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MIDS 187 > Ch 17 Postpartum Uterus > Flashcards

Ch 17 Postpartum Uterus Flashcards

1
Q

Define puerperium?

A

-The postpartum period

-Time immediately following the expulsion of the placenta + uterine contents to 6-8 weeks after birth (or whenever the uterus regains its prenatal shape)

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2
Q

List 5 puerperium indications for scanning?

A

-Postpartum hemorrhage
-Search for causes of puerperal infection
-Evaluate for postpartum ovarian vein thrombophlebitis (POVT)
-RPOC
-Complications arising from c-section (ex. hematomas + abscesses at incision site)

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3
Q

Why do physiologic + biochemical changes occur in the postpartum period?

A

B/c of the withdrawal of pregnancy induced hormones:

-Causes uterus to return/involute back to prepregnancy state (occurs within 1 week of delivery)

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4
Q

Discontinuance of lactation results in what?

A

Resumption of ovulation + menstruation

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5
Q

It is common to image the internal os on day 1, what will it look like?

A

Partially open + ill-defined, as it continues to close following delivery

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6
Q

List the postpartum sonographic appearance of the myometrium + endometrium?

A

Myo: homogeneous, delineated, 7-10cm in thickness

Endo: thickened initially up to 13mm, but should decrease to normal thickness of 3-8mm by end of postpartum period

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7
Q

Why is free fluid in the endo cavity a normal finding in postpartum?

A

B/c blood + other substances slough off from uterus after birth

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8
Q

The endometrium should not measure greater than what in postpartum?

A

1.2-1.4cm or 12-14mm

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9
Q

What are the postpartum uterus measurements?

A

SAG: 14-25cm
TRV: 7-14cm

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10
Q

How will the ovaries look during pregnancy?

A

Should remain the same, except for a few more cysts seen in 1st trimester

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11
Q

Differentiate acute vs delayed hemorrhage?

A

Acute: severe bleeding immediately after delivery, m/c resulting in emergency hysterectomy

Delayed: bleeding that occurs over several days - a few weeks in postpartum period

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12
Q

Define a postpartum hemorrhage?

A

Blood loss of greater than 500 mL during the 3rd stage of labor OR right after a vaginal delivery

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13
Q

A C-section delivery requires how many mL loss to classify as a postpartum hemorrhage?

A

Over 1000 mL

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14
Q

What are the m/c causes of a postpartum hemorrhage?

A

Placenta accreta, increta + percreta

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15
Q

Define a puerperal infection?

A

Any infection in the postpartum period characterized by a temp over 100.4 F/38 C on any 2 days in a row after the first 24 hours postpartum

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16
Q

What is the first sign of postpartum infection?

A

Uterine tenderness (not “afterpains”)

Other symptoms:
-chills, headache, malaise, anorexia, vag discharge (lochia) may be diminished or profuse/odorous

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17
Q

What is the m/c puerperal infection?

A

UTI - but can also be breast infections, thrombophlebitis or endometritis

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18
Q

What is endometritis?

A

Infection of endo - m/c due to the migration of normal vaginal flora which may result in postpartum bleeding

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19
Q

What does VBAC stand for?

A

Vaginal birth after cesarean

20
Q

What increases the risk of endometritis?

A

VBAC

21
Q

SF of endometritis?

A

Thick, irregular endo with potential fluid in endocervical canal

(gas may be seen in endo canal, however after 3 weeks postpartum gas is a normal finding)

22
Q

What is RPOC due to?

A

-Due to incomplete expulsion of products of conception during labor + delivery
-Can cause infection

(only 1% of term deliveries are complicated by RPOC)

23
Q

SF of RPOC?

A

Highly echogenic mass in endo

24
Q

Remnants of placental tissue is called what?

A

Placental polyps - they are due to incomplete placental expulsion from uterus (RPOC)

25
Q

What does RPOC have a similar appearance to sonographically?

A

Endometritis

26
Q

What is uterine atony?

A

When the uterus fails to reach pregravid tone + becomes flaccid and unable to hold its shape

(when uterus doesn’t tighten properly after birth)

27
Q

What is one of the most frequent causes of postpartum hemorrhage?

A

Uterine atony

28
Q

What women are at an increased risk for uterine atony?

A

Multifetal pregnancy, macrosomy, prolonged labor, >5 term pregnancies, rapid labor, polyhydramnios + chorioamnionitis

29
Q

What is thrombophlebitis?

A

The inflammation of a vein caused by a thrombus in the lumen of the vessel

30
Q

What does POVT stand for? When does this condition occur?

A

-Postpartum ovarian vein thrombophelebitis
-Rare condition found m/c in postpartum period, but can occur with malignancies + PID

31
Q

The pathogenesis of POVT relates to what triad?

A

Virchow’s triad

32
Q

The majority of cases of POVT involve the right or left ovarian vein?

A

Right

33
Q

List the 3 m/c symptoms of POVT?

A

-Pelvic pain
-Fever
-Right sided pelvic mass

(experience these within 48-96 hours after delivery)

34
Q

What is the gold standard for diagnosing POVT?

A

CT

35
Q

SF of POVT?

A

Dilated anechoic - hypoechoic tubular structure extending superiorly from adnexa

36
Q

Treatment of POVT?

A

IV therapy of anticoagulants (such as heparin + blood thinners like warfarin)

37
Q

How were C-section incisions done traditionally vs how they are done now?

A

Traditionally: vertically along long axis of uterus
Nowadays: TRV incision

38
Q

SF of a C-section scar?

A

Anechoic to hypoechoic, depending on how the tissue reacts to the surgery

39
Q

What is a common complication of C-sections?

A

Hematomas at site of incision + infection

40
Q

What is the area called where post cesarean hematoms typically develop?

A

Bladder flap - is a cut in the peritoneum b/w urinary bladder + uterus to access the lower uterine segment

41
Q

What do C-section hematomas look like?

A

-Anechoic with ill defined borders ranging from <1cm to >15cm in size
-Can appear complex b/c of clotting, septations or debris within it

42
Q

What 4 things could cause an infection after a C-section?

A

-Long operation time
-Endometritis
-Contaminated amniotic fluid entering incision
-Preexisting infections

(if pt has fever think infection)

43
Q

Where do infections develop after a C-section?

A

In abdominal or uterine wall

44
Q

How would C-section infections look?

A

Can range from anechoic, cystic, complex + with or w/o defined borders

(abscesses can develop along incision line which would look complex)

45
Q

What is the alternate term for postpartum period?

A

Puerperium period

46
Q

How long is the puerperium period?

A

6-8 weeks

MIDS 187 (19 decks)

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