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OBSTETRICS > PUERPERAL COMPLICATION (2) > Flashcards

PUERPERAL COMPLICATION (2) Flashcards

1
Q

What should be considered in postpartum fever differentials related to renal infection?

A

ACUTE PYELONEPHRITIS

Dilated ureters and renal pelvis
return to normal by 2-8 weeks postpartum.

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2
Q

What are common signs and symptoms of acute pyelonephritis?

A
  • Fever
  • costovertebral angle tenderness
  • nausea and vomiting
  • bacteriuria and pyuria on UA.
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3
Q

What is the clinical significance of atelectasis post-surgery?

A

Atelectasis often explains unexplained postoperative fever but is coincidental; it may mislead the clinician from pursuing the true cause of fever.

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4
Q

What are the prevention methods for postoperative atelectasis?

A

Coughing and deep breathing on a fixed schedule after surgery.

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5
Q

What are the mechanisms causing drug fever?

A
  • Hypersensitivity reactions
  • altered thermoregulatory mechanisms
  • reactions directly related to drug administration
  • idiosyncratic reactions.
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6
Q

Define uterine subinvolution.

A
  • Arrest or retardation of involution where the uterus is larger and softer than expected;
  • characterized by prolonged lochia and irregular or excessive bleeding.
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7
Q

What is the weight progression of the uterus postpartum?

A

1000g immediately postpartum,
500g at one week,
300g at two weeks,
100g at four weeks.

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8
Q

What is the management for uterine subinvolution with mild infection?

A

Antimicrobials like Azithromycin (500 mg 2x/day), Doxycycline (100 mg 2x/day), or Ampicillin-Clavulanate (75 mg 2x/day).
Medical(primary tx) - METHYLERGONOVINE

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9
Q

What are retained products of conception (RPOC)?

A

Placental and/or fetal tissue remaining in the uterus after miscarriage, pregnancy termination, or delivery.

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10
Q

What are preventive measures for RPOC?

A
  • Routine placenta inspection
  • uterine exploration for retained fragments
  • careful postpartum curettage.
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11
Q

What clinical manifestations suggest RPOC?

A
  • Uterine bleeding
  • pelvic pain
  • fever
  • uterine tenderness
  • amenorrhea.
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12
Q

What diagnostic evaluations are used for RPOC?

A

CBC for blood loss severity, B-HCG for GTD, ultrasound for confirming RPOC, sonohysterography, and hysteroscopy.

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13
Q

What are management options for stable patients with RPOC?

A
  • Expectant management
  • misoprostol for medical intervention
  • hysteroscopic removal for persistent symptoms.
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14
Q

What should be done for hemodynamically unstable patients with RPOC?

A

Stabilize with fluids and blood products, uterotonic drugs, intrauterine balloon catheter, or surgical options like laparoscopy or hysterectomy.

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15
Q

What injuries of the birth canal can occur during puerperium?

A

Vulvovaginal lacerations
cervical lacerations
puerperal hematomas.

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16
Q

What are the risk factors for vulvovaginal laceration?

A

Nulliparity, maternal age (30-34), prolonged second stage of labor, instrumental delivery, macrosomia, and fetal malposition like occiput posterior.

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17
Q

What is anterior perineal trauma?

A

“Anterior perineal trauma involves injury to the labia

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18
Q

What is posterior perineal trauma?

A

“Posterior perineal trauma involves injury to the posterior vaginal wall

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19
Q

What defines a first-degree perineal laceration?

A

“A laceration involving the fourchette

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20
Q

What defines a second-degree perineal laceration?

A

“A laceration involving the skin

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21
Q

What defines a third-degree perineal laceration?

A

“A laceration involving the skin

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22
Q

What are the subtypes of third-degree perineal laceration?

A

“3A: Less than 50% of external anal sphincter torn; 3B: More than 50% of external anal sphincter torn; 3C: Both external and internal anal sphincters torn.”

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23
Q

What defines a fourth-degree perineal laceration?

A

“A laceration involving all layers of the perineum up to the anal epithelium and/or rectal mucosa.”

24
Q

What are the common causes of perineal lacerations?

A

“Excessive infant size

25
Q

What preventive measures reduce genital tract lacerations?

