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Puerperium + Family Planning Flashcards

(96 cards)

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1
Q

Stage 3 of labor starts with_________ and ends with __________

A

Stage 3 of labor starts with EXPULSION OF THE BABY and ends with THE EXPULSION OF THE PLACENTA

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2
Q

Withtheremoval of the placenta, you can either do _______ or ______

A

With the removal of the placenta, you can do either GENTLE CORD TRACTION or WAIT FOR THE PLACENTA TO BE EXPELLED

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3
Q

Placental separation can either be dirty or shiny? What terms correspond to these?

A

Duncan/dirty

Schultze/shiny

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4
Q

When does puerperium start? And how long does it last?

A

Starts an hour after delivery.

Lasts for 4-6 weeks

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5
Q

What 4 events occur during puerperium?

A

Uterine contraction
Maternal-neonatal bonding or Milk Reflex
Uterine Involution+ Cervical Repair
Return to Fertility

RUMU

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6
Q

Give the components of the Deadly Triad

A

Hemorrhage
Infection
Hypertension

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7
Q

What are minor causes of morbidity/mortality during the puerperium?

A

Fever
Breast engorgement
Pain
Amniotic fluid embolism

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8
Q

During early puerperium what changes happen to the abdomen?

A

Abdomen becomes soft & flaccid (gelatin-like)
Striae: purplish/reddish -> silvery after yrs
Returns to normal with exercise
Diastasis recti: rectus abdominis separate

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9
Q

Immediately after delivery, how many kg would the mother lose?

A

5-6 kg

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10
Q

After diuresis of 2-3 days, how many kg would the mother lose?

A

2-3 kg

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11
Q

After delivery, how many kg would the mother retain?

A

1.4kg

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12
Q

In early puerperium, what is the level of thrombocytes& leukocytes?

A

Thrombocytes are increased

Leukocytes are increased -> 26,000-30,000

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13
Q

During early puerperium, hgb & hct are? Inc or dec?

A

Decreased. That is why iron supplement is indicated up to 3 mos after delivery

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14
Q

During the first 2 days after deliver, cardiac output is ________. After 10 days _______

A

Increased. CO return to its normal prepregnant state after 10 days

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15
Q

If a woman has previous cardiac condition, how many hours/days should you observe her after delivery?

A

1-2 days because she might have sudden cardiac failure or difficulty breathing or cardiomyopathy

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16
Q

If the patient has preeclampsia, she would probably have __________ therefore, you should monitor the patient’s ________

A

Excess retention of fluids

Urine output

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17
Q

If your patient have preeclampsia and does not diures, you should give _______

A

Diuretics -> FUROSEMIDE

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18
Q

What are small tags of tissue found in the vagina after delivery?

A

Myrtiform caruncles

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19
Q

What is the rationale for doing IE 1 hr after delivery?

A

To check for Hematoma because it can occur anywhere even if u didn’t do episiotomy

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20
Q

When does vaginal epithelium begin to proliferate?

A

4-6wks

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21
Q

Lacerations or stretching of the perineum during delivery may result in ________

A

Vaginal outlet relaxation

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22
Q

Damage to the pelvic floor predisposes to _______

A

Urinary incontinence and pelvic organ prolapse

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23
Q

Immediately after delivery, what is the weight of the uterus?

A

1000 g

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24
Q

At 1 wk PP, what is the weight of the uterus?

