Professional Development > Part 51 > Flashcards

Part 51 Flashcards

(151 cards)

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1
Q

Abortion definition

A

deliberate termination of human pregnancy, normally first 28 weeks

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2
Q

Perinatal period

A

From 16 weeks to 28 days after birth

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3
Q

Risks for perinatal death not caused by congenital anomalies (7)

A
  • breech position
  • placental separation
  • pre-eclampsia eclampsia
  • pyelonephritis
  • hydramnios
  • placenta previa
  • twins
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4
Q

Dizygotic (fraternal) twins

A

Originate from 2 zygotes, account for about 2/3 of twins, rates increase with age, can be same or different sex, and having one set increases likelihood of having it happen again

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5
Q

Thick seputm and 2 zygotes on ultrasound indicates…

A

….dizygotic twins

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6
Q

Dizygotic twins have __ amnion and chorions, the monozygotic varies based on when the zygotes divide during development

A

2

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7
Q

Monozygotic (identical) twins, when do they become conjoined?

A

one fertilized ovum, cleavage before 72 hours results in dichorionic diamniotic (best outcome) twins, between days 4-8 monochorionic diamnionic (2nd best) twins, and if 8-13 monochorionic and monoamnionic (worst) twins. Cleavage after day 13 will result in conjoined twins***

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8
Q

Twin complications

A
  • vanishing fetus
  • locking twins (one breech and 2nd cephalic preventing chins from passing each other)
  • dead fetus syndrome (
  • delayed delivery of one twin
  • cord intertwining (high risk for sudden stillbirth in monoamniotic monozygotic twins)
  • abruption
  • acardiac twin (parasitic growth but no actual 2nd twin present)
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9
Q

Prevention of preterm labor (3)

A
  • bed rest NO longer advised
  • early work leave okay at 36 weeks or so
  • corticosteroids can help with lung maturity
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10
Q

Any 12+ (adult) who has even 2 recurrent seizures unprovoked by proximate insult is considered ___, in children they can be due to ___ as well

A

epilepsy, fevers

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11
Q

Epilepsy and pregnancy

A

90% of women have a normal pregnancy, not a contraindication, however increased risk for perinatal complications

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12
Q

Sudden unexpected death in epilepsy (SUPEP)

A

Sudden unexpected witnessed or unwitnessed non traumatic or non drowning death with or without evidence for seizure excluding status epilepticus which does not have autopsy reveal structural or toxicologic cause of death

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13
Q

__% of all pregnancies are unplanned

A

50%

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14
Q

Antiepileptic drug lower ___ putting developing infant at increased risk for ___

A

folic acid, neuro tube defects

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15
Q

All pregnant women should be on __ mg folic acid, epileptics should be on ___

A

.4-.8, 4mg

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16
Q

Valproate and pregnancy

A

Antiepileptic contraindicated in pregnancy because of high teratogenicity unless already established pregnancy (don’t want to have seizure occur during change over)

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17
Q

Drug of choice for seizure abortion in delivery

A

Lorazepam

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18
Q

Fetal hydantoin syndrome

A

Caused by phenytoin (antiepileptic )use in pregnancy can result in craniofacial anomalies, IUGR, developmental delay, cleft lip/palate, etc

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19
Q

Spinal bifida

A

a birth defect that occurs when the spine and spinal cord don’t form properly. It’s a type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the baby’s brain, spinal cord and the tissues that enclose them, treated thru surgery

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20
Q

Keppra (levetiracetam) while pregnant

A

Antiepileptic drug that is the safest for women of reproductive age as it has the lowest incidence of birth defects (same as unexposed pregnancies)

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21
Q

Anticoagulants in pregnancy

A

Heparins are the safest choice, lovonox (lmw heparin) is used throughout with switch to unfractionated heparin in the last month of pregnancy since it is more quickly reversed, anticoagulated patients are not eligible for epidural analgesia,does not cross the placenta so no worry about harming the fetus

