Puerperium

Question 1

List three risk factors for obstetrical nerve injuries.

Answer 1

Nulliparity
Prolonged second stage
Prolonged active second stage

Question 2

What obstetrical nerve injury can be caused by prolonged positioning in stirrups, and how does the injury typically manifest?

Answer 2

Peroneal nerve injury

Foot drop

Question 3

List two aerobes & two anaerobes commonly implicated in puerperal infection.

Answer 3

Aerobes: Enterococcus, GBS, E coli
Anaerobes: Peptostreptococcus, Peptococcus, Bacteroides, Clostridium

Question 4

What is your differential for a postpartum fever?

Answer 4

Endometritis (by far the most common)
Breast engorgement
UTI
Infection of abdominal incision after CS
Infection of perineal incision/laceration
Atelectasis after CS

Question 5

You diagnose endometritis and start your patient on appropriately broad-spectrum antibiotics. After 48 hours she shows no clinical improvement. List three possible reasons for this.

Answer 5

Phlegmon
Abscess
Infected hematoma
Septic pelvic thrombophlebitis
Drug-resistant bacteria (rarely)

Question 6

How do you treat septic pelvic thrombophlebitis?

Answer 6

Antibiotics (no evidence for anticoagulation)

Question 7

List five risk factors for postpartum depression.

Answer 7

Obstetrical complications, especially preterm birth
Previous postpartum mood disorder
Pre-existing depressive disorder
Young maternal age
Unmarried
Smoking, alcohol, substance use
Hyperemesis gravidarum
High use of sick leave in pregnancy

Question 8

Define postpartum blues. How is this treated?

Answer 8

Time-limited, heightened emotional reactivity within the first few weeks after delivery

Treatment: support, reassurance, monitor for possible development of PPD

Question 9

When does postpartum psychosis typically present?

Answer 9

Manic symptoms may occur within the first few days after delivery, frank psychosis follows within two weeks