Sept12 A2-Post-partum Flashcards
puerperium def
post delivery period where pregnancy induced maternal anat and phgy changes go back to nonpregnant states (lasts 4-6 weeks)
reprod tract changes post partum
- multiparity = external os stays wide
- birth canal returns to normal (pelvic floor damage, vaginal atrophy)
- uterus and vessels involute
- cervix involutes (lot of epith remodelling)
uterus involution progress
- 1 kg post portum
- 500g PP week 1
- 300g PP week 2
- 100 g PP week 4 (involution complete)
possible sx in postpartum
- afterpains (uterus keeps its tonus in primiparity. multiparity = vigorous contractions. baby suckling breast = oxytocin release = sx worse
- lochia = vaginal discharge after birth (from sloughing of decidual tissue (RBCs, decidua, epith, bacteria)
abdominal wall changes PP
- is soft and flaccid PP due to ruptured elastic fiberts and prolong distension
- need many weeks to recover
- striae gravidarum = stretch markers
- diastasis recti = muscular rectus abdominus, physio and exercise to go back to normal
urinary system changes PP
- return to GFR normal after 2 weeks
- possible UTIs bc of dilated ureters all throughout pregnancy (same for renal pelvices). back normal after 2-8 weeks
- bladder has increased capacity (excessive residual urine, incomplete emptying). especially with epidural
hemato changes PP
- hypercoagulability in 6 weeks after delivery so NO OCP**
- CO back to normal after 10 days
- low systemic vasc resistance for 2 days PP and then back to normal
- regain of normal non pregnant volume if PP hemorrhage
diuresis changes PP
- pregnancy: increased water retention and ECF and ECF sodium
- PP diuresis to reverse this. loss of residual pregnancy hypervolemia. (rapid weight loss bc of this). maximal 2 weeks PP.
immunization PP
- Anti-D (given PP if baby Rh+)
- varicella
- MMR
menses PP
- if NOT breastfeeding = return after 6-8 weeks. (mean ovulation 7 wks)
- if breast feeding, menses resume in 2nd to 18th month PP
how to know when ovulation restarts in breastfeeding women
return to normal menstrual bleeding = ovulated 2 weeks ago (but one not always with the other)
contraceptive options PP if breastfeeding
- Cu IUD
- LNG-IUS (prog)
- DMPA (prog injection)
- POP (prog only)
- COC (E+P) AFTER 6 weeks PP
- condoms
- lactational method (breastfeed every 3 hours until 6 months PP)
puerperal complications
- puerperal infection (=genital tract)
- breast infection
- obstetrical neuropathies
- PP depression
puerperal infection lethal triad in 20th century
- puerperal infection
- PP hemorrhage
- pre-eclampsia
puerperal infection ddx
- breast engorgement
- UTI
- incisions
- resp complications
endometritis def
inflammatory reaction of lining of endo due to infection
uterine infections PP (puerperal) RFs
- C-section
- low SES
- malnutrition, anemia
- chorioamnionitis
- prolonged labor
- obesity
puerperal UTI sx and tx
- sx = fever, abd pain, uterine tenderness, high WBCs, foul smelling lochia
- tx = IV Abx**
puerperal breast infection charact
- 3% of pts PP
- parenchymal infection
- RFs = cracked nipples, difficulty with breastfeeding
- 3-4 weeks after delivery
puerperal breast infection sx
- unlitateral
- pain
- redness
- induration of breast
puerperal breast infection tx
- oral abx
- abscess drainage
name for breast infection
mastitis
cause of obstetrical neuropathies
- pressure on branches of lumbosacral plexus during labor
- long labor = longer time head pressing on nerves, ischemia, damageo nn erves
obstetrical neuropathies sx
- intense neuralgia or cramp like pains extending in leg
- sensory loss
- muscle paralysis
- foot drop
most common PP obstetrical neuropathies
lateral femoral cutaneous neuropathy
RFs for obstetrical neuropathies
- nulliparity
- prolonged 2nd stage of labour
- pushing for long duration in Fowler (legs extended on side)
obstetrical neuropathies tx
sx resolve in 2 weks to 18 months
other name for PP depression
maternity blues. time limited period of heightened emotional reactivity. in first week PP
predominant mood in PP depression
happiness. but labile emotions, mix with other things, depression, irritability
why hormones affect mood PP (same reasons as PMS, PMDD)
estrogen linked to
- higher 5HT synthesis
- less 5HT breakdown
- serotonin-R modulation
- all these good effects during pregnancy and then estrogen drops PP*
RFs for PP Depression
- young maternal age
- antenatal depression
- unmarried
- smoking
- newborn required ICU
- adverse obstetrical events
- hx of stressors during pregnancy
most imp RF for PP depression
prevous history of depression
PP depression approach after diagnosed with a questionnaire
following an algorithm, either of
- anti-psychotics
- emergency psychiatry
- psychotherapy
- mood stabilizer
- etc
PP depression what if left untx
25% depressed 1 year PP
-increased nbr of sequelae
PP visit charact
- 6-8 weeks PP
- asses bleedingm pain, tearing, breastfeeding, mood sx, intercourse
- PE (perineum, C-Section scar, pap test if not up to date)
- discuss contraception
