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OB-GYN > Puerperium + Family Planning > Flashcards

Puerperium + Family Planning Flashcards

1
Q

Stage 3 of labor starts with_________ and ends with __________

A

Stage 3 of labor starts with EXPULSION OF THE BABY and ends with THE EXPULSION OF THE PLACENTA

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2
Q

Withtheremoval of the placenta, you can either do _______ or ______

A

With the removal of the placenta, you can do either GENTLE CORD TRACTION or WAIT FOR THE PLACENTA TO BE EXPELLED

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3
Q

Placental separation can either be dirty or shiny? What terms correspond to these?

A

Duncan/dirty

Schultze/shiny

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4
Q

When does puerperium start? And how long does it last?

A

Starts an hour after delivery.

Lasts for 4-6 weeks

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5
Q

What 4 events occur during puerperium?

A

Uterine contraction
Maternal-neonatal bonding or Milk Reflex
Uterine Involution+ Cervical Repair
Return to Fertility

RUMU

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6
Q

Give the components of the Deadly Triad

A

Hemorrhage
Infection
Hypertension

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7
Q

What are minor causes of morbidity/mortality during the puerperium?

A

Fever
Breast engorgement
Pain
Amniotic fluid embolism

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8
Q

During early puerperium what changes happen to the abdomen?

A

Abdomen becomes soft & flaccid (gelatin-like)
Striae: purplish/reddish -> silvery after yrs
Returns to normal with exercise
Diastasis recti: rectus abdominis separate

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9
Q

Immediately after delivery, how many kg would the mother lose?

A

5-6 kg

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10
Q

After diuresis of 2-3 days, how many kg would the mother lose?

A

2-3 kg

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11
Q

After delivery, how many kg would the mother retain?

A

1.4kg

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12
Q

In early puerperium, what is the level of thrombocytes& leukocytes?

A

Thrombocytes are increased

Leukocytes are increased -> 26,000-30,000

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13
Q

During early puerperium, hgb & hct are? Inc or dec?

A

Decreased. That is why iron supplement is indicated up to 3 mos after delivery

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14
Q

During the first 2 days after deliver, cardiac output is ________. After 10 days _______

A

Increased. CO return to its normal prepregnant state after 10 days

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15
Q

If a woman has previous cardiac condition, how many hours/days should you observe her after delivery?

A

1-2 days because she might have sudden cardiac failure or difficulty breathing or cardiomyopathy

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16
Q

If the patient has preeclampsia, she would probably have __________ therefore, you should monitor the patient’s ________

A

Excess retention of fluids

Urine output

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17
Q

If your patient have preeclampsia and does not diures, you should give _______

A

Diuretics -> FUROSEMIDE

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18
Q

What are small tags of tissue found in the vagina after delivery?

A

Myrtiform caruncles

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19
Q

What is the rationale for doing IE 1 hr after delivery?

A

To check for Hematoma because it can occur anywhere even if u didn’t do episiotomy

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20
Q

When does vaginal epithelium begin to proliferate?

A

4-6wks

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21
Q

Lacerations or stretching of the perineum during delivery may result in ________

A

Vaginal outlet relaxation

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22
Q

Damage to the pelvic floor predisposes to _______

A

Urinary incontinence and pelvic organ prolapse

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23
Q

Immediately after delivery, what is the weight of the uterus?

A

1000 g

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24
Q

At 1 wk PP, what is the weight of the uterus?

A

500g

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25
Q

When does the uterus weigh 250-300g and become a pelvic organ once again?

A

2 weeks PP

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26
Q

When does the uterus return to its prepregnant state?

A

4 wks PP

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27
Q

Why does the uterus need to be contracted even after the mother goes home?

A

To prevent pp hemorrhage

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28
Q

When does oxytocin receptors increase?

A

Late gestation

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29
Q

What tissues locally synthesizes oxytocin?

A

Placenta, extraembryonic tissue, decidua

PED

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30
Q

What are the 4 fxns of oxytocin?

A

Uterine contractions during labor
Uterine contractions postpartum
Milk reflex
Protein synthesis for involution

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31
Q

What is the dose of oxytocin given to mothers?

A

20 units in 1 L crystalloid

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32
Q

Normally, __________ blood is lost in NSD

A

500 cc

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33
Q

_________ blood is lost during CS

A

1000 cc

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34
Q

During emergency cs, ________ blood is lost

A

1500 cc

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35
Q

During emergency cs with hysterectomy, ________ blood is lost

A

2000 cc

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36
Q

What is the rationale for occluding blood vessels after delivery?

A

To initiate thrombosis

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37
Q

What should you do to address uterine atony?

A

Massage
Uterotonics
Surgery

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38
Q

How would you manage lacerations and trauma?

A

Visualization & Repair

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39
Q

How would u manage retained placental fragments?

A

Manual excavation

40
Q

True or False: Not all bleeding can be addressed by oxytocin

A

True

41
Q

What are the 4 etiologies of Hemorrhage PP?

A

Trauma (lacerations)
Tissues (retained)
Thrombosis (coagulopathy)
Tone

42
Q

If the hematoma is 2-3 cm in size, what is the mgt?

A

Observe only

43
Q

If the hematoma is enlarging, what is the mgt?

A

Evacuate!

Slice, obliterate the space, then give ice packs

44
Q

Protocol for PPH:

A 
Bimanual massage
Help
2nd IV line
Blood transfusion
Explore
Monitor Urine output

BEH 2M

45
Q

What type of blood should u give patient experiencing pph?

A

O- fresh whole blood.

46
Q

What is agood measure of blood volume in a patient with pph?