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22
Q

Pregnancy coagulability

A

Pregnancy is a hypercoaguable state with increased factor II, VII, VIII, X, and XII and decreased protein S

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23
Q

Most DVT occur in the __ leg in pregnancy

A

left

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24
Q

5 inherited autosomal thrombophilias

A

-factor v leidan
-prothrombin gene mutation
-hyperhomocystinemia
-protein C deficiency
Protein S deficiency

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25
Overt diabetes vs gestational
Overt is having known to have diabetes prior to pregnancy while gestational is diagnosed for the first time during pregnancy (and is the majority of cases)
26
If a mother has fasting hyperglycemia early in pregnancy it likely represents ___, while if it occurs later then it likely represents ___
overt DM, true gestational diabetes
27
Screening for gestational diabetes
- Universal between 24-28 weeks, done uniquely with carbohydrate challenge***** (only time this is used to diagnose any type of diabetes) involving 50gm glucose load done randomly with threshold of 130 mg/dLl being nearly 90% predictive - positive indicates confirmatory test, 100g 3 hour oral glucose tolerance test after overnight fast where plasma glucose fasting cannot exceed 95mg/dL, 1 hr 185, 2 165, etc.
28
Gestational diabetes etiology (2)
- hPL stimulating insulin release, decreased glucose uptake and gluconeogensis causing mother to get progressively more insulin resistant - PCOS can worsen
29
Risk factors for gestational diabetes (6)
- previous history of gestational diabetes - obesity - age >30 - previous delivery of large infant - persistent glycosuria - family history of DM in first degree relative of many minority populations
30
Fetal complications of gestational diabetes (3)
- fetal anomalies not increased in gestational diabetes unlike overt (congenital heart defects) - stillbirth increased if there is fasting hyperglycemia but not with postprandial hyperglycemia only - macrosomia (weight >90th percentile)
31
Management of DM in pregnancy (5)
- diet - exercise - glyburide - insulin (typically regular not long term like lantus) - metformin
32
More than half of gestational diabetics will ultimately develop....
....overt diabetes in the following 20 years
33
Maternal risks of gestational diabetes (4)
- polyhydramnios - C section - infection - preeclampsia/eclampsia
34
Neonatal hypoglycemia
-blood glucose <30mg/dL that occurs when blood sugar goes up in infant when mother is poorly controlled diabetic becomes hyperinsulinemic due to hypertrophy of pancreatic tissue to comopensate resulting in low blood glucose which then requires NICU until stabilization and eventual return to normal
35
If glycemic control is strict, women are at no higher risk than general population for....
...macrosomic infant
36
Most common medical risk factor in prenancy
Hypertension
37
Deadly triad of maternal mortality
- hemorrhage - infection - hypertension (most common)
38
Gestational vs chronic hypertension
Gestational sees BP elevation after 20 weeks of pregnancy, chronic begins before
39
Pre-eclampsia definition
Disease only occurring in pregnancy with BP >140/90 mmhg after 20 weeks of gestation and proteinuria 300mg/24 hr or +1 on urine dipstick, increased in certainty with supplemental findings such as elevated creatinine, platelets, elevated ALT or AST, persistent headache, or persistent epigastric pain
40
Eclampsia definition
Meets criteria for pre-eclampsia but also has seizures that cannot be attributed to other causes (difficult to differentiate in epileptics), sees rapid increase in BP followed by convulsions or coma usually preceded by unrelenting severe headache
41
HELLP syndrome
Syndrome that occurs with pre-eclampsia characterized by hemolysis, elevated liver enzymes (doubled normal), and low platelet count (<100,000)
42
Eclampsia risk factors (7)
- primigravid status - family history - previous episode of pre or eclampsia - new paternity - BMI elevation - extremes of maternal age - preexisting disease - twins increased risk
43
Pathogenesis of eclampsia
