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Obstetrics and Gynecology > Puerperium and Lactation > Flashcards

Puerperium and Lactation Flashcards

1
Q

Going back to pregnant state

A

Involution

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2
Q

Reappearance of rugae in birth canal

A

3rd week

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3
Q

Vaginal epithelium proliferates in

A

4-6 weeks postpartum

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4
Q

Uterus puerperi changes

A

Calibers of vessels become smaller
External os lacerated
Opening readily admits 2 fingers

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5
Q

Cervix forms at end of

A

2 weeks

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6
Q

Postpartum, the uterus can be palpated readily just

A

slightly below the umbilicus

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7
Q

The myometrium deconstructs (goes back to normal nonpregnant state) after

A

2 days

Heavy immediatelty post partum
1 week pp - 500
2 weeks pp - 300
4 weeks pp - 100

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8
Q

Not sloughed off because not reactive to hormones so the basalis now divides itself into

A

Superficial - necrotic

Basal - intact and source of new endometrium

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9
Q

Endometrium is not adherent to the entire cavity, only one point in the endometrial cavitt wherein placenta is attached.

All other parts wherein the placenta was not attached will involute or go back rapidly except

A

on placental side

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10
Q

Afterpains

A

Pimirparous - tonically contracted
Multiparous - contracts vigorously at intervals (worsens as baby sucks)

Pain should be decreased by the 3rd day (if there ks pain after 3rd day, you have to reassess)

Persistent pain - after 3rd day; infection

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11
Q

Decidua sloughing off

Erythrocytes, shredded decidua, epithelial cells, bacterial

Duration?

A

Lochia

24-36 days

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12
Q

Lochia in first few days

A

Rubra

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13
Q

Lochia in 3-4 days

A

Serosa

pale

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14
Q

Lochia white or yellow white, 10th day

Mixture of leukocytes and reduced fluid content

A

Alba

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15
Q

Placental site involution

A

6 weeks to complete extrusion
After delivery, palm sized

end of 2nd week - 3-4cm in size

Duration: 24-36 days

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16
Q

Placental site regenerates by a new endometrial proliferation

There is sloughing off of infarcted and necrotic tissue followed by remodelling

A

Exoliation

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17
Q

Proper timing of placental involution does not happen

A

Subinvolution

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18
Q

Signs of subinvolution

A

Prolonged lochia
Excessive uterine bleeding
Uterus Larger and softer than usual

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19
Q

Subinvolution Tx

A

Ergonovine/Methylergonovine

Azithromycin/Doxycycline

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20
Q

Late postpartum hemorrhage

A

1 day-12 weeks after delivery

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21
Q

Retained products of conception Dx

A

UTZ

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22
Q

Most common cause of late postpartum hemorrhage

A

Retained products of conception

Tx: Suction curettage

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23
Q

Urinary tract puerperium

A

1 day postpartum - hyperfiltration (inc urination)
2 weeks - urinary tract returns to its non-pregnant state
2-8 weeks - dilated ureters return to non-pregnant state

The degree of bladder trauma depends on length of labor: atony, fluids or urine cannot be expelled

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24
Q

Muscles of rectus abdominis become atonic

Separation of rectus abdominis muscle this much

A

Diastasis recti

>2.7 cm

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25
Q

Hematologic changes puerperium

A

H and H fluctuate
Increased plasma fibrinogen in first week
Increased sedimentation rate

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26
Q

Pregnancy induced hypervolemia returns to nonpregnant state in

A

1 week

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27
Q

Cardiac output remains elevated 1-2 days post partum and in the non pregnant state after

A

10 days

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28
Q

Increased CO puerperially may induce

A

cardiomyopathy

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29
Q

Systemic vascular changes puerperium

A

Rise to nonpregnant levels

30
Q

Increased ECF Na and H20 postpartum lead to

A

Postpartum diuresis
Weight loss of 2-3kg max at 2nd week

Surplus weight gain 1.4kg cannot be removed

31
Q

Puerperal Fever Causes

A

Fever of 38 or higher
Breast engorgement - less in patients who breast feed
Urinary tract infection - uncommon due to diuresis, acute pyelonephritis, fever with atelectasis
Perineal lacerations
Episiotomy
Respiratory complications after CS

32
Q

Most persistent post-partum fever

A

Genital tract infections of uterus

Endometritis, endomyometritis, endoparametritis

33
Q

Single significant risk factor of uterine infection

A

Route of delivery

Less in vaginal

34
Q

Bacteria responsible for Female Genital Infections

A 
Aerobes
G+ (strep A,B,D)
Enterococcus, Staph aureus, Staph epidermidis
G- (E coli, Klebsiella, Proteus)
Gram variable - Gardnerella

Mycoplasma, Chlamydia, Neisseria

Anaerobes (Peptostreptococcus, peptococcus)
Clostridium, Bacteroides, Fusobacterium, Mobiluncus

35
Q

Most important criterion of uterine infection

A

Fever

Chills - endotoxemia
Abdominal pain
Leukocytosis - 15,000-30,000
Vaginal discharge - Foul smelling

