvis
| - most commonly from transverse to either anterior or posterior
77
What occurs during extension?
- after further descent, fetal head reaches the introitus
| - to accomodate the upward curve of the birth canal - the flexed head now extends
78
What occurs during external rotation?
- 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
What should be done to baby once head is delivered?
- 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
What happens in the 3rd stage of labor?
- 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
What should be closely observed during stage 4 of labor?
```
- 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
APGAR assessment?
- color
- heart rate
- reflex activitiy
- muscle tone
- respirations
83
Milk production after labor? Nipple care?
- 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
How can labor be induced? When is this done?
- 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
What is the MC major operation performed in US?
- c section
- can have vaginal birth after cesarean (VBAC)
called trial of labor after cesarean (TOLAC)
86
Breech presentation?
- 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
What happens to the uterus postpartum?
- 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
What happens to vagina postpartum?
- 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
What happens to ovarian fxn postpartum?
- 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
How common is PPD?
- 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