- arterial vasospasm causing leaking of fluid from capillaries and third spacing - this reduces renal perfusion and glomerular filtration, with serum uric acid being elevated, liver injury or rupture, placental intrauterine growth restriction or abruption, edema, thrombocytopenia***** - retinal artery vasospasm causes visual disturbances - multifocal petechial hemorrhages at gray mater white matter junction, edema, thrombosis, and gross hemorrhage of the brain occurs
44
Prediction of eclampsia
No screening tests that are reliable, valid, or economic
45
Lab eval for eclampsia (3)
- 24 hr urine protein - CBC for thrombocytopenia - urinalysis for proteinuria
46
Preclampsia treatment (4)
- Precise knowledge of the age of the fetus as delivery of fetus and placenta very much curative - observation either at home or in hospital - reduce activity - deliver at 37 weeks gestation (or if greater than 34 weeks just get it out)
47
Treatment for eclampsia seizure (3)
- magnesium sulfate*** - CXR - ABG
48
Chronic hypertension medication treatment options in order of most to least effective (4)
- labetolol - nifedipine - diuretics - AVOID ACEs and ARBs (teratogenic)
49
Pre-eclampisa and eclampsia see a decrease in....
...long term maternal survival rate for years following the pregnancy
50
Pain of uterine contraction
Conducted thru small sensory nerve fibers of the paracervical and inferior hypogastric plexuses to join the sympathetic nerve chain at L2 L3, pain of uterine contractions often referred to the area over the upper sacrum and the lower lumbar spine (diffuse and not well localized), as fetus descends thru pelvic floor pain becomes predominantly somatic and is better localized, high progesterone levels reduce anesthetic requirements by activating endorphins which increases threshold to pain, but augmentation with oxytocin increases strength of contraction and pain
51
Parenteral or systemic opioids
Play a role in labor pain relief, inexpensive and require no specialized expertise other than IV access, however often have little effect on maternal pain scores and provide unreliable analgesia and commonly have ADR's
52
2 commonly used systemic opioids for labor
- fentanyl - - morphine
53
Opioid agents impact on fetus
- Reduce fetal heart rate - neonatal respiratory suppression - freely crosses placenta - drug elimination takes longer than in adults
54
Nonopioid with similar effect to morphine in pain control in labor
IV tylenol
55
Local infiltration agent for pain relief during labor
1% lidocaine
56
Pudendal block
Provides analgesia of the vaginal introitus and perineum by bilateral injections of 1% lidocaine 5-10mL for pain relief of the 2nd stage of labor, relatively small systemic absorption therefore little opportunity to affect fetus
57
Paracervical block
Rarely used for labor pain relief as associated with fetal acidosis and bradycardia, good for excellent pain relief in the first stage of labor, very effective and fast
58
Regional (neuraxial) analgesia and anesthesia
-Includes epidural and spinal techniques, require administration by qualified healthcare provider, suitable for labor analgesia and operative analgesia, provides pain relief during labor with minimal maternal and neonatal adverse effects, >60% of US women use
59
Lumbar epidural analgesia
Injection in the potential space between the bone and the dura mater
60
Epidural advantages (3)
- patient remains awake and cooperative - incidence of complication is very low - can be used for analgesia or anesthesia for vaginal or c section delivery
61
Epidural disadvantages (6)
- possibility of poor perineal analgesia - presence of hotspots where analgesia is insufficient - delayed onset of action up to 10 min - technical difficulty - accidental dural puncture - hypotension
62
Spinal block
Not often used lidocaine or tetracaine not used until all criteria for forceps delivery are met, , excellent anesthetic for C section
63
Intrathecal narcotic only injection
-used during first stage of labor, no local anesthetic and therefore no paralysis, allowing for ambulation, causes "itching", 2 hours excellent analgesia, uses fentanyl and morphine
64
Post spinal headache
Postural headache in 1% of parturients developed after spinal, caused by CSF leaking from puncture site and incidence is reduced with use of noncutting needles in administration of spinal, duration 5-12 days and blood patch can treat in severe cases (draw blood and inject it to clot the CSF leak really fixing headache quick)
