Chapter 35: The Postpartum Uterus

Question 1

formation of a blood clot owing to inflammation

Answer 1

thrombophlebitis

Question 2

Radiographic examination of the vein performed after injection of a radiopaque contrast medium

Answer 2

Venogram

Question 3

stones within the kidney

Answer 3

nephrolithiasis

Question 4

radiographic images of the kidneys, ureters, and bladder after injection of a radiopaque dye

Answer 4

intravenous pyelogram

Question 5

reduction of an organ to its normal size and appearance

Answer 5

involution

Question 6

removal of the uterus

Answer 6

hysterectomy

Question 7

collection of blood outside the vessels

Answer 7

hematoma

Question 8

moving particles, such as thrombosis or air, within the bloodstream

Answer 8

emboli

Question 9

portion of the uterine lining which forms the maternal portion of the placenta

Answer 9

decidua basalis

Question 10

defect in the body’s clotting mechanism resulting in bleeding

Answer 10

coagulopathy

Question 11

inflammation of the amnion and chorion owing to a bacterial infection

Answer 11

chorioamnionitis

Question 12

lack of normal muscle tone

Answer 12

atony

Question 13

The puerperium:
a. describes the postdelivery condition of the female external genitalia
b. starts immediately post delivery including the placenta and continues until the uterus retains it prenatal shape
c. is an infection of the placental site within the uterus
d. extends from placental delivery until the first normal menstruation

Answer 13

b

Question 14

Lactation termination usually produces:

Answer 14

menstrual resumption

Question 15

sonography in the puerperium period is used for all except:
a. evaluation puerperal infection
b. postpartum hemorrhage
c. complications following cesarean delivery
d. to routinely determine whether the uterus has returned to prepregnancy state

Answer 15

d

Question 16

Select the true statement regarding the postpartum uterus.
a. the internal os will be visualized as closed and well delineated following placental delivery
b. the endometrium will measure 3 to 8 mm within 24 hours of delivery
c. free fluid in the endometrial cavity indicates intrauterine infection
d. longitudinal uterine measurements range from 14 to 25 cm

Answer 16

d

Question 17

during pregnancy, ovaries generally:
a. remain the same as prepregnancy state with the exception of a few more cysts in the first trimester
b. involute
c. enlarge owing to hormone production
d. develop a thickened outer cortex

Answer 17

a

Question 18

A placenta that completely invades the uterine myometrium extending into the serosa is:

Answer 18

placenta percreta

Question 19

Select the condition that is not likely to be related to postpartum hemorrhage.
a. decreased hematocit
b. shock
c. hypertension
d. hysterectomy

Answer 19

c

Question 20

RPOC has a similar sonographic appearance to:

Answer 20

highly echogenic mass in the endometrial canal

Question 21

Usually the first indication of uterine (pueperium) infection is:

Answer 21

uterine tenderness

Question 22

the only infection that is not typically related to postpartum infection is:

Answer 22

salpingitis

Question 23

which of the following is not identified with uterine atony?
a. chorioamnionitis
b. prolonged labor
c. oligohydramnios
d. macrosomy

Answer 23

c

Question 24

The most common signs of POVT are:

Answer 24

fever, right sided pelvic mass, and pelvic pain

Question 25

cesarean section delivery: a. has an increased risk of infection b. is mostly performed with a vertical incision c. requires a low-frequency transducer when hematoma occurs adjacent to the bladder flap d. accounts for approximately 13.8% of all US deliveries

Answer 25

a

Question 26

the most frequent site of postpartum thrombophlebitis is:

Answer 26

right ovarian vein

Question 27

Endometritis: a. is an infection of the endometrium that may extend to the myometrium, which may lead to postpartum bleeding b. appears as an extremely thin endometrium and irregular walls c. produces a fluid-filled endometrium d. causes a flaccid uterus post deliver

Answer 27

a

Question 28

The postpartum period may also be called the ______

Answer 28

puerperium

Question 29

complications seen most frequently following cesarean section are _____ and ____ at the incision site