A

Urine output

47
Q

Uterine artery ligation would not cause necrosis because _____________

A

The uterus is also supplied by the Ovarian Artery

48
Q

Aside from the uterine a, what other artery can u ligate to manage pph?

A

Hypogastric A

49
Q

What do you call the suspenders-like sutures around the uterus that compress and occlude the blood vessels?

A

B-lynch sutures

50
Q

If every intervention for pph fails, do ______

A

Hysterectomy

51
Q

How would you manually reposition the uterus after resolving pph?

A

Insert IV
Give Tocolytics
Reposition
Give uterotonics

“URTI”

52
Q

How would you manage hypovolemia of the the px with pph?

A

Crystalloids: 3x estimated blood loss
Colloids (500cc)
Blood transfusion (if large amt of blood loss)

“CCB”

53
Q

T or F: Afterpains is most sever in primiparas?

A

F. Afterpains is most pronounced as parity increases

54
Q

Afterpains can also be perceived as _______

A

Hypogastric pain

55
Q

When do afterpains subside?

A

3rd day

56
Q

What kind of lochia appears on the 10th day? What is its composition?

A

Lochia Alba: leukocyte + reduced fluid content

57
Q

After ______ days, lochia serosa composed of _______ is noted.

A

3-4 days. Old blood.

58
Q

After a few days lochia _______ is seen and is color red.

A

Lochia rubra

59
Q

After delivery, endometrium splits into 2 layers. The superficial layer becomes the ______ and the basal layer becomes the _____

A

Lochia

New endometrium

60
Q

Why do mothers experience overdistention of the bladder after delivery?

A

Because of oxytocin which is also an ADH

61
Q

The glomerular filtration rate goes back to normal by ______

A

2 wks

62
Q

Because of the dilated collecti system, coupled with residual urine and bacteuria im the traumatized bladder, _____ is a comcerm

A

UTI

63
Q

What are common changes in the urinary tract after delivery?

A

Overdistention
Incomplete emptying
Excessive residual urine

64
Q

What substances are incresed after delivery?

A 
Estrogen
Progesterone
Placental lactoge 
Prolactin
Cortisol
Insulin
65
Q

When does colostrum start to appear?

A

2nd day pp

66
Q

Colostrum has: ______ protein & AA

_____ sugar & fat

A

More

Less

67
Q

What component found in the colostrum protects the infants from enteric pathogens?

A

IgA

68
Q

How mucn milk can the mother produce in 1 day?

A

600 mL

69
Q

What vitamin is not found in breast milk? What vitamin is low in breast milk?

A

Vit K-> give injection to baby to prevent hge

Vit D

70
Q

What is the whey:casein of breast milk?

A

60:40-> ideal absorption

71
Q

What condition causes the inability of the mother to breastfeed her child?

A

Sheehan Syndrom-> pituitary necrosis

72
Q

What neurotransmitter is inhibited by the suckling reflex?

A

Dopamine

73
Q

What are the maternal benefits of breastfeeding?

A

Dec breast ca risk
Dec chd
Dec weight retentiom

74
Q

What are the benefits of breastfeeding in infants?

A

IgA against e coli, rotavirus, atopic dermatitis, wheezing illness

75
Q

This can be observed within 3-5 days PP if the woman does not breastfeed

A

Breast engorgement, milk fever

76
Q

What are the contraindications for breastfeeding?

A 
Illicit drug use
Alcoholism
HIV
Untreated TB
Cytotoxic drugs
Infant Galactosemia
Hepa B if infant not immunized
Active HSV in breast
77
Q

To minimize infant exposure, drugs must..

A

Have shorter half life
Poor oral absorption
Lower lipid solubility

Give after feeding & prior to sleep

78
Q

What are the possible etiologies for fever in puerperium?

A

Breast engorgement
Infection
Thrombophlebitis
Dehydration

79
Q

If mother has fever during puerperium, you can give her:

A 
Antipyretics
Antibiotics
Hydration
Early ambulation
Breastfeeding with warm compress
80
Q

Mature milk is produced by….

A

4-6wks pp

81
Q

After delvery, the mother should be monitored ________

A

Every 15 ,pmins for 1 hr

82
Q

If the patient has inability to void, suspect _____

A

Hematoma

83
Q

Up to how many days/months is postpartum blues physiologic?

A

2 mos

84
Q

If the mother has postpartum blues exceeding 2 mos and has _______ & _____, the patient already has….

A

Suicidal ideations & infanticide

Major depression

85
Q

What are the symptoms of Amniotic fluid embolism?

A

Hypotension, hypoxia, consumptive coagulopathy (DIC)

86
Q

Placental site involution is completed within….

A

6 wks

87
Q

This is an arrest or retardation of involution presenting with prolonged lochia, bleeding, large & soft uterus

A

Subinvolution

88
Q

What should u give px woth subinvolution?

A

Uterotonics: methylergometrine via IM 0.2mL

Doxycycline for infection most prob due to chlamydia trachomatis

89
Q

This is hge that occurs from 24 hrs to 12 wks after delivery usually due to….

A

Late PP Hge

Abnormal placental site involution

90
Q

In patients with late pph, do not do ______

A

Dilatation and curettage

91
Q

In a stable px with late pph hge, you cam give:

A

Ergonovine, oxytocin, pg analog

92
Q

If there are large clots seen in a px with late pph, do….

A

Gentle suction curettage

93
Q

This is a palpable non-tender mass caused by am obstructed milk duct

A

Galactocele

94
Q

T or F: in a patient with galactocele, the px presents with fever and chills

A

False

95
Q

What is the most common pathogen causing mastitis at 3-4 wks pp?

A

Staph aureus

96
Q

T or F: does a patient with mastitis present with fever, chils and tachycardia

A

True

OB-GYN (4 decks)

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