PUERPERAL COMPLICATION (2) Flashcards
(56 cards)
What should be considered in postpartum fever differentials related to renal infection?
ACUTE PYELONEPHRITIS
Dilated ureters and renal pelvis
return to normal by 2-8 weeks postpartum.
What are common signs and symptoms of acute pyelonephritis?
- Fever
- costovertebral angle tenderness
- nausea and vomiting
- bacteriuria and pyuria on UA.
What is the clinical significance of atelectasis post-surgery?
Atelectasis often explains unexplained postoperative fever but is coincidental; it may mislead the clinician from pursuing the true cause of fever.
What are the prevention methods for postoperative atelectasis?
Coughing and deep breathing on a fixed schedule after surgery.
What are the mechanisms causing drug fever?
- Hypersensitivity reactions
- altered thermoregulatory mechanisms
- reactions directly related to drug administration
- idiosyncratic reactions.
Define uterine subinvolution.
- Arrest or retardation of involution where the uterus is larger and softer than expected;
- characterized by prolonged lochia and irregular or excessive bleeding.
What is the weight progression of the uterus postpartum?
1000g immediately postpartum,
500g at one week,
300g at two weeks,
100g at four weeks.
What is the management for uterine subinvolution with mild infection?
Antimicrobials like Azithromycin (500 mg 2x/day), Doxycycline (100 mg 2x/day), or Ampicillin-Clavulanate (75 mg 2x/day).
Medical(primary tx) - METHYLERGONOVINE
What are retained products of conception (RPOC)?
Placental and/or fetal tissue remaining in the uterus after miscarriage, pregnancy termination, or delivery.
What are preventive measures for RPOC?
- Routine placenta inspection
- uterine exploration for retained fragments
- careful postpartum curettage.
What clinical manifestations suggest RPOC?
- Uterine bleeding
- pelvic pain
- fever
- uterine tenderness
- amenorrhea.
What diagnostic evaluations are used for RPOC?
CBC for blood loss severity, B-HCG for GTD, ultrasound for confirming RPOC, sonohysterography, and hysteroscopy.
What are management options for stable patients with RPOC?
- Expectant management
- misoprostol for medical intervention
- hysteroscopic removal for persistent symptoms.
What should be done for hemodynamically unstable patients with RPOC?
Stabilize with fluids and blood products, uterotonic drugs, intrauterine balloon catheter, or surgical options like laparoscopy or hysterectomy.
What injuries of the birth canal can occur during puerperium?
Vulvovaginal lacerations
cervical lacerations
puerperal hematomas.
What are the risk factors for vulvovaginal laceration?
Nulliparity, maternal age (30-34), prolonged second stage of labor, instrumental delivery, macrosomia, and fetal malposition like occiput posterior.
What is anterior perineal trauma?
“Anterior perineal trauma involves injury to the labia
What is posterior perineal trauma?
“Posterior perineal trauma involves injury to the posterior vaginal wall
What defines a first-degree perineal laceration?
“A laceration involving the fourchette
What defines a second-degree perineal laceration?
“A laceration involving the skin
What defines a third-degree perineal laceration?
“A laceration involving the skin
What are the subtypes of third-degree perineal laceration?
“3A: Less than 50% of external anal sphincter torn; 3B: More than 50% of external anal sphincter torn; 3C: Both external and internal anal sphincters torn.”
What defines a fourth-degree perineal laceration?
“A laceration involving all layers of the perineum up to the anal epithelium and/or rectal mucosa.”
What are the common causes of perineal lacerations?
“Excessive infant size
