Puerperium + Family Planning Flashcards
Stage 3 of labor starts with_________ and ends with __________
Stage 3 of labor starts with EXPULSION OF THE BABY and ends with THE EXPULSION OF THE PLACENTA
Withtheremoval of the placenta, you can either do _______ or ______
With the removal of the placenta, you can do either GENTLE CORD TRACTION or WAIT FOR THE PLACENTA TO BE EXPELLED
Placental separation can either be dirty or shiny? What terms correspond to these?
Duncan/dirty
Schultze/shiny
When does puerperium start? And how long does it last?
Starts an hour after delivery.
Lasts for 4-6 weeks
What 4 events occur during puerperium?
Uterine contraction
Maternal-neonatal bonding or Milk Reflex
Uterine Involution+ Cervical Repair
Return to Fertility
RUMU
Give the components of the Deadly Triad
Hemorrhage
Infection
Hypertension
What are minor causes of morbidity/mortality during the puerperium?
Fever
Breast engorgement
Pain
Amniotic fluid embolism
During early puerperium what changes happen to the abdomen?
Abdomen becomes soft & flaccid (gelatin-like)
Striae: purplish/reddish -> silvery after yrs
Returns to normal with exercise
Diastasis recti: rectus abdominis separate
Immediately after delivery, how many kg would the mother lose?
5-6 kg
After diuresis of 2-3 days, how many kg would the mother lose?
2-3 kg
After delivery, how many kg would the mother retain?
1.4kg
In early puerperium, what is the level of thrombocytes& leukocytes?
Thrombocytes are increased
Leukocytes are increased -> 26,000-30,000
During early puerperium, hgb & hct are? Inc or dec?
Decreased. That is why iron supplement is indicated up to 3 mos after delivery
During the first 2 days after deliver, cardiac output is ________. After 10 days _______
Increased. CO return to its normal prepregnant state after 10 days
If a woman has previous cardiac condition, how many hours/days should you observe her after delivery?
1-2 days because she might have sudden cardiac failure or difficulty breathing or cardiomyopathy
If the patient has preeclampsia, she would probably have __________ therefore, you should monitor the patient’s ________
Excess retention of fluids
Urine output
If your patient have preeclampsia and does not diures, you should give _______
Diuretics -> FUROSEMIDE
What are small tags of tissue found in the vagina after delivery?
Myrtiform caruncles
What is the rationale for doing IE 1 hr after delivery?
To check for Hematoma because it can occur anywhere even if u didn’t do episiotomy
When does vaginal epithelium begin to proliferate?
4-6wks
Lacerations or stretching of the perineum during delivery may result in ________
Vaginal outlet relaxation
Damage to the pelvic floor predisposes to _______
Urinary incontinence and pelvic organ prolapse
Immediately after delivery, what is the weight of the uterus?
1000 g
At 1 wk PP, what is the weight of the uterus?
500g
When does the uterus weigh 250-300g and become a pelvic organ once again?
2 weeks PP
When does the uterus return to its prepregnant state?
4 wks PP
Why does the uterus need to be contracted even after the mother goes home?
To prevent pp hemorrhage
When does oxytocin receptors increase?
Late gestation
What tissues locally synthesizes oxytocin?
Placenta, extraembryonic tissue, decidua
PED
What are the 4 fxns of oxytocin?
Uterine contractions during labor
Uterine contractions postpartum
Milk reflex
Protein synthesis for involution
What is the dose of oxytocin given to mothers?
20 units in 1 L crystalloid
Normally, __________ blood is lost in NSD
500 cc
_________ blood is lost during CS
1000 cc
During emergency cs, ________ blood is lost
1500 cc
During emergency cs with hysterectomy, ________ blood is lost
2000 cc
What is the rationale for occluding blood vessels after delivery?
To initiate thrombosis
What should you do to address uterine atony?
Massage
Uterotonics
Surgery
How would you manage lacerations and trauma?
Visualization & Repair
How would u manage retained placental fragments?
Manual excavation
True or False: Not all bleeding can be addressed by oxytocin
True
What are the 4 etiologies of Hemorrhage PP?
Trauma (lacerations)
Tissues (retained)
Thrombosis (coagulopathy)
Tone
If the hematoma is 2-3 cm in size, what is the mgt?
Observe only
If the hematoma is enlarging, what is the mgt?
Evacuate!
Slice, obliterate the space, then give ice packs
Protocol for PPH:
Bimanual massage Help 2nd IV line Blood transfusion Explore Monitor Urine output
BEH 2M
What type of blood should u give patient experiencing pph?
O- fresh whole blood.
What is agood measure of blood volume in a patient with pph?
Urine output
Uterine artery ligation would not cause necrosis because _____________
The uterus is also supplied by the Ovarian Artery
Aside from the uterine a, what other artery can u ligate to manage pph?