Answer 29

Hematomas Abscesses

Question 30

It is essential to remember to use a _____ pressure than when imaging the nongravid uterus

Answer 30

Lighter

Question 31

If a post C-section patient cannot tolerate trans abdominal or transvaginal imaging, the ____ or _____ imaging method may visualize the C-section incision

Answer 31

Translabial Transperineal

Question 32

The adnexal ligaments of the postpartum patient are typically _____ immediately following delivery, usually returning to their pregravid states within ______

Answer 32

Flaccid 1 month

Question 33

Postpartum hemorrhage is considered over ____ mL of blood with a vaginal delivery and over _____ mL of blood in a cesarean delivery.

Answer 33

500 1000

Question 34

The cause of placenta accreta, percreta, and increta is complete or partial absence of the _______

Answer 34

Decidua basalis

Question 35

Antepartum rupture of the uterus causes emergency delivery and ______

Answer 35

Hysterectomy

Question 36

Sonography helps identify the multiple intraplacental ____ that are indicators of placental invasion of the myometrium

Answer 36

Lakes

Question 37

The sonographic appearance of endometritis is that of a _____, irregular endometrium that may have ______ in the endocervical canal.

Answer 37

Thick Fluid

Question 38

Retained products of conception image as an _____ mass within an irregularly shaped uterus

Answer 38

Echogenic

Question 39

Sonographically, POVT images as a dilated anechoic to hypoechoic _____ structure extending superiorly from the adnexa

Answer 39

Tubular

Question 40

Hematomas found in the bladder flap region are sonographically ______ with ill-defined borders that range in size from less than 1 cm to greater than 15cm

Answer 40

Anechoic

Question 41

A ____-frequency transducer is sometimes needed to adequately assess postpartum cesarean section hematomas

Answer 41

High

Question 42

Infections following cesarean sections have appearances of anechoic, _____, _____, and with or without definite margins

Answer 42

Cystic Complex

Question 43

The postpartum period may also be called the:

Answer 43

puerperium

Question 44

period of time extending from immediately following the expulsion of the placenta and uterine contents to 6 to 8 weeks after birth or whenever uterus regains its prenatal shape

Answer 44

peurperium

Question 45

Changes to postpartum uterus back to prepregnancy because of:

Answer 45

withdrawal of pregnancy-induced hormones

Question 46

Discontinuance of lactation results in:

Answer 46

resumption of ovulation and menstruation

Question 47

The uterus returns back to the pelvic area between the _____ and ____ within _____ of delivery

Answer 47

pubic symphysis umbilicus 1 week

Question 48

Heavier pressure compresses the uterus resulting in:

Answer 48

thinning of the AP diameter increasing transverse diameter

Question 49

It is common to image the internal os on day ___ as partially open and ill-defined as it continues to close following delivery

Answer 49

1

Question 50

The myometrium should measure __-__ cm in thickness

Answer 50

7-10

Question 51

The endometrium can measure up to ___mm

Answer 51

13

Question 52

The endometrium will decrease to normal thickness by:

Answer 52

end of postpartum period

Question 53

It is common to visualize free fluid within the endometrium though it should not measure greater than ___-____ cm.

Answer 53

1.2 1.4

Question 54

The sagittal postpartum uterus will measure between __ and ___ cm

Answer 54

14 25

Question 55

The transverse postpartum uterus will measure between __ and ___ cm

Answer 55

7 14

Question 56

The _____ are typically flaccid immediately following delivery and usually return to pregravid state within one month.