65
General anesthesia for labor
Uncommon method for vaginal or cesarean delivery usually limited to emergency deliveries or when epidural is contraindicated or has already failed, problems is that labor begins without warning so can't do if on a full stomach (causes aspiration)
66
Anethesia risk factors for complication (8)
- marked obesity - severe edema or anatomical anomalies of face and neck - small mandible - short stature, arthritis of neck - large thyroid - asthma, copd, cardiac disease - severe pre/eclampsia - previous history of anesthetic complications
67
Anesthesia related death causes (5)
- aspiration - intubation problems - inadequate ventilation - respiratory failure - cardiac arrest
68
General anesthetic agents (3)
- gaseous nitrous oxide - inhaled isoflurane and halothane - IV thiopental or propofol
69
Epidural does NOT increase ____ rate
C section
70
Spinal or general anesthesia is appropriate for emergency c section when there is no...
...epidural
71
In absence of contraindication, maternal request is sufficient medical indication for pain relief in...
...labor
72
3 stages of labor
1) begins with onset of contractions and ends when cervix is fully dilated 2) complete dilation of cervix and delivery of infant 3) delivery of infant to delivery of placenta and membranes
73
3 clinical signs of onset of labor
-cervical changes "bloody show" -contractions -rupture of membranes
74
Contractions of labor
Painful physiologically unique muscular contractions involuntary and independent of extrauterine control
75
Pushing during labor
Increased intraabdominal pressure from mother using valsalva assists in the involuntary uterine contractions
76
Cervical effacement and cervical dilation
Shortening of the cervical canal from 2cm to paper thin edges Stretching open of cervix from a few milimeters to 10 cm
77
Placental separation in labor
Uterine contraction reduces area of placental implantation causing expulsion by uterine contraction
78
3 geographical descriptions of the fetus
``` Fetal lie (longitudinal or transverse (sideways baby)) Fetal presentation (cephalic, breech, or shoulder) Fetal position (left or right, and if posterior fontanelle is anterior or posterior) (LOA ROA LOP ROP) ```
79
Frank breech vs incomplete vs complete
Frank has ankles to ears, incomplete has one knee bent, complete is both knees are bent
80
Leopold maneuvers
2 handed (except for the 3rd) series of 4 maneuvers on the pregnant womans stomach, helpful in determining head and rear location for auscultation of fetal heart rate
81
Cardinal movements of labor (9)
- Engagement (lowest part of head passes thru the pelvic inlet, can be palpated at the ischial spine, eyes face left or right hip) - descent (head descends thru pelvis due to pressure of amniotic fluid, maternal pushing, fundus pressuring breech, and extension and straightening of fetal body) - flexion (descending head meets resistance from pelvic floor causing flexion of fetal chin upon thorax, if brows are presenting in extension typically cannot be delivered) - internal rotation (pressure of presenting part against pelvic structures rotates head OA or OP) - extension (occurs when head reaches vulva, extending and popping out) - external rotation (head turns to the left or right - restitution) - expulsion (get this shit out of me) These are all fluid and occur together
82
Caput succedaneum
Edema of he fetal scalp in the portion immediately over the cervical os, normal compression of the fetal head from external compressive forces allows for delivery (molding)
83
Contractions of true vs false labor
- Regular vs irregular - intervals gradually shorten vs remain long - intensity increases vs remains unchanged - discomfort in back and abdomen vs lower abdomen - cervix dilates vs stays closed - discomfort not relieved by sedation vs is
84
Oral intake during first stage of labor
Clear liquids and hydration, not solids to prevent vomiting
85
Management of first stage of labor (9)
- monitor fetal well being - monitor uterine contractions - vital signs - maternal IV fluids - antibiotics if group B strep positive - maternal positioning (ambulation is good unless contraindicated) - analgesia - amniotomy if membranes haven't ruptured naturally (but delay if possible to prevent infection) - follow urinary bladder functioning