36
Q

Puerperal Infection Tx

A

Ampicillin + Gentamycin

37
Q

Perioperative prophylaxis for CS

A

Single dose Ampicillin or

1st Gen Cephalosporin

38
Q

Pelvic infection Post CS Tx

Gold standard

A

Clindamycin + Gentamycin

39
Q

Separation of fascial layer
Occurs on 5th postop day
Accompanied by serosanguinous discharge along with abdominal organs

A

Wound dehiscence

If no separation of fascial layer, SSI

40
Q

Monomicrobial Nec Fasciatis causative agent

A

GABHS

41
Q

Parametrial cellulitis following Cesarean delivery and leaves behind a fibrous formation in leaves of the broad ligament

Fever persistence >3 days despite IV antimicrobials

A

Parametrial phlegmon

42
Q

Septic phlebitis arises from venous routes and may cause thrombosis

A

Both ovarian venous plexus

43
Q

Acute febrile illness with associated headache, menta confusion, diffuse macular erythematous rash, subcutaneous edema, nausea, vomiting, water diarrea, marked hemoconcentration

Follows in rapid sequence: renal failure, hepatic failure, disseminated intravascular coagulation, and circulatory collapse

A

Toxic Shock Syndrome

During recovery, rash undergoes desquamation

44
Q

Most common organism that causes Toxic Shoch Syndrome

A

Staph areus with exotoxin TSST-1

45
Q

Small amount of TSST-1 activates 5-30% T cells causing

A

cytokine storm

46
Q

Colostrum secretion is from

A

5 days to 2 weeks

Converts to mature milk by 4-6 weeks
Mature milk: fat, protein, carbohydrates, minerals, vitamins and hormones

Rich in immunologic component
More globulins
Less sugar and fat

47
Q

A nursing mother produces milk daily

A

600 mL

48
Q

Milk proteins

A

L lactalbumin
B lactoglobulin
Casein

49
Q

Breastmilk contains most vitamins except

A 
Vit K
Vit D (low 22)
50
Q

Milk serum containing large amounts kf IL-6

Whey:Casein Ratio

A

Whey

60:40

51
Q

Not destroyed by gastric acid

Promote growth and maturation of NB intestinal mucosa

A

Epidermal growth factor

52
Q

Endocrinology of Lactation

A

Delivery
Decreased progesterone and estrogen
Loss of inhibitory influence of progesterone to L-lactalbumin
Stimulates lactose synthesis to inc milk lactose
Unopposed prolactin stimulation to L-lactalbumin
Serotonin secretion to maintain milk production

53
Q

SSRI SE in breastfeeding

A

Decreased milk production due to inhibition to serotonin

54
Q

Hypopituitarism from pituitary ischemia and necrosis secondary to obstetric blood loss

Persistent hypotension, tachycardia, hypoglycemia and lactation failure

Ave time to diagnosis: 13 years

A

Sheehan syndrome

55
Q

Most life threatening complication of Sheehan

A

Adrenal insufficiency

56
Q

Latching

A

Baby mouth wide open
Baby chin touches the breast
Baby lower lip curled outward
Lower portion of the areola is not visible

57
Q

Hep B

A

Breastfeeding not contraindicated if Hep B IgG given

58
Q

Drugs taken multiple dose should be taken after

A

closest feed

59
Q

Drugs taken single dose

A

Just before the longest infant sleep interval (at bedtime)

60
Q

Absolute CI in breastfeeding

A

Cyototoxic drugs
Inc risk of childhood cancer

Cyclophosphamide, cyclosporine, doxorubicin, methotrexate, mycophenolate

61
Q

Withholding initiation of progestin-containing contraception in the immediate postpartum because progesterone withdrawal is integral to which process?

A

Breast milk production

62
Q

Best contraception for breastfeeding mothers?

A

Progestin

63
Q

May only be given at least 6 weeks postpartum

A

DMPA

Combined progesterone and estrogen pills

64
Q

The major cause of neonatal deaths?

A

Prematurity

65
Q

How many newborn deaths occur in first week of life?

A

75%

66
Q

Several tags of tissue representing the hymen

A

Myrtiform caruncle

67
Q

Most common cause of maternal mastitis

A

Infant’s nose and throat

68
Q

Women not breastfeeding usually menstruate within

A

6-8 weeks

69
Q

In breastfeeding there is delayed ovulation and menstruation resumes

A

2-18 months postpartum

70
Q

For LAM to work,

A

The baby must be under 6 months
Woman must not have had a period
Baby must be exclusively breastfed at least every 4 hours at day and every 6 hours at night

71
Q

For breastfeeding women, these may be initiated any time during puerperium because they do not affect quality or quantity of milk

A

Progestin-only
Depot Medroxyprogesterone
Progestin implant

72
Q

Estrogen-progestin effect on quantity of breast milk

A

Reduced

Withheld until first 4 weeks because of higher thromboembolic risk

Obstetrics and Gynecology (18 decks)

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