Hypogastric A
What do you call the suspenders-like sutures around the uterus that compress and occlude the blood vessels?
B-lynch sutures
If every intervention for pph fails, do ______
Hysterectomy
How would you manually reposition the uterus after resolving pph?
Insert IV
Give Tocolytics
Reposition
Give uterotonics
“URTI”
How would you manage hypovolemia of the the px with pph?
Crystalloids: 3x estimated blood loss
Colloids (500cc)
Blood transfusion (if large amt of blood loss)
“CCB”
T or F: Afterpains is most sever in primiparas?
F. Afterpains is most pronounced as parity increases
Afterpains can also be perceived as _______
Hypogastric pain
When do afterpains subside?
3rd day
What kind of lochia appears on the 10th day? What is its composition?
Lochia Alba: leukocyte + reduced fluid content
After ______ days, lochia serosa composed of _______ is noted.
3-4 days. Old blood.
After a few days lochia _______ is seen and is color red.
Lochia rubra
After delivery, endometrium splits into 2 layers. The superficial layer becomes the ______ and the basal layer becomes the _____
Lochia
New endometrium
Why do mothers experience overdistention of the bladder after delivery?
Because of oxytocin which is also an ADH
The glomerular filtration rate goes back to normal by ______
2 wks
Because of the dilated collecti system, coupled with residual urine and bacteuria im the traumatized bladder, _____ is a comcerm
UTI
What are common changes in the urinary tract after delivery?
Overdistention
Incomplete emptying
Excessive residual urine
What substances are incresed after delivery?
Estrogen Progesterone Placental lactoge Prolactin Cortisol Insulin
When does colostrum start to appear?
2nd day pp
Colostrum has: ______ protein & AA
_____ sugar & fat
More
Less
What component found in the colostrum protects the infants from enteric pathogens?
IgA
How mucn milk can the mother produce in 1 day?
600 mL
What vitamin is not found in breast milk? What vitamin is low in breast milk?
Vit K-> give injection to baby to prevent hge
Vit D
What is the whey:casein of breast milk?
60:40-> ideal absorption
What condition causes the inability of the mother to breastfeed her child?
Sheehan Syndrom-> pituitary necrosis
What neurotransmitter is inhibited by the suckling reflex?
Dopamine
What are the maternal benefits of breastfeeding?
Dec breast ca risk
Dec chd
Dec weight retentiom
What are the benefits of breastfeeding in infants?
IgA against e coli, rotavirus, atopic dermatitis, wheezing illness
This can be observed within 3-5 days PP if the woman does not breastfeed
Breast engorgement, milk fever
What are the contraindications for breastfeeding?
Illicit drug use Alcoholism HIV Untreated TB Cytotoxic drugs Infant Galactosemia Hepa B if infant not immunized Active HSV in breast
To minimize infant exposure, drugs must..
Have shorter half life
Poor oral absorption
Lower lipid solubility
Give after feeding & prior to sleep
What are the possible etiologies for fever in puerperium?
Breast engorgement
Infection
Thrombophlebitis
Dehydration
If mother has fever during puerperium, you can give her:
Antipyretics Antibiotics Hydration Early ambulation Breastfeeding with warm compress
Mature milk is produced by….
4-6wks pp
After delvery, the mother should be monitored ________
Every 15 ,pmins for 1 hr
If the patient has inability to void, suspect _____
Hematoma
Up to how many days/months is postpartum blues physiologic?
2 mos
If the mother has postpartum blues exceeding 2 mos and has _______ & _____, the patient already has….
Suicidal ideations & infanticide
Major depression
What are the symptoms of Amniotic fluid embolism?
Hypotension, hypoxia, consumptive coagulopathy (DIC)
Placental site involution is completed within….
6 wks
This is an arrest or retardation of involution presenting with prolonged lochia, bleeding, large & soft uterus
Subinvolution
What should u give px woth subinvolution?
Uterotonics: methylergometrine via IM 0.2mL
Doxycycline for infection most prob due to chlamydia trachomatis
This is hge that occurs from 24 hrs to 12 wks after delivery usually due to….
Late PP Hge
Abnormal placental site involution
In patients with late pph, do not do ______
Dilatation and curettage
In a stable px with late pph hge, you cam give:
Ergonovine, oxytocin, pg analog
If there are large clots seen in a px with late pph, do….
Gentle suction curettage
This is a palpable non-tender mass caused by am obstructed milk duct
Galactocele
T or F: in a patient with galactocele, the px presents with fever and chills
False
What is the most common pathogen causing mastitis at 3-4 wks pp?
Staph aureus
T or F: does a patient with mastitis present with fever, chils and tachycardia
True
