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O&G > Puerperium > Flashcards

Puerperium Flashcards

1
Q

what is Puerperium

A
  • deliver of placenta till 6-8 weeks post childbirth for pre-pregnancy states to re establish
  • Essentially referred to as ‘4th trimester’

involves Routine post-partum management à to ensure the well-being of the mother and baby.

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2
Q

list the three common complaints immediately after surgery

A
  1. Shivering – pathogenesis is unclear – begins in minutes of delivery but shouldn’t last more than 30 mins. maybe d/t anaesthesia
    1. RX:Conservative
  2. Cramping – d/t hypertonic uterine contractions . often more sever in multiparous women rx;NSAIDS – spontaneously resolves by 1 week
  3. Perineal pain –d/2 swelling, & engorement of perineum. worse if lacerations or episiotomy are present. lasts [[1-2 wks]]
    1. Ice packs in 24hours à heating pads / Sitz bath in order to drain.
    2. Nsaids can also be given
      1. Given for C/S pain too!
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3
Q

list the following criteria that mus be checked post partum for any abnormalities (12)

A
  1. Temperature
  2. BP
  3. Pulse
  4. Blood
  5. Lochia
  6. Wounds
  7. Abdomen
  8. Fundal height
  9. Urination –
  10. Defecation
  11. Lactation
  12. Mental status
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4
Q

temperature in pp

A

Slightly increased d/t dehydration during labour

Returns to normal in 24 hrs

causes of increased temp

  1. PP infection if T = 100.4/38 + on 2 readings, on days 2-10 PP
  2. filling of breast milk on 3rd - 4th day
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5
Q

changes of BP during pregnancy

A

1st trimester – heart works faster to handle ^ vol. BP remqins same = 120/80

2nd trimester – decreases slightly d/t lowered peripheral resistnce as placenta expands rapidly =>heart beats faster = 114/65

3rd trimester – BP back to pre pregnant state

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6
Q

puerperal changes in BP and pathologies

A

causes pof increased BP in pp

140/90 + could signify PP pre-eclampsia.

Oxytocic meds [Pitocin] > delivery could ^ BP

causes of decreased BP in pp

  • [90/60 or below] with dizziness is “Orthostatic hypotension”; could signify hemorrhage.
  • Take BP/pulse lying/sitting/standing. Compare values.
  • dg Orthostatic if: BP drops 15-20 mmHg and pulse increases 20 bpm or more. Caution for falls.

rx: Needs IV fluids. order for CBC.

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7
Q

how does pp affect pulse

A
  • HR increases in 1st hour.
  • 8-10 weeks – return back to pre pregnant state

Rapid pulse or thready pulse – indicates PP Hg or infection

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8
Q

how does bloood change during pregnancy and puerperium

A

the circulatory system increases its activity by 30-50% during pregnancy

pre-pregnant = 4000cc; pregnant state = 5250cc

  • Patient should not be anemic entering delivery
  • Possible blood transfusion with large blood loss.

blood volume returns to normal in 1-2 weeks w/ diuresis + blood loss during delivery

  1. VD – 300 cc
  2. C/S 500 cc
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9
Q

hematocrit during preg and pp

A

Non pregnant: HCT=37 - 47% & HGB=12 - 16g/dL

Pregnant: HCT=32 -42 % & HGB = 11.5 – 14g/dL

hematocrit decreases in preg d/2 increased blood vol

HCT drops by 4 %. & HGB drops by 1 g. for every 250cc. of blood loss.

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10
Q

lochi during PP

(shedding of the superficial portion of the decidua basalis)

A

continues for up to 1 month PP Should be 200-500 ml

different appearance over time

  1. Lochia rubra – red to brown – 1st few days
  2. Lochia serosa – pink – 1-2 weeks PP
  3. Lochia alba – yellow/ white – 2-4 weeks PP

foul smelling= INFECTION

larger than 500ml= HmrhG

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11
Q

wounds cheking

A

check stitches . check CS

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12
Q

abdominal exam to detrmine feeding after preg in puerperial period

A

VD

  • normal bowel sounds – can eat

C/S =

  • bowl sounds are HYPOactive in 1st 8 hours.
  • if General anaesthesia used = NPO for 6/8 hours
  • BM is observed on the 34d/ 4th day d/t surgery but you can Discharge w/o BM if flatus is present
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13
Q

fundal height changes and assesment in puerperium

A

palpation immedieltely after delivery by supporting lower segment to prevent uterine inversion. Asses for firmness and position

drops one finger breadth a day for ten days

  1. delivery - 24 hours= remains at umbilicus
  2. 1st day PP-1 FB under umbilicus
  3. Day 10 – back to normal position in pelvic cavity
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14
Q

pathologies of fundal height in PP

A

causes of false readings

  1. Increase fundal height d/2 full bladder
  2. Decrease fundal height from oxytocin release in BreastFeeding ===2 FB under umbilicus on 1 st day

delayed fundal height decrease

  1. retained placenta/clots decreases effective contraction of uterus not possible ==> Risk of PP Hg!!!
  2. multiparous pt
  3. multi-fetuses.
  4. exhaustion
  5. C/S involutes slower; d/t surgery & less initiation of BF PP.
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15
Q

peurperal changes to the urinary system

A
  • difficulty urinating d/2 traumatic vaginal delivery=> injury to pudendal nerve
  • leads to straining but voiding is still possible

LOSS OF VOIDING- can lead to stasis=> uti/renal failure

  • bladder scan shows- over 250ml of urine
  • catheterization – may cause dysuria afterwards

