PUERPERIUM

Question 1

IMMEDIATE CHANGES AFTER BIRTH

Answer 1

fever - lasts around 24 hours
leukocytosis
shivering

sweating
pain - uterus contrcating

these done necessarily mean infection

Question 2

early puerperium

Answer 2

from placental delivery to 5-6 days

Question 3

late puerperium

Answer 3

from 6 days after birth to 6-8 weeks after

Question 4

uterine involution

Answer 4

uterus now starting to go back to its state pre- pregnancy. You have contraction to prevent bleeding

Question 5

what’s the state of the fundus of uterus immediately after birth

Answer 5

Immediately after delivery, fundus is normally firm, non tender, and located midway between symphysis pubis and umbilicus

Next 12 hours, it rises just above/below umbilicus, then recedes by ~1cm/day to lie
midway between symphysis pubis + umbilicus by the end of 1st postpartum week

Question 6

what kind of lochia arrives in order

Answer 6

cruenta, rubra, l serosa, l alba

Question 7

how long avergae bleeding time after birth lochia

Answer 7

around 1 month

Question 8

total volume of lochia

Answer 8

200-500ml

Question 9

type of lochia

Answer 9

4 cruenta, rubra, l serosa, l alba

Question 10

def lochia

Answer 10

Past-partum vaginal bleeding/discharge = Lochia (contains blood, mucous and uterine tissue)

Question 11

rubra

Answer 11

Lasts for the first few days(3- 4 days from birth) – looks darker and resembles colour of menstrual blood
normal to see clots

Question 12

serosoa

Answer 12

, with more watery consistency, and lighter , may have small clts

Question 13

alba

Answer 13

white/yellow discharge, very small amount, or no blood, no clots

Question 14

how long can lochia last

Answer 14

up to 5 weeks/6 weeks

Question 15

kegel excercises

Answer 15

are to streghten tone of vagina and pelvic floor muscles which are relaxed

Question 16

why do breast feeding women take longer to get periods

Answer 16

because of the hyperprolactinemia which decreases oestrogen as it inhibits the relasing hormone from hypothalmus

Question 17

what happens to CO

Answer 17

increases immediately after delivery and. then slowly teturen to normal within weeks/mnths

Question 18

when does blood volume return to normal

Answer 18

by 10th day post partum

Question 19

hemotological system changes

Answer 19

Hematologic changes return to baseline by 6 – 12 weeks after delivery
 Hb concentration in the first postpartum days
  Fibrinogen + other clotting factors in first few days. Prothrombotic state takes
weeks to resolve-  risk of thromboembolic disease

Question 20

what do we check 2 hours after delivery and what do we monitor

Answer 20

bleeding, uterine contractions, HR, and BP

psychiatric sttate - for post partum depression
fever - if longer than 24 h could mean infection
lochia smell - sweet
surgical wounds

Question 21

urination + poo after birth

Answer 21

should urinate 4 hours post-partum after vaginal delivery and in c-section, 4 hours after removal of catheter. If this doesn’t occur, miction can be stimulated by – sound of running water, medications (Furanthril)

Defecation should occur after 3rd day for vaginal delivery – if not, can be stimulated with laxatives or with enema

Question 22

the most common pathological puerperium

Answer 22

The most common complications include:

a. Postpartum haemorrhage (discussed in other essays)
b. Genital tract infections
c. Urinary tract infections
d. Mastitis

Question 23

definition of puerperal infection

Answer 23

Defined as any infection of the genitourinary tract during the puerperium accompanied by a temperature of 38oC or higher that occurs for at least two of the first 10 days postpartum (excluding the first 24 hours)

Question 24

rf for ddeveloping a UTI

Answer 24

catheterisation
C section
epidural
traume to bladder suding normal delivery

Question 25

how does mastiitis happens

Answer 25

The most common causative agent is Staphylococcus aureus from the infant’s nose and throat, which usually enters the breast through the nipple at the site of a fissure or abrasion during nursing.

Question 26

pulmoanry embolism signs

Answer 26

pathognomic features/signs but some common clinical presentations include:

· Sudden onset of unexplained dyspnoea

· Pleuritic chest pain (sharp, stabbing pain which worsens with breathing)

· Haemoptysis (if infarct occurs)

· Fever

· Fatigue

· Syncope (in massive PTE)

· Calf or thigh pain

Question 27

diagnosisng a PE

Answer 27

. Blood gases

§ hypoxemia and hypocapnia

§ Pa02 <70 mmHg not explained by CXR suggests a PTE

b. ECG

§ Sinus tachycardia

§ Atrial fibrillation and other tachyarrhythmia may occur

§ Evidence of RV strain = inversion of T waves in V1-V4. The McGinn-White Sign = “S1 Q3 T3” (deep S wave in lead 1, Q wave in lead 3 and inverted T wave in lead 3).

c. Blood tests

§ Leucocytosis

§ Elevated ESR

§ Elevated LDH

d. Plasma D-dimer = elevation of this is an indication of PTE and if it is undetectable then a diagnosis of PTE is excluded.
e. Imaging tests

· X-Ray

· Echocardiography

· CT - Golden Standard for PTE = CT pulmonary angiography

Question 28

POST PARTUM DEPRESSION

Answer 28

a transient illness observed 4-5 days after delivery