Postpartum

Question 1

postpartum period (PP)

Answer 1

period between birth and the return of the reproductive organs to their normal nonpregnant state
approx 6 weeks

Question 2

involution

Answer 2

return of the uterus to the nonpregnant space

Question 3

fundal assessment

Answer 3

firm :)
boggy :( = massage fundus
12 hrs after delivery= at level of umbilicus
may go up slightly, then descend.
descends about 1cm every day.
by 2 weeks postpartum= fundus should not be palpable

Question 4

oxytocin

Answer 4

hormone released by pituitary gland
strengthens and coordinates uterine contractions (compresses blood vessels and promotes hemostasis)

Question 5

pitocin administration

Answer 5

contracts the uterus
causes cramping

Question 6

rubra lochia

Answer 6

ruby (dark) red
1-4 days after delivery
(if over one week, concerning)

Question 7

lochia serosa

Answer 7

pink brown
4-9 days after delivery
(old blood, old tissue)

Question 8

lochia alba

Answer 8

white yellow
10-14 days after delivery, up to a few months
(leukocytes, endothelial cells, mucus)

Question 9

lochia amount

Answer 9

scant- less than 2in stain on a pad
excessive- saturation of a pad within 15 min
can be decreased for csection deliveries
can increase with ambulation and breastfeeding (oxytocin release causes contraction)

Question 10

placenta

Answer 10

detaches from uterine wall and passes within 30 minutes of delivery
endometrial regeneration occurs for 6 weeks

Question 11

perineal care

Answer 11

warm water in peri bottle
sitz bath (15 min)
cold pack
witch hazel pads (pain r/t hemorrhoids)
topical anesthetic (benzocaine spray)

Question 12

breast engorgement

Answer 12

encourage emptying breasts completely with each feeding
(the more we empty, the more it fills back up)
apply warm compress to breast before feeding
can lead to mastitis

Question 13

colostrum

Answer 13

higher protein, fats, antibodies than normal breast milk
lasts for 1-2 days

Question 14

if pt does not want to breastfeed..

Answer 14

wear supportive bra for 72 hrs after birth
apply fresh cold cabbage leaves to breast
avoid warm water/stimulation on breasts

Question 15

breast care

Answer 15

apply breast milk to sore nipples

Question 16

postpartum immunizations (PRN)

Question 17

rubella immunity

Answer 17

if not immune, give MMR
AFTER pregnancy.
do not get pregnant within 28 days of vaccination

Question 18

varicella immunity

Answer 18

give first dose in hospital
second dose 6 wks later
avoid pregnancy for 28 days following both doses

Question 19

tdap

Answer 19

given at 30-32 weeks of pregnancy
but if not given during pregnancy, give before discharge

Question 20

Rho gam

Answer 20

Rh immunoglobin
given within 72 hrs of delivery
if mom is Rh -

Question 21

postpartum hemorrhage

Answer 21

vaginal delivery- 500mL+
csection- 1000mL/1L+
saturating pad in less than 15 min
soft boggy fundus
blood clots larger than an egg
constant flow of blood from vagina

Question 22

hypovolemic shock

Answer 22

from pph
tachycardia
hypotension
tachypnea
cool clammy skin

Question 23

risk factors for pph

Answer 23

uterine atony (causes boggy fundus)
birth canal trauma
precipitous delivery (quick)
retained placental fragments
subinvolution
DIC or ITP
multipolarity (multiple pregnancies)
multifetal birth (twins)
fetal macrosomia

Question 24

labs from PPH

Answer 24

decreased H/H (below

Question 25

treatment of pph

Answer 25

massage fundus
admin oxygen
admin fluids (LR)
elevating legs
eliminate bladder distention
uterine stimulants (pitocin, methergin, hemobate)
bimanual compression (MD only)
uterine packing (MD only)
surgical intervention (hysterectomy)

