The puerperium Flashcards
What is the puerperium?
6 weeks following delivery
Give uterine changes in the puerperium?
involutes from 1kg to 100g
felt at umbilicus after delivery
becomes pelvic organ at 10 days
pains due to its contractions
Give cervical changes in puerperium
firms over 3 days
internal os closes by 3 days
external os closes by 3 weeks
What is lochia
endometrial slough, red and white cells
When is lochia normally red
first 3 days
When does lochia change from yellow to white?
over the next 10 days
then stays white until 6 weeks
When does milky discharge appear from the breasts?
during last trimester
when does milk replace colostrum?
3 days after birth
what are swollen, red and tender breasts a sign of at 3-4 days?
physiological engorgement
What should be given if women are Rh-ve?
anti D within 72 hrs
What are signs of endometritis or retained products?
persistent red lochia
failure of uterine involution
PPH
immunity to what should be checked in the first few days after birth?
rubella
What is puerperal Pyrexia defined as
Temp >38 in the first 14 days after delivery OR miscarriage
what are ix for puerperal pyrexia
MSU culture, high vaginal swabs, blood and sputum
what are the main causes of puerperal pyrexia
endometritis: most common cause urinary tract infection wound infections (perineal tears + caesarean section) mastitis venous thromboembolism
What is rx of puerperal pyrexia
cephalexin + metronidazole
What are the signs of endometritis
lower abdominal pain
offensive lochia
tender uterus on BMV
What is rx of endometritis
clindamycin and gentamicin until afebrile for greater than 24 hours
What is the treatment of breast infection
flucloxacillin for 10 or more days to prevent abscesses
Should breastfeeding be continued w breast infection?why or why not
continue to prevent milk stagnation
What is superficial thrombophlebitis what is the rx
painful tender vein
NSAID
stockings
what is involves in 6 week postnatal examination regarding the mother
- Looking at baby and mother rship
- BP and weight
- FBC if anaemic
- Cervical smear if due
- Check contraceptive plans
Explain how lactational amenorrhoea works
Breastfeeding delays return of ovulation
when is lactational amenorrhoea most effective?
fully breastfeeding day and night, <6m postpartum and amenorrhoeic
When is average first menstruation after birtuh?
28.4 weeks
When is lactational amenorrhoea less effective?
- Periods return
- > 6m
- breastfeeding frequency
- Night feeding stops
- Separation from the baby
- Mother or baby become ill or stressed
When can pOP be started postpartum?
any time
When can COCP be started postpartum?
3w if not breastfeeding
When is it recommended to start depot in breastfeeding women?
after 6 weeks
What drug is involved in depot and when can it be given if not breastfeeding?
medroxyprogesterone acetate 5 days postpartum
When can progesterone implants be given?
after 6w in breastfeeding
21-28 if not breastfeeding
When is IUD inserted postpartum?
either in first 48hrs
or
until 4 weeks
