POSTPARTUM Flashcards
What are the major hallmarks of sheehan syndrome?
Signs of hypopituitarism such as impaired lactation, central hypothyroidism (Low T4,TSH), secondary adrenal insufficiency (hypotension, hypoglycemia)
The number 1 cause of post partum hemmorhage
Uterine Atony
usually manifests with an enlarged, soft, non-contracted uterus and significant vaginal bleeding after delivery due to insufficient myometrial blood vessel constriction. In uterine atony, bimanual uterine massage and uterotonic agents (oxytocin, misoprostol, carboprost) should be used to promote uterine contraction and tranexamic acid may be indicated to stop fibrinolysis.
What are the risk factors for uterine atony?
Multiparity, post-term pregnancy
Affected individuals most commonly present with symptoms of hyperthyroidism, followed by a hypothyroid phase due to the exhaustion of thyroglobulin stores and the inhibition of TSH secretion by high concentrations of serum thyroid hormones (T3 and T4). As the inflammation remits, the follicles regenerate and hormone synthesis resumes, reestablishing the euthyroid state. What is the condition?
Post Partum Thyroiditis
____________ _____________ ______________ is caused by a subacute autoimmune inflammation of the thyroid gland that results in lymphocytic infiltration, destruction of the follicular cells, and subsequent release of preformed thyroid hormones.
Post Partum Thyroiditis
What is first line recommendation for patients with inadequate vaginal lubrication while postpartum/breastfeeding?
Recommend lubricants, you can consider low dose estrogen but we want to avoid any systemic absorption of estrogen
What is the leading cause of neonatal sepsis?
GBS
A 2 day postpartum pt develops a mild fever and shortness of breath. She had been given prophylactic antibiotics prior to c-section, she has no breast tenderness or erythema, no ronchi, wheezes or crackles on auscultation, no lower extremity edema, and the surgical incision is clean and dry from her c-section. The fundus is firm and nontender. What is the MOST LIKELY cause of her fever and SOB?
Atelactasis
An acute, typically polymicrobial infection of the urerine endometrium. It typically presents with fever, tenderness to palpation of the uterine fundus, and mucopurulent vaginal discharge.
Endometritis, this is a cause of PPH
Signs and symptoms of this condition include slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension, and amenorrhea.
Sheehan
What are the risk dactors for infection postpartum?
prolonged labor, prolonged rupture of membranes, multiple vaginal examinations, internal fetal monitoring, and manual removal of the placenta.
The most common cause of postpartum fever is…
Endometritis
What are the most common causal organisms for endometritis?
Staph a and strep, they are usually polymicrobial infections with a mix of anerobes and aerobes in the genital tract
When do we consider postpartum depression over postpartum blues?
Signs and symptoms of depression that last for less than 2 weeks are the blues (which occur in 40-85% of women). PPD can occur anywhere from 2weeks to 6 months post partum.
Post c-section, why is obesity the greatest risk factor for surgical site infection?
Its multifactorial and is thought to include wound tension and hypovascularity of adipose which also may reduce antibiotic penetration.