A

“Well-timed episiotomy

26
Q

What are the symptoms of genital tract lacerations?

A

“Postpartum bleeding despite a contracted uterus

27
Q

What are the diagnostic methods for cervical lacerations?

A

“Routine cervical inspection using vaginal retractors and ovum forceps to check the full circumference of the cervix for lacerations.”

28
Q

What is the management for cervical lacerations?

A

“Suturing with the first suture placed above the angle of the wound and serial interrupted or continuous sutures outward.”

29
Q

What is a puerperal hematoma?

A

“A circumscribed

30
Q

What are the classifications of hematomas based on location?

A

“Vulvar hematoma

31
Q

What are the risk factors for puerperal hematomas?

A

“Vaginal/perineal lacerations

32
Q

What are the clinical signs of puerperal hematomas?

A

“Tense

33
Q

What is the management for small to moderate puerperal hematomas?

A

“Observation as they will eventually organize and absorb unless enlarging.”

34
Q

What is the management for expanding or massive puerperal hematomas?

A

“Surgical exploration

35
Q

What are the rare injuries of the cervix?

A

“Colporrhexis (partial or complete cervical avulsion) and annular or circular detachment.”

36
Q

What are the signs of cervical lacerations?

A

“Profuse vaginal bleeding

37
Q

What are the 4Ts of early postpartum hemorrhage?

A

Tone (uterine atony), Tissue (retained placenta), Trauma (lacerations), Thrombin (coagulation).

38
Q

What is the most frequent cause of postpartum hemorrhage?

A

Failure of the uterus to contract sufficiently and arrest bleeding from the placenta implantation site.

39
Q

What should be done after immediate postpartum hemorrhage to exclude birth canal laceration?

A

Careful inspection and routine inspection of the placenta after delivery to check for retained fragments.

40
Q

When does early postpartum hemorrhage occur?

A

Within the first 24 hours postpartum.

41
Q

When does late postpartum hemorrhage occur?

A

Between 24 hours and 12 weeks postpartum.

42
Q

What are the causes of late postpartum hemorrhage?

A

Suboptimal involution of the placental site, retained placental fragments, and coagulopathies like Von Willebrand disease.

43
Q

What is the recommended management for postpartum hemorrhage if the uterine cavity is empty and the patient is stable?

A

Use uterotonics and administer antimicrobials if a uterine infection is suspected.

44
Q

What is postpartum urinary retention, and what causes it?

A

Bladder overdistention and urinary retention caused by increased bladder capacity and insensitivity to intravesical pressure postpartum.

45
Q

What is the typical duration of postpartum blues?

A

It lasts from 2 to 10 days after delivery.

46
Q

What are some risk factors for obstetrical neuropathies?

A

Nulliparity, prolonged second stage of labor, and pushing for a long duration in a semi-Fowler position.

47
Q

What nerve is commonly injured during cesarean delivery?

A

The iliohypogastric and ilioinguinal nerves.

48
Q

What is a common symptom of musculoskeletal tear after delivery?

A

Pain in the pelvic girdle or lower extremities due to stretching or tearing injuries.

49
Q

What is the normal distance of the symphyseal joint, and what distance indicates symphyseal separation?

A

The normal distance is 0.4-0.5 cm. Separation greater than 1 cm indicates symphyseal separation.

50
Q

What is the management for symphyseal separation greater than 4 cm?

A

Surgical intervention is recommended.

51
Q

What is the classic sign of complete uterine inversion?

A

The uterus protruding from the birth canal.

52
Q

What are the risk factors for uterine inversion?

A

Placental implantation at the fundus, uterine atony, cord traction before placental separation, and short cord.

53
Q

What is the management for uterine inversion if the placenta is attached?

A

Reposition the uterus with the placenta in situ.

54
Q

What drug can aid uterine relaxation during uterine inversion repositioning?

A

A 250 μg subcutaneous dose of Terbutaline.

55
Q

What is the conservative management for symphyseal separation?

A

Advise the patient to lie in a lateral decubitus position and wear a fitted binder.

56
Q

What complication can arise from uterine inversion?

A

Profuse bleeding leading to hypovolemic shock.

OBSTETRICS (13 decks)

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