86
Management of second stage of labor (6)
- lasts 50 min or so - maternal expulsitive effort with coaching - preparation for delivery by positioning - episiotomy performed sometimes if shoulder dystocia occurs (not often) - clearing of nasopharynx - clamping cord and cutting it after waiting 30 sec
87
Management of third stage of labor (4)
- placenta separates (sudden rush of blood, uterus rises in abdomen, umbilical cord appears to lengthen) - placenta inspected for complete expulsion - oxytocic agents administered - repair of episiotomy and or lacerations
88
Preferred type of breech presentation
Frank breech, protective against cord prolapse
89
Risk factors for breech presentation (5)
- increased parity - multiple fetuses - polyhydramnios - oligohydramnios - previous breech
90
Complications of breech presentation (3)
- prolapsed umbilical cord (if squished will strangulate newborn - head entrapment - injuries to newborn
91
Recommendation for type of delivery in breech presentation
-c section
92
Breech delivery procedure
- Pop the legs out one at a time - once scapulas are visible then pop the arms out one at a time, twisting each time (takes 2 providers) - delivery of head sometimes with piper forceps
93
Dystocia
Abnormal labor, consequence of 4 distinct abnormalities (of expulsive force, of bony pelvis, of presentation/position/development of fetus, or of soft tissue of repro tract)
94
Cervical dilation during active phase of labor
Cervical dilation occurs at rate of at least 1.2cm per hour, cervical dilations of 3-4cm in presence of uterine contractions represents active labor
95
Causes of inadequate labor (4)
- epidural analgesia - chorioamnionitis - maternal positioning - false labor/being in latent phase
96
Different pelvis types and characteristics
Gynecoid (round, most common, good prognosis) Anthropoid (long and oval, good prognosis) Android (heat shaped, poor prognosis)
97
Management of inadequate labor (3)
- amniotomy (rupture the membranes, improves contraction) - pitocin (oxytocin) - possible c section
98
Preconceptual, antepartum, and intrapartum risks for shoulder dystocia (5)
- previous - maternal obesity - abnormal pelvis shape - macrosomia - abnormal labor or instrumental use in delivery
99
Shoulder dystocia complications (3)
- maternal lacerations or hemorrhage - transient brachial plexus palsy (permanent) of the newborn*** - fracture
100
shoulder dystocia maneuvers (8)
- suprapubic pressure applied by assistant (not fundal, but goal is o push on shoulder) - McRobert's maneuver - sharply flex legs upon the abdomen - Woods maneuver (rotating the posterior by grabbing it manually) - delivery of posterior shoulder (pull arm out and raise it up and around) - rubin's maneuver (rock shoulders back and forthe) - zavanelli maneuver (replacing head in pelvis and proceeding to c section - risk for c section) - deliberate fracture of the clavicle - symphysiotomy (cut the cartilage between the pubic symphysis as alternative to c section but concern about cutting bladder)
101
Maternal indications for labor induction (5)
- fetal demise - severe hypertensive disease - other medical problems (DM, renal) - high distance from hospital or quick labor - premature rupture of membranes
102
Fetal indications for labor induction (5)
- post term pregnancy - chorioamnionitis - oligohydramnios - IUGR - Rh sensitization
103
Risks of labor induction (5)
- greater c section risk - iatrogenic prematurity - more painful - longer duration - increased risk of infection
104
Induction of labor methods (4)
- membrane stripping - amniotomy (cervix has to be dilated to reach) - pitocin (oxytocin) - vaginal prostaglandins - misoprostol
105
Relative contraindications to labor induction (4)
- placenta previa - abnormal presentation - active genital herpes infection - invasive cervical cancer
106
Maternal morbidity from forceps (2)
- maternal injuries increased with rotations - - more episiotomies and lacerations
107
Vacuum extractor
Alternative to forceps in assisting delivery that doesn't require precise positioning but has the ssame indications and contraindications, operator should abandon procedure if it does not proceed easily "pop off rule"