Question 26

uterine stimulant considerations

Answer 26

pitocin 10-40u in 1000ml LR
no methergin if hypotensive
no hemobate if asthmatic

Question 27

primary PPH

Answer 27

early, acute within 24 hrs

Question 28

secondary PPH

Answer 28

later, 24hrs-6 weeks

Question 29

risk factors for puerperal infections

Answer 29

c section patients
immunocompromised pts

Question 30

endometritis

Answer 30

infection of the endometrium/uterus
fever!!
suprapubic pain
excessive malodorous lochia
tachycardia
hypotension

Question 31

risk factors for endometritis

Answer 31

c section births
chorioamniocitis
retainedd placental fragments
prolonged membrane rupture
prolonged labor
internal fetal monitoring
multiple cervical exams

Question 32

endometritis treatment

Answer 32

antibiotics
analgesics

Question 33

mastitis

Answer 33

inflammation of breast
flu like symptoms
malaise, body aches, fever
unilateral pain, erythema, and swelling of the breast

Question 34

mastitis risk factors

Answer 34

infrequent feeding
feeding only on one breast a clogged milk duct
nipple damage (from improper latch)
poor hand hygiene

Question 35

mastitis treatment

Answer 35

antibiotics
analgesics
apply heat prior to feeding
fully empty breast (pump or manual expression PRN)

Question 36

malasma

Answer 36

darkening of the face
“mask pregnancy”

Question 37

change in vitals postpartum

Answer 37

temp may be elevated due to metabolic demand and dehydration
pulse elevated for first hr

Question 38

preeclampsia (dx, risk factors, and signs)

Answer 38

BP of 140/90+ on two occasions 4hrs apart
protein in urine
risk factors:
signs: HA, blurred vision, right sided epigastric pain (r/t liver enzyme elevation), thrombocytopenia

Question 39

preeclampsia treatment

Answer 39

give magnesium sulfate to reduce seizure risk

Question 40

antidote for magnesium sulfate

Answer 40

calcium gluconate
give if decreased respirations and no reflexes

Question 41

TORCH infections

Answer 41

teratogenic, transferrable
toxoplasmosis (parasitic, do not clean cat box)
other (varicella, parvo, syphilis)
rubella
cytomegaly virus
herpes simplex

Question 42

risk factors for retained placenta

Answer 42

uterine surgeries (removing fibroids)
past c sections

Question 43

nonadherent retained placenta

Answer 43

free floating retained placenta

Question 44

adherent retained placenta / placenta accreta

Answer 44

grows into uterine muscle

Question 45

placenta increta

Answer 45

placenta is midway through muscle

Question 46

placenta percreta

Answer 46

placenta perforates entire uterus
can be seen on US
usually requires hysterectomy

Question 47

we wait _____ for placenta to fall out

Answer 47

30 minutes

Question 48

inversion of the uterus

Answer 48

life threatening
uterus exiting vagina
caused by excessive oxytocin use or baby pulling on chord

Question 49

placenta previa

Answer 49

placenta implanted on or over the cervical opening
causes bleeding in 3rd trimester
dx by US
signs: painless bright red bleeding

Question 50

risks to not breastfeeding

Answer 50

formula is expensive
decreased antibodies to baby
GI risk for baby
increased SIDS risk
increased PPH risk
increased ovarian and breast cancer risk

Question 51

lactogenesis

Answer 51

prolactin prepares breasts to secrete milk
supply meets demand
oxytocin- let down reflex

Question 52

main immunoglobin in breastmilk

Answer 52

IgA

Question 53

benefits of breastfeeding for mom

Answer 53

decreased cancer risk
increased bone density
may enhance postpartum weight loss

Question 54

risk factors for birth trauma

Answer 54

geriatric moms (35+)
young moms (under 16)
primigravida (1st pregn)
uterine dysfunction
CPD (baby head too big)
macrosomia (big baby)
difficult presentation (breach)
obstetric birth techniques (forceps, vaccum)
oligohydramnios (not enough fluid)