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Bloc I - Reproduction > Sept12 A2-Post-partum > Flashcards

Sept12 A2-Post-partum Flashcards

1
Q

puerperium def

A

post delivery period where pregnancy induced maternal anat and phgy changes go back to nonpregnant states (lasts 4-6 weeks)

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2
Q

reprod tract changes post partum

A
  • 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)
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3
Q

uterus involution progress

A
  • 1 kg post portum
  • 500g PP week 1
  • 300g PP week 2
  • 100 g PP week 4 (involution complete)
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4
Q

possible sx in postpartum

A
  • 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)
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5
Q

abdominal wall changes PP

A
  • 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
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6
Q

urinary system changes PP

A
  • 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
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7
Q

hemato changes PP

A
  • 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
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8
Q

diuresis changes PP

A
  • 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.
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9
Q

immunization PP

A
  • Anti-D (given PP if baby Rh+)
  • varicella
  • MMR
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10
Q

menses PP

A
  • if NOT breastfeeding = return after 6-8 weeks. (mean ovulation 7 wks)
  • if breast feeding, menses resume in 2nd to 18th month PP
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11
Q

how to know when ovulation restarts in breastfeeding women

A

return to normal menstrual bleeding = ovulated 2 weeks ago (but one not always with the other)

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12
Q

contraceptive options PP if breastfeeding

A
  • 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)
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13
Q

puerperal complications

A
  • puerperal infection (=genital tract)
  • breast infection
  • obstetrical neuropathies
  • PP depression
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14
Q

puerperal infection lethal triad in 20th century

A
  • puerperal infection
  • PP hemorrhage
  • pre-eclampsia
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15
Q

puerperal infection ddx

A
  • breast engorgement
  • UTI
  • incisions
  • resp complications
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16
Q

endometritis def

A

inflammatory reaction of lining of endo due to infection

17
Q

uterine infections PP (puerperal) RFs

A
  • C-section
  • low SES
  • malnutrition, anemia
  • chorioamnionitis
  • prolonged labor
  • obesity
18
Q

puerperal UTI sx and tx

A
  • sx = fever, abd pain, uterine tenderness, high WBCs, foul smelling lochia
  • tx = IV Abx**
19
Q

puerperal breast infection charact

A
  • 3% of pts PP
  • parenchymal infection
  • RFs = cracked nipples, difficulty with breastfeeding
  • 3-4 weeks after delivery
20
Q

puerperal breast infection sx

A
  • unlitateral
  • pain
  • redness
  • induration of breast
21
Q

puerperal breast infection tx

A
  • oral abx

- abscess drainage

22
Q

name for breast infection

A

mastitis

23
Q

cause of obstetrical neuropathies

A
  • pressure on branches of lumbosacral plexus during labor

- long labor = longer time head pressing on nerves, ischemia, damageo nn erves

24
Q

obstetrical neuropathies sx

A
  • intense neuralgia or cramp like pains extending in leg
  • sensory loss
  • muscle paralysis
  • foot drop
25
Q

most common PP obstetrical neuropathies

A

lateral femoral cutaneous neuropathy

26
Q

RFs for obstetrical neuropathies

A
  • nulliparity
  • prolonged 2nd stage of labour
  • pushing for long duration in Fowler (legs extended on side)
27
Q

obstetrical neuropathies tx

A

sx resolve in 2 weks to 18 months

28
Q

other name for PP depression

A

maternity blues. time limited period of heightened emotional reactivity. in first week PP

29
Q

predominant mood in PP depression

A

happiness. but labile emotions, mix with other things, depression, irritability

30
Q

why hormones affect mood PP (same reasons as PMS, PMDD)

A

estrogen linked to

  • higher 5HT synthesis
  • less 5HT breakdown
  • serotonin-R modulation
  • all these good effects during pregnancy and then estrogen drops PP*
31
Q

RFs for PP Depression

A
  • young maternal age
  • antenatal depression
  • unmarried
  • smoking
  • newborn required ICU
  • adverse obstetrical events
  • hx of stressors during pregnancy
32
Q

most imp RF for PP depression

A

prevous history of depression

33
Q

PP depression approach after diagnosed with a questionnaire

A

following an algorithm, either of

  • anti-psychotics
  • emergency psychiatry
  • psychotherapy
  • mood stabilizer
  • etc
34
Q

PP depression what if left untx

A

25% depressed 1 year PP

-increased nbr of sequelae

35
Q

PP visit charact

A
  • 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

Bloc I - Reproduction (57 decks)

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