108
Complications of vacuum extractor use in labor (5)
- scalp lacerations and bruising - subgaleal hematoma - cephalohematoma - intracranial hemorrhage - subconjunctival hemorrhage
109
Elective induction of labor should only be done at ___ weeks gestation or later
39
110
Gestational age of > or = to 39 weeks implied by the following criteria (3)
- ultrasound measurement at less than 20 weeks gestation that supports clinically determined gestational age equal to or greater than 39 weeks - 36 weeks having elapsed since serum or urine hCG based pregnancy test was reported positive - fetal heart tones have been documented for 30 weeks by doppler ultrasonogrphay - last menstrual period doesn't matter!!!
111
Indications of labor induction (7)
- pre/eclampsia - fetal demise - abruption - chorioamnionitis - premature rupture of membranes - post term pregnancy - fetal compromise
112
Contraindications to labor induction (4)
-vasa previa -complete previa -umbilical cord prolapse -active genital herpes (just move to c section for most of these)
113
Urine pregnancy test becomes positive day __ after conception Fetal doppler can hear fetal heart rate at ___ weeks Earliest cardiac activity can be measured on ultrasound is ___weeks
10, 12, 6 weeks
114
Bishop score
Scoring system to determine likelihood of successful induction based on cervix dilation, effacement, etc with a score of 6 or less considered unfavorable and 8 or more very good
115
Mechanical cervical dilators (3)
- laminaria (drug associated with increased peripartum infections) - balloon catheters (low cost, stable at room temp) - extra-amniotic saline infusion (30-40ml/hr)
116
Nipple stimulation for labor induction
Old school technique where self stimulation of unilateral nipples helped increase uterine contraction
117
Membrane stripping procedure
Unpredictable technique that induces labor at some time after from 1 day to weeks later that is contraindicated in rupture of membranes and GBS infection that involves sweeping the cervix (sometimes causing bleeding) with finger manipulation
118
Misoprostol (cytotec) for labor induction
Drug with No evidence of longterm neonatal harm but can be misused and cause complication such as tachysystole in labor induction, also used for peptic ulcer disease
119
PGE2 for labor induction
Gel syringe kept refrigerated and inserted into vagina approved for cervical ripening, increases risk of tachysystole but generally considered safe to use
120
Methods of labor induction (4)
- oxytocin - membrane stripping - amniotomy (often when combined with oxytocin can produce delivery less than 24 hours but if can't access cervix well then don't do it) - nipple stimulation
121
Almost every obstetrical law suit involves the use of...
....oxytocin (start low and go slow!)
122
Absolute indications for c section (5)
- significant abruption of placenta (complete abruption baby is dead) - hemorrhage from placenta previa - prolapse of umbilical cord - active genital herpes infection - impending maternal death
123
Complications of c section are up to __% of patients
8% (this is actually close to being on par with vaginal birth as well
124
C section complications (7)
- hemorrhage requiring transfusion - endometriosis - wound infection - operative injury - aspiration under anesthesia - UTI - thrombophlebitis and PE
125
TLAC and VBAC
Trial of Labor after C-section, Vaginal Birth after C-section
126
Contraindications to VBAC (2)
- Previous classical uterine incision - - suspected macrosomia in diabetic patient
127
Candidates for VBAC (4)
- one prior low transverse c section if there were previous vaginal births - women with 2 low transverse c sections if successful vaginal birth prior to first - clinically adequate pelvis - availability of obstetritian and team for emergency c section
128
Uterine rupture
Partial or complete rupturing of previously sealed uterus, diagnosed via sudden severe fetal heart rate deceleration and bradycardia, abdominal pain, loss of station of presenting part of baby, shoulder or chest pain
129
Uterine rupture prognosis
- 50-75% mortality rate of fetus - seldom fatal to mother - 20% of mothers will require hysterectomy to control hemorrhage