A

500g

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25
When does the uterus weigh 250-300g and become a pelvic organ once again?
2 weeks PP
26
When does the uterus return to its prepregnant state?
4 wks PP
27
Why does the uterus need to be contracted even after the mother goes home?
To prevent pp hemorrhage
28
When does oxytocin receptors increase?
Late gestation
29
What tissues locally synthesizes oxytocin?
Placenta, extraembryonic tissue, decidua PED
30
What are the 4 fxns of oxytocin?
Uterine contractions during labor Uterine contractions postpartum Milk reflex Protein synthesis for involution
31
What is the dose of oxytocin given to mothers?
20 units in 1 L crystalloid
32
Normally, __________ blood is lost in NSD
500 cc
33
_________ blood is lost during CS
1000 cc
34
During emergency cs, ________ blood is lost
1500 cc
35
During emergency cs with hysterectomy, ________ blood is lost
2000 cc
36
What is the rationale for occluding blood vessels after delivery?
To initiate thrombosis
37
What should you do to address uterine atony?
Massage Uterotonics Surgery
38
How would you manage lacerations and trauma?
Visualization & Repair
39
How would u manage retained placental fragments?
Manual excavation
40
True or False: Not all bleeding can be addressed by oxytocin
True
41
What are the 4 etiologies of Hemorrhage PP?
Trauma (lacerations) Tissues (retained) Thrombosis (coagulopathy) Tone
42
If the hematoma is 2-3 cm in size, what is the mgt?
Observe only
43
If the hematoma is enlarging, what is the mgt?
Evacuate! | Slice, obliterate the space, then give ice packs
44
Protocol for PPH:
``` Bimanual massage Help 2nd IV line Blood transfusion Explore Monitor Urine output ``` BEH 2M
45
What type of blood should u give patient experiencing pph?
O- fresh whole blood.
46
What is agood measure of blood volume in a patient with pph?
Urine output
47
Uterine artery ligation would not cause necrosis because _____________
The uterus is also supplied by the Ovarian Artery
48
Aside from the uterine a, what other artery can u ligate to manage pph?
Hypogastric A
49
What do you call the suspenders-like sutures around the uterus that compress and occlude the blood vessels?
B-lynch sutures
50
If every intervention for pph fails, do ______
Hysterectomy
51
How would you manually reposition the uterus after resolving pph?
Insert IV Give Tocolytics Reposition Give uterotonics "URTI"
52
How would you manage hypovolemia of the the px with pph?
Crystalloids: 3x estimated blood loss Colloids (500cc) Blood transfusion (if large amt of blood loss) "CCB"
53
T or F: Afterpains is most sever in primiparas?
F. Afterpains is most pronounced as parity increases
54
Afterpains can also be perceived as _______
Hypogastric pain
55
When do afterpains subside?
3rd day
56
What kind of lochia appears on the 10th day? What is its composition?
Lochia Alba: leukocyte + reduced fluid content
57
After ______ days, lochia serosa composed of _______ is noted.
3-4 days. Old blood.
58
After a few days lochia _______ is seen and is color red.
Lochia rubra
59
After delivery, endometrium splits into 2 layers. The superficial layer becomes the ______ and the basal layer becomes the _____
Lochia | New endometrium
60
Why do mothers experience overdistention of the bladder after delivery?
Because of oxytocin which is also an ADH
61
The glomerular filtration rate goes back to normal by ______
2 wks
62
Because of the dilated collecti system, coupled with residual urine and bacteuria im the traumatized bladder, _____ is a comcerm
UTI
63
What are common changes in the urinary tract after delivery?
Overdistention Incomplete emptying Excessive residual urine
64
What substances are incresed after delivery?
``` Estrogen Progesterone Placental lactoge Prolactin Cortisol Insulin ```
65
When does colostrum start to appear?
2nd day pp
66
Colostrum has: ______ protein & AA | _____ sugar & fat
More | Less
67
What component found in the colostrum protects the infants from enteric pathogens?
IgA
68
How mucn milk can the mother produce in 1 day?
600 mL
69
What vitamin is not found in breast milk? What vitamin is low in breast milk?
Vit K-> give injection to baby to prevent hge | Vit D
70
What is the whey:casein of breast milk?
60:40-> ideal absorption
71
What condition causes the inability of the mother to breastfeed her child?
Sheehan Syndrom-> pituitary necrosis
72
What neurotransmitter is inhibited by the suckling reflex?
Dopamine
73
What are the maternal benefits of breastfeeding?
Dec breast ca risk Dec chd Dec weight retentiom
74
What are the benefits of breastfeeding in infants?
IgA against e coli, rotavirus, atopic dermatitis, wheezing illness
75
This can be observed within 3-5 days PP if the woman does not breastfeed
Breast engorgement, milk fever
76
What are the contraindications for breastfeeding?
``` Illicit drug use Alcoholism HIV Untreated TB Cytotoxic drugs Infant Galactosemia Hepa B if infant not immunized Active HSV in breast ```
77
To minimize infant exposure, drugs must..
Have shorter half life Poor oral absorption Lower lipid solubility Give after feeding & prior to sleep
78
What are the possible etiologies for fever in puerperium?
Breast engorgement Infection Thrombophlebitis Dehydration
79
If mother has fever during puerperium, you can give her:
``` Antipyretics Antibiotics Hydration Early ambulation Breastfeeding with warm compress ```
80
Mature milk is produced by....
4-6wks pp
81
After delvery, the mother should be monitored ________
Every 15 ,pmins for 1 hr
82
If the patient has inability to void, suspect _____
Hematoma
83
Up to how many days/months is postpartum blues physiologic?
2 mos
84
If the mother has postpartum blues exceeding 2 mos and has _______ & _____, the patient already has....
Suicidal ideations & infanticide | Major depression
85
What are the symptoms of Amniotic fluid embolism?
Hypotension, hypoxia, consumptive coagulopathy (DIC)
86
Placental site involution is completed within....
6 wks
87
This is an arrest or retardation of involution presenting with prolonged lochia, bleeding, large & soft uterus
Subinvolution
88
What should u give px woth subinvolution?
Uterotonics: methylergometrine via IM 0.2mL | Doxycycline for infection most prob due to chlamydia trachomatis
89
This is hge that occurs from 24 hrs to 12 wks after delivery usually due to....
Late PP Hge | Abnormal placental site involution
90
In patients with late pph, do not do ______
Dilatation and curettage
91
In a stable px with late pph hge, you cam give:
Ergonovine, oxytocin, pg analog
92
If there are large clots seen in a px with late pph, do....
Gentle suction curettage
93
This is a palpable non-tender mass caused by am obstructed milk duct
Galactocele
94
T or F: in a patient with galactocele, the px presents with fever and chills
False
95
What is the most common pathogen causing mastitis at 3-4 wks pp?
Staph aureus
96
T or F: does a patient with mastitis present with fever, chils and tachycardia
True

OB-GYN (4 decks)

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