OB: Postpartum Care 6%

Question 1

(PPP 396)

what is endometritis?

Answer 1

infection of the decidua (or pregnancy endometrium)

Question 2

(PPP 396)

what is the biggest RF for endometritis?

Answer 2

C-SECTION

Question 3

(PPP 396)

how is endometritis diagnosed?

Answer 3

mainly clinically

Question 4

(PPP 396)

what are four primary clinically presentations of endometritis?

Answer 4

fever (>38C)

tachycardia

abd pain

uterine tenderness 2-3 days after C-section (postpartum or post-abortal)

Question 5

(PPP 396)

how is endometritis managed post C-section?

Answer 5

first line: clindamycin + gentamicin

clindamycin covers gram + & anaerobes, gent covers gram -

Question 6

(PPP 396)

what can be given prophylactically to prevent endometritis?

Answer 6

a first gen cephalosporin (like CEFAZOLIN) x 1 dose during the C-section

Question 7

(PPP 383)

what are the four T’s of postpartum hemorrhage?

Answer 7

Tone (uterine atony is MC cause - 80%!)

Tissue (retained placental tissue)
Trauma (trauma to cervix, perineum, vagina, lacerations)
Thrombin (coag abnormalities)

Question 8

(PPP 383)

what is first line treatment for postpartum hemorrhage?

Answer 8

bimanual uterine massage and compression

Question 9

(PPP 383)

what is first line medical (pharmacological) treatment for postpartum hemorrhage?

Answer 9

IV oxytocin is first line medical management of atony

Question 10

(PPP 383)

if IV oxytocin is ineffective at managing postpartum hemorrhage/atony, what do we use?

Answer 10

methylergonovine (if pt has no HTN, coronary or cerebral artery disease)

or prostaglandin analogs like IV carboprost tromethamine or misoprostol