Answer 56

adnexal ligaments

Question 57

Postpartum hemmorrhage limits vaginal and csection

Answer 57

vaginal 500 mL csection 1000mL

Question 58

most common causes of postpartum hemorrhage include

Answer 58

placenta accreta placenta increta placenta percreta

Question 59

Placenta accreta, increta, percreta are due to:

Answer 59

complete or partial absence of the decidua basalis

Question 60

occurs when placenta adheres to myometrium of uterus instead of endometrium

Answer 60

placenta accreta

Question 61

occurs when placenta invades myometrium of uterus further than is seen with accreta

Answer 61

placenta increta

Question 62

occurs when placenta completely penetrates uterine myometrium and extends into uterine serosa

Answer 62

placenta percreta

Question 63

indicators of placental invasion of the myometrium

Answer 63

placental lakes

Question 64

through to be caused by atypical blood flow because of abnormal decidual basalis

Answer 64

placental lakes

Question 65

severe bleeding immediately following delivery

Answer 65

acute hemorrhage

Question 66

Acute hemorrhage usually results in:

Answer 66

emergency hysterectomy

Question 67

bleeding that occurs over several days to a few weeks in postpartum period

Answer 67

delayed hemorrhage

Question 68

Hemorrhage is associated with:

Answer 68

decreased hematocit hypotension hysterectomy renal failure shock sometimes death

Question 69

any infection in the postpartum period characterized by a temperature over 100.4 degrees on any two successive days after first 24 hours postpartum

Answer 69

puerperal infection

Question 70

signs/symptoms of puerperal infection:

Answer 70

uterine tenderness chills headache malaise anorexia lochia or vaginal discharge

Question 71

Most puerperal infections are:

Answer 71

urinary tract infections

Question 72

infection of the endometrium

Answer 72

endometritis

Question 73

usually caused by migration of normal vaginal flora

Answer 73

endometritis

Question 74

thick, irregular endometrium that may have fluid in the endometrial canal

Answer 74

endometritis

Question 75

incomplete expulsion of miscellaneous products of conception during labor and delivery

Answer 75

RPOC

Question 76

highly echogenic mass in the endometrial canal, placental polyp, remnants of placental tissue, heterogeneous mass may contain necrotic tissue, clot, or infection, affects about 1% of term deliveries

Answer 76

RPOC

Question 77

one of the most frequent causes of puerperineal infection

Answer 77

uterine atony

Question 78

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

Answer 78

uterine atony

Question 79

natural reaction to bleeding

Answer 79

clot

Question 80

inflammation of a vein caused by a thrombus found in lumen of vessel

Answer 80

thrombophlebitis

Question 81

rare condition found typically in postpartum period, but can also occur with malignancies and PID

Answer 81

thrombophlebitis

Question 82

hypercoagualability of blood during pregnancy and postpartum period venous stasis venous wall damage as a result of uterus expansion and contraction

Answer 82

Virchow's triad

Question 83

Majority of thrombophlebitis involves:

Answer 83

right ovarian vein

Question 84

______ flow in the left ovarian vein reduces spread of infection from uterus

Answer 84

retrograde

Question 85

During the postpartum period, body decreases blood production, resulting in _____

Answer 85

venous stasis

Question 86

Thrombophlebitis symptoms typically occur during the first __-__ hours following delivery

Answer 86

48 96

Question 87

dilated anechoic to hypoechoic tubular structure extending superiorly from adnexa, lack of color or spectral Doppler signal, echogenic thrombus in lumen

Answer 87

thrombophlebitis

Question 88

Most common site for thrombophlebitis

Answer 88

where IVC and right ovarian vein meet

Question 89

common csection complications

Answer 89

hematoma abscess

Question 90

peritoneum between urinary bladder and uterus

Answer 90

bladder flap

Question 91

site of most hematomes

Answer 91

bladder flap

Question 92

occur when there is bleeding at site of incision and body has not reabsorbed blood

Answer 92

hematoma

Question 93

Placenta accreta, increta, and percreta are abnormal placental penetration of the myometrium, which may lead to _____

Answer 93

postpartum bleeding

Question 94

______ is an infection of the endometrium that may extend to the myometrium and parametrial tissues

Answer 94

endometritis

Question 95

______ and endometritis have a similar sonographic appearance

Answer 95

RPOC

Question 96

Failure of the uterus to contract can lead to:

Answer 96

hemorrhage

Question 97

Postpartum ovarian vein thrombophlebitis occurs more often in the:

Answer 97

right ovarian vein

Question 98

_____ and ____ are two complications of a cesarean section

Answer 98

hematomas infection