Puerperium Flashcards
Involution of uterus
Immediately
Puerperium
4-6 w postpartum
Decidua becomes differentiated to necrotic sup layer and basal layer
2-3 d pp
Uterus to true pelvis
2 w
Entire endometrium restored
3 weeks
Uterus at non pregnant size
4 w
Lochia
1-3
4-10
10- 4 to8 w
Rubra
Serosa
Alba
Prolongation of lochial discharge
Uterine bleeding
Uterus is larger and softer than normal
Retention of placental fragments or pelvic infection
Subinvolution of Uterus
Uterotonics and antibiotics
Hemorrhage 1-2 w pp
Abn involution or placental retention or placental polyp
Late pp hemorrhage
Vaginal ruggae appear
Lacerations and episiotomy repairs healed
4 w
1-2 w
Diuresis is greatest
Normal function
2-5 d
4-6 w
Normal BV
Normal CO
1 w
2 w
Post partum weight loss Uterine evacuation Diuresis Dec Na space Pre preg weights
5-6 kg
2-3 kg
2 kg
6 months
Colostrum lacks
Vit K
Major proteins of mature human milk
Lactobumin
Casin
CI BF
Drugs and alcohol Galactosemia HIV PTB active Uncertain meds Breast ca tx
Tearful mom still caring for herself and baby
10 d pp
Resolve 2-3 d after
Postpartum blues
Reassurance
6 w pp
Hopeless anxious
Neglects herself and baby
PP depression
Psychotherapy and anti depressants
3 w
Hallucinations and delusions
Neglects herself and baby
PP psychosis
Hospitalization and Anti psychotics
Contraception
POP
2-3 weeks
Ovulation delay
Lactating
Non lactating
12 w
6-8 w
Fever >38C on any 2 of the first 10 d of exclusive of the first 24 h
PP fever
RF PP fever
CS
MCC PP fever
Endometritis
PP fever 0 1 2-3 4-5 5-6 7-21
Wind pulmonary exercises Water CVA tenderness antibiotics Womb uterine tenderness and discharge Clinda Genta IV Wound drainage and antibiotics Walk IV heparin for 7-10 d Mastitis drainage and antibiotics
Fever >72 h despite IV antibiotics
Adnexal infections
- ovarian abscess
- parametrial phlegmon
