Pre + Postpartum care Flashcards by Linda Chen

preconception care promotes healthy lifestyles in men and women of ____ age

18-44

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what nutritional supplements may be recommended in the peripartum time frame

folic acid
calcium

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how should you take folic acid when trying to get pregnant

start taking 2-3mths before pregnancy + continue for 4-6wks after or as long as breastfeeding

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how much folic acid is recommended for a patient with no RFs

0.4mgd

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how much folic acid is recommended for a patient with FHx of neural tube defects

1mg

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how much folic acid is recommended for a patient that takes medication increasing their risk for neural tube defects

1mg

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how much folic acid is recommended for a patient that has had a previous neural tube defect in pregnancy or either them/ their partner has a neural tube defect

4mg/d

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how much calcium should one be taking why trying for pregnancy

1000mg elemental calcium - usually in diet but can add supplements

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what is the recommendation for immunizations in pregnancy

get all live/ live attenuated before, then avoid in pregnancy

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what is normal weight gain in pregnancy

5lb in first 10wks, then 1lb/ wk after

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how many lb do women usually gain a pregnancy

25-35lb

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hypertension in pregnancy is defined as

BP =>140/90

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what is nonsevere HPTN in preg/ what about severe?

> 160/110 = severe

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why might BP decrease in first trimester

decreased peripheral vascular resistance

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what is the target BP in pregnancy

<85mmHg

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what is preeclampsia

pregnancy spec onset of HPTN that involves new onset proteinuria
Multisystem, occurs after 20wks of gestation + resolves after delivery + no seizure yet

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preeclampsia occurs after _______ of gestation and _____ seizures

20wks
does not include seizures

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what is eclampsia

HPTN + proteinuria + seizure has occured

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what is HPTN in pregnancy with new onset proteinuria

preeclampsia

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how to treat eclampsia

IV antiHPTN tx with hydralazine or labetalol
seizure prophylaxis with magnesium sulfate

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what is HELLP syndrome

severe form of preeclampsia that includes hemolysis, elevated liver enzymes, low platelets

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DBP >90 mmHg <20 wks gestation is probably

chronic/ prepreg HPTN (at risk of developing superimposed preeclampsia)

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DBP >90 mmHg >20 wks gestation with no target organ involvement is probably

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gestational hypertension

DBP >90 mmHg >20 wks gestation with target organ involvement is probably

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preeclampsia

1st line antihypertensive meds in pregnancy

labetalol, methyldopa, long acting oral nifedipine, other BB

2nd line AHA in pregnancy

clonidine, hydralazine, thiazide diuretics

when should prophylaxis for thromboembolism be considered for pregnant women

prior VTE, inherited thrombophilia

what is the drug of choice for thromboembolism prophylaxis in pregnant women

LMWH

what meds are used for cervix ripening

PGE2 like dinoprostone misoprostol (PGE1)

what med is used to stimulate uterine contractions

oxytocin IV

what treatments may be used to prevent preterm labour

progesterone 17-hydroxyprogesterone caproate

if the pt has a short cervix, _____ may be given to prevent preterm labour

vaginal progesterone

if a pt has a hx of preterm labour _____ may be given

IM or vaginal progesterone

postpartum care is a period of _____ after delivery

6wks

perineal pain usually resolves by

6wks

typically a ____ will be done to prevent tearing to the anus

mediolateral

tx for perineal pain from vaginal deliveries

sitz baths, rinse area with warm water, kegel exercises to prevent, hamamelis (witch hazel), acetaminophen/ NSAIDs

treatments for cracked nipples

ensure correct latching warm compress before feeding lanolin to nipple acetaminophen/ NSAIDs applying few drops of breast milk on nipple before/ after oi massage

how to treat painful engorged breasts

warm showers just before feeding, cold compress in between feeds

how to treat mastitis from blocked milk duct

Warm wet towels/ massage before feeding Increase fluids More BF on affected side Acetaminophen and NSAIDs for pain If no improvement in 24hrs or fever develops see HCP

how to treat mastitis from infection

Sim sx to blocked milk duct + sx like fever and flu like sx Encourage milk flow from affected breast either BF or pump + continue while on tx Hot compresses Usual pathogen: staph aureus Oral abx: cloxacillin, cephalexin, (clindamycin if beta lactam allergy or MRSA), IV abx if severe

what antibiotics are used for mastitis from infection

cloxacillin, cephalexin, (clindamycin if beta lactam allergy or MRSA), IV abx if severe

PPD is sx of depressed mood/ loss of interest for a minimum of ____

2wks

list 2 RF of PPD

hx prev PDD (40%), dep/anx during pregnancy, hx/FHx prev MDD, poor social supports, poor marital relationship, stressful life events, OB complications- almost like PTSD

postpartum blues onset + lasts

onset 3-4d lasts 2-4wks

sx of postpartum blues

mood changes- from happy to feeling uncontrollably sad, and may have inexplicable spells of irritability, weepiness, and anxiety

postpartum depression onset

4-12wks after delivery

what syndrome has the following symptoms: Nonpsychotic depression that occurs shortly after birth- depressed mood, anxiety, not sleeping well (not able to sleep the entire time baby sleeps), fatigue, lower concentration and inability to think recurrent thoughts of death/ suicide

post partum depression

in postpartum depression 1. some pts are primarily anxious 2. may have rapidly fluctuating mood 3. typically resolves in 2-4wks after delivery 4. requires immediate intervention

how long should SSRI/SNRIs be continued in PPD

at least 6mths after remission to prevent relapse

how to start SSRI/SNRI dosing in PPD

Some start at ½ dose, then ↑ in 2-3wks as those who just gave birth may be more sensitive

which AD has the most passage into breast milk

fluoxetine, citalopram

which AD has lower release into breast milk

sertraline, fluvoxamine, paroxetine

most studied AD in BF

sertraline, paroxetine

monitoring pts with PPD - AD should be reassessed in ___

2-4wks

what to monitor for in infants once mother starts AD

colic, fussiness, changes in sleep, difficulty feeding- LT effects on children exposed to AD in breast milk remain unknown

if a pt was on fluoxetine during pregnancy for MDD, should we switch her AD during BF?

no- if it were a new dx in BF, would not choose fluvoxamine but since she's already on it, it's fine

Pre + Postpartum care Flashcards

(57 cards)