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OB > Puerperium > Flashcards

Puerperium Flashcards

1
Q

What are the genital tract changes that occur after delivery?

A

Takes 4 - 6 weeks to return back to normal
- involution of the uterus & placenta
- uterus returns to non-gravid size by 8 weeks
- immediately after delivery uterus is at or below umbilicus

If placenta is retained -> sub involution

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2
Q

What is after pain?

A

Labour like pain secondary to involution -> becomes mild by day 3

  • occurs more with breastfeeding -> secondary to oxytocin release
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3
Q

What are the types of lochia?

A

1- Lochia rubra -> erythrocytes, bacteria, decidua, epithelial cells
2- Lochia serosa-> pale after 3 - 4 days
3- Lochia Alba -> less fluid more leucocytes (yellow) -> white after 10th day

Continues till 24 - 36 days postpartum

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4
Q

What are the causes of maternal morbidity during puerperium?

A
  • puerperal infections & sepsis
  • secondary postpartum hemorrhage
  • venous thromboembolic disorders
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5
Q

What is puerperal fever?

A

38 C or 100.4 F or higher

  • 80% of ladies develop fever in first 24 hours
    -> 70% after CS
    -> 20% pelvic infection

Spiking fever > 39C due to group A streptococcal infections

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6
Q

WhatWhat are the causes of postpartum fever?

A

1- breast engorgement
2- atelectasis (complication of anesthesia post CS)
3- pelvic infections
4- urinary tract infections
5- abdominal incisions & perineal lacerations

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7
Q

What are the types of uterine infections?

A
  • endometritis
  • endomyometritis
  • endoparametritis

Occurs after delivery

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8
Q

What are the risk factors for uterine infections?

A

Maternal
- DM
- obesity
- HIV infections

Intrapartum
- prolonged labour
- rupture membranes
- multiple vaginal exams
- retained products of conception

Procedure
- manual removal of placenta
- operative vaginal delivery
- cervical cerclage
- C section

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9
Q

How do uterine infections present?

A
  • fever
  • headache
  • malaise
  • lower abdominal pain & uterine tenderness
  • offensive lochia
  • secondary PPH
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10
Q

What are the pathogens that cause uterine infections?

A

Gram +ive
- group A B D streptococci
- staph aureus

Gram - ive
- E. coli
- Klebsiella
- Proteus

Mycoplasma, Chlamydia trachomatis, Niesseria gonorrhea

Anaerobic (with C section)
- bacteroids
- Pepto cocci
- Pepto streptococci

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11
Q

What investigations are done in suspected uterine infection?

A

1- CBC: anemia, leukocytosis 15 000 - 30 000, low PLT
2- Renal function tests: urea & electrolyte
3- High vaginal swab
4- blood culture if there are systemic features
5- Coagulation profile: DIC
6- Pelvic ultrasound: retained products or abscess

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12
Q

How are uterine infections treated?

A

AFTER C SECTION -> clindamycin + gentamicin
AFTER VAGINAL -> oral treatment if mild
-> if moderate or severe: IV Ampicillin + gentamicin

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13
Q

What are the complications of metritis?

A

1- pelvic abscess
2- peritonitis
3- parametritis
4- septic pelvic thrombophlebitis

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14
Q

How can incidence of wound infection be reduced?

A

1- prophylactic antibiotics 2g 1st generation cephalosporin before skin incision
2- skin cleaning before operation with chlorhexidine

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15
Q

What are the risk factors for wound infections?

A
  • immunosuppression
  • hematoma formation
  • diabetes
  • obesity
  • hypertension
  • anemia
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16
Q

What is the presentation of wound infection?

A
  • fever on the 4th day usually
  • wound erythematous
  • drains pus
17
Q

How are wound infections managed?

A

1- antimicrobial therapy
2- surgical drainage
3- debridement of devitalized tissue
4- wound dressing twice daily till clear
5- secondary wound closure

18
Q

What is mastitis & what are its causes?

A

Infection of breast parenchyma -> 3rd or 4th week

Due to
- Staph aureus esp MRSA
- cracks at nipple & breast engorgement

19
Q

What is the presentation & treatment of mastitis?

A

Fever, pain, swelling, & painful breast feeding

Treat with -> Dicloxacillinb 500mg 4 times a day for 10 days
-> for MRSA: vancomycin

20
Q

When is breastfeeding contraindicated?

A

1- maternal HIV or active TB
2- breast cancer treatment
3- infant galactosemia
4- women taking street drugs & uncontrolled alcohol use

21
Q

What are the risk factors for urinary retention post partum?

A

1- primiparity
2- operative vaginal delivery
3- perineal lacerations
4- epidural analgesia
5- prolonged labour

22
Q

How is bladder dysfunction diagnosed postpartum?

A

1- enlarged bladder is felt suprapubically
2- if lady doesn’t void for 4 hours after delivery -> urine is emptied and left for 24hrs by urinary catheter
3- voiding trial done again -> residual volume > 200ml (failed)

23
Q

What vaccinations should be taken during puerperium?

A
  • rubella
  • varicella
  • COVID 19
24
Q

When can a lady return to coitus & what are the problems she might face?

A

By 2nd month postpartum, most by 4 months

Problems
- Pain -> due to episiotomies & lacerations
- Dryness -> due to hypoestrogenic state
- Dyspareunia -> after C section

OB (42 decks)

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