LOSS OF BLADDER TONE d/2 anesthesia/ swelling

  • reduced urge to void d/2 reduced bladder sensitivity
  • urinary stasis=> UTI/ hydronephrosis
    • RX W/ DIURESIS & exclude UTI
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16
Q

defacation in the PP period

A

vaginal delivery: defacation can occur in 2 days

C/S: defacation in 2 days aswell but no eating until the passage of gasses

constipation is common in pp

  • d/2 decreased gastric emptying
  • reduced movment post labour
  • hemmorhoids case painful defacation and aversion
17
Q

physiology of lactation

A
  • Early pregnancy, ↑ estrogen stimulates growth of milk glands & size of breasts.
  • Colostrum: 1-middle of pregnanc(16wks) 2)days 1-3 PP,
    • Thin, watery pre-lactation secretion. Rich in antibodies; passes to baby in 1-3 days.
  • Breasts begin to get tender; fill up w. milk. in 3rd to 4th day PP D/2
    • [let down reflex] =oxytocin released causing > delivery of placenta and estrogen & progesterone lvls drop
    • ^ production of prolactin by anterior pituitary
    • Milk ducts become distended & fluid turns bluish-white
  • Infant suckling on breast produces more prolactin, which in turn stimulates more milk production.
18
Q

LACTATION-benefits

A

Advanatages

  • Promotes bonding between mother & baby.
  • High nutritional value for infant.
  • Promotes uterine involution thru release of oxytocin from posterior pituitary.
  • Reduces cost of feeding & preparation time
19
Q

LACTATION CONTRAINDICATIONS

A

Mom receiving meds not appropriate for Br. fdg. [Lithium]

Exposure to radioactive compounds [thyroid testing]; pump & dump breast milk x 48 hrs. Flush in toilet.

Breast Cancer; HIV

20
Q

pathologies of lactation (4)

A

1)Sore/ cracked / bleeding nipples

  • d/2 improper positioning or not enough areolar in baby’s mouth
  • Rest nipple + apply Lanolin ointment prn or tea bag

2)Engorgement=> breasts hard, painful to touch.

  • Warm soaks, hot showers, express milk manually, breast feed q 2-3
  • Pumping produces more milk.
  • Cabbage leaves; diuretic property.
  • nursing bra or tight bra and ice packs x 24-36 hrs
  • Analgesics [Tylenol 650 mg. q 4 - 6 hrs.prn

3)Plugged Ductt=>firm nodule under arm; temporarily blocked duct;

  • relieved by infant sucking.
  • Warm compresses prn.
  • Evaluate carefully since may be malignant growth.

4)Mastitis –“inflammation of milk duct/gland d/2 infection

  • Poss. antibiotic therapy.
  • Manual expression,
  • continue to breast feed
  • frequent warm compresses
21
Q

common pathologies of mental status in PP

A

pp depression

  • History of depression and anxiety are leading RFs
  • Can last up to 1 year PP
  • Screening tool = Edinburgh PP depression tool
    • RX: BF helps d/t release of oxytocin IMPROVES MOOD

post partum blues

  • feel a sense of abandonment/disappointment d/t decrease in estrogen/ progesterone levels
  • sx: No interest in surrounding. anhedonia. Fatigue. Decrease hygiene. Odd food cravings.OCD.Irritable

pp psychosis

  • Mania, Halucinations,Delusions, Guilt
22
Q

weight loss in pp

A

Average loss at 13 lbs

  • 5lbs diuereis
  • 2-3lbs – lochial flow
  • At 6 weeks à may still be above pre pregnant state.
    • stretch marks – appear red at first . fade by 3 to 6 months.
23
Q

puerperium of the uterus (involution)

A
  1. reduces from 1000g to 150g
  2. back to normal size by 10-12th day (l) 6thwk(google)
24
Q

what causes failued involution

A

retained placental tissue

  • impairs uterine contraction
  • causes post partum hemorrgh
25
Q

puerperium of cervix

A

cervical opening closes but cervix never returns to nulliparous state

26
Q

puerperium of vagina

A

vagina returns to nulliparous state

oedema resolves by 3rd week

27
Q

perineum puerperium

A

swelling and engprment resolves by 1-2 wks

laceration/ episiotomy

  • 1st degree:from vagina to base of labia minora
  • 2nd: vagina to 1/2 perineum
  • 3rd; vag to entire perineum and anal sphincter
  • 4th: rectal tissue
  • delayed resolution
    • ice pack heat bath nsaids
28
Q

ovariy puerperium

A

ovulation is delayed until 7-9 weeks d2 high lvls of prolactin

29
Q

what’s the most imprtant cause of death in puerperium

A

puerperial bacterial infection of the Genitourinary tract

RF

  1. premature ROM
  2. anemia
  3. hemorrhage
  4. placental retention
  5. episiotomy/ C/S
30
Q

what are the most common causative agents of puerperial infection

A
  • myocplasma
  • gram-ve : E.coli/ Klebsiella
  • staph aureus
  • chlamydia
  • clostridia
31
Q

how does puerperial infection of genital tract present

(least to most severe)

A

cervicitis

uterine infection

adnexitis

Septic Pelvic Thrombophlebitis

Septicimia

32
Q

how is puerperial infection rxed

A

Nutrition and supplements => anemia

broad spec high dose antibiotics

drainage

Thrombophlebitis rx

O&G (43 decks)

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