Sept12 A2-Post-partum Flashcards
(35 cards)
puerperium def
post delivery period where pregnancy induced maternal anat and phgy changes go back to nonpregnant states (lasts 4-6 weeks)
reprod tract changes post partum
- multiparity = external os stays wide
- birth canal returns to normal (pelvic floor damage, vaginal atrophy)
- uterus and vessels involute
- cervix involutes (lot of epith remodelling)
uterus involution progress
- 1 kg post portum
- 500g PP week 1
- 300g PP week 2
- 100 g PP week 4 (involution complete)
possible sx in postpartum
- afterpains (uterus keeps its tonus in primiparity. multiparity = vigorous contractions. baby suckling breast = oxytocin release = sx worse
- lochia = vaginal discharge after birth (from sloughing of decidual tissue (RBCs, decidua, epith, bacteria)
abdominal wall changes PP
- is soft and flaccid PP due to ruptured elastic fiberts and prolong distension
- need many weeks to recover
- striae gravidarum = stretch markers
- diastasis recti = muscular rectus abdominus, physio and exercise to go back to normal
urinary system changes PP
- return to GFR normal after 2 weeks
- possible UTIs bc of dilated ureters all throughout pregnancy (same for renal pelvices). back normal after 2-8 weeks
- bladder has increased capacity (excessive residual urine, incomplete emptying). especially with epidural
hemato changes PP
- hypercoagulability in 6 weeks after delivery so NO OCP**
- CO back to normal after 10 days
- low systemic vasc resistance for 2 days PP and then back to normal
- regain of normal non pregnant volume if PP hemorrhage
diuresis changes PP
- pregnancy: increased water retention and ECF and ECF sodium
- PP diuresis to reverse this. loss of residual pregnancy hypervolemia. (rapid weight loss bc of this). maximal 2 weeks PP.
immunization PP
- Anti-D (given PP if baby Rh+)
- varicella
- MMR
menses PP
- if NOT breastfeeding = return after 6-8 weeks. (mean ovulation 7 wks)
- if breast feeding, menses resume in 2nd to 18th month PP
how to know when ovulation restarts in breastfeeding women
return to normal menstrual bleeding = ovulated 2 weeks ago (but one not always with the other)
contraceptive options PP if breastfeeding
- Cu IUD
- LNG-IUS (prog)
- DMPA (prog injection)
- POP (prog only)
- COC (E+P) AFTER 6 weeks PP
- condoms
- lactational method (breastfeed every 3 hours until 6 months PP)
puerperal complications
- puerperal infection (=genital tract)
- breast infection
- obstetrical neuropathies
- PP depression
puerperal infection lethal triad in 20th century
- puerperal infection
- PP hemorrhage
- pre-eclampsia
puerperal infection ddx
- breast engorgement
- UTI
- incisions
- resp complications
endometritis def
inflammatory reaction of lining of endo due to infection
uterine infections PP (puerperal) RFs
- C-section
- low SES
- malnutrition, anemia
- chorioamnionitis
- prolonged labor
- obesity
puerperal UTI sx and tx
- sx = fever, abd pain, uterine tenderness, high WBCs, foul smelling lochia
- tx = IV Abx**
puerperal breast infection charact
- 3% of pts PP
- parenchymal infection
- RFs = cracked nipples, difficulty with breastfeeding
- 3-4 weeks after delivery
puerperal breast infection sx
- unlitateral
- pain
- redness
- induration of breast
puerperal breast infection tx
- oral abx
- abscess drainage
name for breast infection
mastitis
cause of obstetrical neuropathies
- pressure on branches of lumbosacral plexus during labor
- long labor = longer time head pressing on nerves, ischemia, damageo nn erves
obstetrical neuropathies sx
- intense neuralgia or cramp like pains extending in leg
- sensory loss
- muscle paralysis
- foot drop
