Week 10 pt 2 highlights

Question 1

Uterine involution: Uterus returns to pre-pregnant size by ___ weeks postpartum

Answer 1

6

Question 2

Define lochia

Answer 2

uterine discharge

Question 3

___________ generally helps to resolve lochia more rapidly

Answer 3

Breastfeeding

Question 4

Will generally regain fertility ____________ first menses after birth

Answer 4

BEFORE

Question 5

Ovulation returns ~ ____ days (nonlactating women)

Answer 5

45

Question 6

Define galactocele

Answer 6

milk-filled cyst

Question 7

Define mastitis and what most commonly causes it

Answer 7

Slight fever, chills, develops over 2-4wks, redness, soreness of breast, most commonly caused by staph aureus

Question 8

List 2 aspects of the abdominal wall post-birth

Answer 8

1) striae gravidarum
2) Diastasis recti

Question 9

What occurs in the hematopoietic system after birth for several days?

Answer 9

Leukocytosis

Question 10

1) Define endometritis
2) What do you do for it?

Answer 10

1) Temp > 100.4, pain, foul d/c.
2) ADMIT, CBC, cultures, begin IV abx therapy

Question 11

Give some highlights of Postpartum Care & Teaching

Answer 11

1) Bonding
2) Lochia
3) VS and edema
4) signs of infection
5) postpartum depression
6) Bottle vs breast

Question 12

Encourage activity/ambulation postpartum; patients are still ______________

Answer 12

hypercoaguable

Question 13

Postpartum:
1) When is rhogam needed?
2) What is needed if mom is non-immune?
3) What should be given if not UTD?

Answer 13

1) Rhogam if indicated w/in 72hrs
If mom is Rh neg and baby is Rh positive.
2) Rubella vaccine while in hospital if mom is non-immune
3) Tdap (if not given during pregnancy)
Household members should also be UTD

Question 14

Name a RARE obstetric emergency causing cardio-respiratory collapse that has a maternal mortality of 80% (most pts die within an hour of onset)

Answer 14

Amniotic Fluid Embolism (AFE)

Question 15

Amniotic Fluid Embolism (AFE):
During which phase is there hypoxia and SOB?

Answer 15

Phase 1

Question 16

True or false: All pregnant and recently pregnant patients are hypercoagulable

Answer 16

True

Question 17

PE responsible for about _____% of maternal deaths in US

Answer 17

20%

Question 18

What is one important test to do in a DVT/PE workup?

Answer 18

Doppler

Question 19

Frequent, non-productive cough, especially at night; dyspnea with exertion; intolerance of activity; edema; tachycardia; hemoptysis

What are these all warning signs for?

Answer 19

Cardiac Decompensation

Question 20

Cerebral bleeds are responsible for _____% of all maternal deaths

Answer 20

10%

Question 21

Cerebral bleeds: Incidence of stroke is ______ times of that found in non pregnant women of similar age.

Answer 21

13

Question 22

Hemiparesis will be seen in what condition?

Answer 22

Cerebral Bleeds/ stroke

Question 23

Postpartum Hemorrhage (PPH): In industrialized countries, PPH usually ranks in the top _____ causes of maternal mortality, along with embolism and HTN.

Answer 23

3

Question 24

Postpartum Hemorrhage (PPH): Define this condition and the 2 types

Answer 24

Defined as blood loss >500 mL following vaginal delivery OR >1000 mL following cesarean delivery.
1) Early or primary PPH = loss of these amounts within 24 hrs of delivery
2) Late (delayed) or secondary PPH = losses occur 24 hrs to 12 wks after delivery

Question 25

What is the primary cause of PPH?

Answer 25

Uterine atony (TONE) (is it boggy?)

Question 26

List the 4 Ts of PPH

Answer 26

1) Tone 2) Tissue 3) Trauma 4) Thrombin

Question 27

PPH: Evaluate excessive bleeding __________

Answer 27

immediately

Question 28

List important elements of assessing/ treating PPH based on pt status

Answer 28

1) Bimanual exam: Bimanual uterine massage 2) Inspect perineum (laceration?) 3) Assess clotting 4) Administer uterotonics (oxytocin)

Question 29

T/F: You should Identify patients who are high risk before any bleeding episodes

Answer 29

True

Question 30

Two options for third stage of labor= ____________ or ___________ management

Answer 30

physiological or active

Question 30

Active management of the _______ stage of labor reduces the incidence of PPH by as much as 70%.

Answer 30

third

Question 31

T/F: Postpartum infection includes any infection after birth

Answer 31

True

Question 32

_________________ is the most common source of postpartum infection.

Answer 32

Endometritis

Question 33

If symptoms of infection are present (elevated WBC, fever, pain, purulence), what are 2 important things to do?

Answer 33

1) Culture everything (blood, urine, lochia) 2) Treat with broad spectrum abx until cultures finalized if taken

Question 34

What has a 1.5-18% incidence after C/S?

Answer 34

Postpartum endometritis

Question 35

What should you do if postpartum endometritis doesn't improve within 36-48 hrs (2 things)?