130
Elective cesarean section principles
-mortality and morbidity is near identical to vaginal, vaginal is responsible for urinary incontinence, rectal incontinence, uterine prolapse, etc., it avoids painful labor, it can be scheduled, slighlty statistical higher iq compared to vaginal
131
___ doubled in subsequent pregnancy delivered by c section
Placenta previa
132
After pains
Tonic contractions worsened with breastfeeding (oxytocin release), easily relieved with NSAIDS and typically resolves by day 3
133
Lochia
Discharge from sloughing of decidua (leftover material in uterus) for up to 6 weeks after pregnancy, can be either rubra (red), serosa (pink/clear), or alba (white)
134
Subinvolution/prolongation of lochial discharge and treatment (3)
Arrest of involution of the uterus following delivery, can be due to part of placenta fragments left behind or infectious cause Treatment is oxytocic agents, oral antibiotics, and sometimes D&C
135
Cervical changes after delivery
After first delivery onward, transverse slit like external os persists due to laceration, marking there has been a delivery forever
136
Time for a normal postpartum visit
6 weeks (by this point cervix has typically returned to normal, as has uterus size, and vagina)
137
Breast feeding suppresses...
....ovulation, to the point of sometimes being hypestrogenic (dryness and friction dysparunia)
138
Dilation ureters and renal pelvis postpartum
Normal occurrence, returns to normal 2-8 weeks later often, can cause increased urinary retention and increased UTI concern
139
Decline in estrogen and progesterone result in ____ by day 3 postpartum
breast engorgement
140
Puerperium
Period up to 6 weeks after delivery where the mothers reproductive organs return to the prepregnant state
141
Complications of puerperium and how are they each treated? (blood loss, uterine atony, retention of products of conception, laceration, uterine rupture, infection)
- blood loss (can be limited with weight pads to measure blood loss) - uterine atony (treated with oxytocics) - retained products of conception (requires manual exploration of uterus) - laceration (repair immediately) - uterine rupture (exploration and repair) - infection (endomyometritis most common, has foul smelling lochia and tender uterus within first few days postpartum, treated with gentamycin/clindomycin)
142
Milk fever
Elevation in temp lasting <24 hours during milk production in the newborn mother, rarely above 101 degrees and a normal finding without concern
143
Sheehan's syndrome
Postpartum necrosis of the anterior pituitary followed from blood loss during pregnancy followed by circulatory collapse of the pituitary causing an array of multiglandular disorders, agitation, hallucinations, delusoins, and depression, sees failure of lactation, amenorrhea, breast atrophy, loss of pubic and axillary hair, hypothyroidism, and adrenal cortical insufficiency
144
Immunizations puerperium
Ideal time to administer vaccine for those not found immune (such as rubella), Rh- women with Rh+ baby should receive appropriate amounts of Rh immune globin
145
Contraception puerperium
Ovulation may occur as soon as week 6, sexual intercourse often resumed by week 2-3, oral contraceptives may be started 4 weeks post partum in nonlactating mothers (to avoid increase risk of dvt), injected depo provera can be given before hospital discharge, immediate IUD's are safe and effective with few contraindications but must be careful cause higher expulsion rates, nexplanon being given more commonly and it also does not interrupt breastfeeding
146
Bromocriptine suppresses what relating to obstetrics?
Breast feeding (dopamine agonist)
147
Drugs absolutely contraindicated in breastfeeding (3)
- tobacco and alcohol - chemotherapeutic or cytotoxic - chloramphenicol
148
Menses return in ___ weeks in nonlactating women
6-8 weeks, may not return until lactation ceases
149
Immediately after expulsion of the fetus the fundus of the uterus is located at the...
...umbilicus
150
Perineal laceration degrees (4)
1st degree just tears mucosa 2nd tears superficial muscles 3rd tears anal sphincter 4th enters directly into the rectum
151
Best indicator of post partum infection
Maternal temp
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