PUERPERIUM Flashcards
IMMEDIATE CHANGES AFTER BIRTH
fever - lasts around 24 hours
leukocytosis
shivering
sweating
pain - uterus contrcating
these done necessarily mean infection
early puerperium
from placental delivery to 5-6 days
late puerperium
from 6 days after birth to 6-8 weeks after
uterine involution
uterus now starting to go back to its state pre- pregnancy. You have contraction to prevent bleeding
what’s the state of the fundus of uterus immediately after birth
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
what kind of lochia arrives in order
cruenta, rubra, l serosa, l alba
how long avergae bleeding time after birth lochia
around 1 month
total volume of lochia
200-500ml
type of lochia
4 cruenta, rubra, l serosa, l alba
def lochia
Past-partum vaginal bleeding/discharge = Lochia (contains blood, mucous and uterine tissue)
rubra
Lasts for the first few days(3- 4 days from birth) – looks darker and resembles colour of menstrual blood
normal to see clots
serosoa
, with more watery consistency, and lighter , may have small clts
alba
white/yellow discharge, very small amount, or no blood, no clots
how long can lochia last
up to 5 weeks/6 weeks
kegel excercises
are to streghten tone of vagina and pelvic floor muscles which are relaxed
why do breast feeding women take longer to get periods
because of the hyperprolactinemia which decreases oestrogen as it inhibits the relasing hormone from hypothalmus
what happens to CO
increases immediately after delivery and. then slowly teturen to normal within weeks/mnths
when does blood volume return to normal
by 10th day post partum
hemotological system changes
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
what do we check 2 hours after delivery and what do we monitor
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
urination + poo after birth
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
the most common pathological puerperium
The most common complications include:
a. Postpartum haemorrhage (discussed in other essays)
b. Genital tract infections
c. Urinary tract infections
d. Mastitis
definition of puerperal infection
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)
rf for ddeveloping a UTI
catheterisation
C section
epidural
traume to bladder suding normal delivery
how does mastiitis happens
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.
pulmoanry embolism signs
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
diagnosisng a PE
. 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
POST PARTUM DEPRESSION
a transient illness observed 4-5 days after delivery
