Post Partum Care

Question 1

The period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition

Answer 1

Puerperium

Question 2

When does the involution of the uterus happen?

Answer 2

Immediately after delivery – below umbilicus and firm
Back into pelvis in 2 weeks

Question 3

How long does it take for the uterus to return back to it’s normal size?

Answer 3

6 weeks

Question 4

Blood clots and thrombi expelled, decidue necrotic and sloughs

Fairly heavy at first then rapidly decreases over first 2-3 days, but can
last several weeks

Answer 4

Lochia

Question 5

Which type of lochia is described below?

menses-like, first several days

Answer 5

Lochia rubia

Question 6

Which type of lochia is described below?

next few days lighter color, considerably less blood

Answer 6

Lochia serosa

Question 7

Which type of lochia is described below?

whitish discharge that may persist several weeks

Answer 7

Lochia alba

Question 8

Lochia resolves more quickly in women who do what?

Answer 8

breastfeed = uterine contractions

Question 9

Post delivery, how long does it take for the cervix to return to down to 1 cm?

Answer 9

1 week

Question 10

Post delivery, what shape does the os of the cervix take?

Answer 10

Round os becomes transverse

Question 11

When is the return of ovarian functioning in a lactating and non-lactating patient?

Answer 11

45 days non-lactating

189 days lactating

Question 12

At a patient’s 6 weeks post partum checkup, inflammatory changes because of a healing cervix may result in what on the pap smear?

Answer 12

inflammatory changes because of healing of the cervix may result in minor atypia on a pap smear performed at this time

Question 13

Which elevated hormone suppresses function and acts as a natural birth control?

Answer 13

Prolactin

Question 14

What hormone levels fall immediately after delivery, back to normal in 2 weeks if breastfeeding not initiated?

Answer 14

Estrogen

Question 15

A woman’s cardiovascular system takes how long to return to normal after delivery?

Answer 15

2-3 weeks back to normal

Question 16

Ureter and renal pelvis dilation persists how long post delivery?

Answer 16

6-8 weeks

Question 17

Galactocele

Answer 17

plugged duct

Question 18

What is produced first 5 days then replaced with mother’s milk?

Answer 18

Colostrum

Question 19

Colostrum contains what important substance?

Answer 19

immunoglobin A

Question 20

What medication is prescribed to help with breastmilk production?

Answer 20

Regland

Question 21

> 500mL of blood after vaginal delivery

4% of vaginal deliveries

Criteria: 10% drop in hematocrit, need for transfusion, tachycardia/tachypnea, orthostatic changes, delayed cap refill, narrowed pulse pressures

Answer 21

Postpartum Hemorrhage

Question 22

What is the most common cause of postpartum hemorrhage?

Answer 22

uterine atony

Question 23

Describe the difference between primary and secondary postpartum hemorrhage

Answer 23

Primary - Within 24 hours of delivery, much more serious

Secondary - 24 hours to 12 weeks

Question 24

List some complications/sequalae of a postpartum hemorrhage?

Answer 24

ARDS
coagulopathy
shock
loss of fertility
Sheehan syndrome (pit necrosis)

Question 25

What are some risk factors for a postpartum hemorrhage?

Answer 25

Prolonged third stage of labor
Multiple deliveries
Episiotomy
History of post-partum hemorrhage
Fetal macrosomia

Question 26

What treatment alone is often successful in causing uterine contraction, and this should be done while preparations for other treatments underway?

Answer 26

Bimanual uterine massage

Question 27

List some medications that are used in the treatment of uterine atony that cause uterine contractions

Answer 27

IV oxytoxin
methylergonovine maleate (Methogen) – ergot derivative
Prostaglandins
possibly packed RBCs
Cytotec and hemabeta – given for uterine bleed post-delivery

Question 28

List some causes of a a postpartum hemorrhage

Answer 28

Uterine atony
Retained Placenta
Uterine Rupture
Abnormal placenta separation
Lacerations
Coagulopathies
Hematoma
Amniotic fluid embolism

Question 29

Why is it VERY IMPORTANT to assess delivered placenta and make sure intact?

Answer 29

Placental tissue remaining can interfere with uterine contractions, which can lead to atony and post partum hemorrhaging

Question 30

Frank opening between uterine cavity and abdominal cavity

Can be at site of previous C-section

Surgical repair required 🡪 medical emergency!!

Answer 30

Uterine Rupture

Question 31

What medical emergency has significantly high mortality rates in mother and fetus?

Answer 31

Uterine Rupture

Question 32

Rare, sudden, and can be fatal

Often results in severe coagulopathy

Hemorrhage with uterine inversion is characteristically drastic and sudden

Answer 32

Amniotic fluid embolism

Question 33

An inflammation or irritation of the lining of the uterus

Higher risk in C-section than vaginal birth

Onset is often sudden and within 24 hours of delivery

Answer 33

Endometritis

Question 34

In mother, significant postpartum fever may indicate what condition? And what is the most common organism?

Answer 34

postpartum endometritis 🡪 may be caused by infection with GBS

Question 35

What is the single largest risk factor for endometritis?

Answer 35

Caesarean section

Question 36

List some risk factors for endometritis

Answer 36

Caesarean section
Prolonged rupture of membranes
Severe meconium staining in liquor
Long labor with multiple examinations
Manual removal of placenta
Obesity
Diabetes or impaired glucose tolerance
History of pelvic infection
Retained products of conception
Mother’s age at extremes of reproductive span
Low socio-economic status
Maternal anaemia
Prolonged surgery
Internal fetal monitoring
General anaesthetic

Question 37

What is the most common cause for chronic endometritis?

Answer 37

Retained products of conception

Question 38

List the most common signs and symptoms of endometritis?

Answer 38

Significant fever and tachycardia

Onset sudden and within 24 hours of delivery

Question 39

What testing is done prior to birth to help prevent the incidence of endometritis?

Answer 39

Test for group B strep 35-37 weeks

All women who are GBS positive by rectovaginal culture should
receive antibiotic prophylaxis in labor or with rupture of membranes
(or if status unknown when going to delivery)