Answer 35

Blood cultures (if +, consult Infectious Disease) Obtain pelvic CT to rule out septic thrombophlebitis

Question 36

Endometritis: 1) Generally, how many pathogens isolated? 2) What pathogen has been associated with late-onset postpartum endometritis? 3) What has been identified in <25% of women who received cephalosporin prophylaxis?

Answer 36

1) 2 or 3 2) Chlamydia 3) Enterococcus

Question 37

Endometritis after C/S: What is the Preferred initial IV abx regimen (no GBS colonization)?

Answer 37

Clindamycin q8hrs + Gentamycin IV q24 hrs

Question 37

Endometritis after C/S: If GBS colonized OR if no response in 24-48hrs, add ____________ IV abx regimen

Answer 37

Ampicillin

Question 37

Endometritis: If GBS colonized OR if no response in 24-48hrs, add Ampicillin IV abx regimen; describe this regimen

Answer 37

Clinda q8hrs + Gent q24hrs + Ampicillin q6hrs OR Ampicillin-sulbactam (Unasyn) q6hrs)

Question 38

Endometritis: 1) Treat until _________ > 24 hrs then can DC home 2) ___________ after successful IV treatment is unnecessary and does not improve outcomes

Answer 38

1) afebrile 2) Oral abx

Question 39

Sheehan Syndrome: 1) Define this condition 2) What is a main clinical feature?

Answer 39

1) Infarction or necrosis of the pituitary gland after postpartum hemorrhage causing hypopituitarism 2) Hx of PPH so severe to cause hypotension and requires transfusion

Question 40

Differentiate when severe, moderate, and mild Sheehan's occur

Answer 40

1) Severe = inability to lactate during first days or weeks 2) Moderate = failure to lactate or menstruate for weeks to months 3) Mild = possibly starts many years later

Question 41

“Empty sella” seen on brain MRI with what condition? (important)

Answer 41

Sheehan syndrome

Question 42

What deficiency causes inability to breastfeed & has no treatment available?

Answer 42

PRL deficiency

Question 43

What is the main Tx for Sheehan syndrome?

Answer 43

Replace the hormones

Question 44

What is the only hormone not replaced in Sheehan syndrome?

Answer 44

GH

Question 45

It is recommended that all women are screened at least ________ during the perinatal period for depression and anxiety, with screening at least once during the antenatal period and once during the postpartum period being preferred.

Answer 45

once

Question 46

Unfortunately, most women are only screened one time for depression at their _________ postpartum appointment

Answer 46

6-week

Question 47

Postpartum Depression: 1) What is the most common Tx? 2) What is the only one in this category that should be avoided? Why?

Answer 47

1) SSRIs 2) Paroxetine; linked to fetal cardiac defects

Question 48

Postpartum Psychosis: Onset is typically sudden, most often in first _____ weeks

Answer 48

2

Question 49

What mental health issue postpartum is considered a medical emergency and patient should be referred for immediate, often inpatient, treatment?

Answer 49

Postpartum Psychosis

Question 50

Bipolar illness or schizophrenia predispose to what?

Answer 50

Postpartum Psychosis

Question 51

List some highlights of immediate newborn care

Answer 51

1) Suction 2) Dry 3) Delayed cord clamping 4) skin-to-skin contact with mother 5) breastfeeding 6) Monitor infant’s vital signs 7) Closely monitor

Question 52

Immediate Newborn Care: 1) May perform __________ Scoring System 2) Perform ________ scoring to assess infant’s adjustment to extrauterine life at 1 and 5min after birth

Answer 52

1) Ballard 2) Apgar

Question 53

Record Apgar scores every ___ minutes until scores equal to or greater than ____ are obtained

Answer 53

5; 7

Question 54

When are apgar scores done?

Answer 54

Scores are assigned at 1 and 5min and at every 5min until 20min thereafter if the 5min Apgar is <7

Question 55

Describe the stratification of Apgar risk factors

Answer 55

1) 7 to 10 = no active resuscitation required 2) 4 to 7 = mildly to moderately depressed 3) 0 to 4 = severely depressed, requires active resuscitation

Question 56

The best marker of fetal status is the blood coming FROM the baby in the ________________

Answer 56

umbilical arteries.

Question 57

What indicates birth asphyxia or hypoxia?

Answer 57

Umbilical artery blood pH < 7.00 + metabolic pattern (High CO2, High Base Deficit)

Question 58

List 3 important parts of Newborn Prophylaxis

Answer 58

1) Eye ointment to prevent neonatal conjunctivitis 2) Vitamin K to promote appropriate clotting. 3) Hep B vaccination started within 24hrs of birth

Question 59

List some Common Problems During Breastfeeding

Answer 59

1) Sore nipples 2) Low milk supply 3) Plugged duct 4) Newborn Jaundice

Question 60

List the aspects of an APGAR score (important)

Answer 60

Question 61

What does APGAR stand for?

Answer 61

Appearance, Pulse, Grimace, Activity, Respiration