Women's Health OB Flashcards

Question

Preg Changes - MSK

Answer 1

LORDOSIS: abd. Distension + shift in center of gravity Enlarged uterus = DIASTASIS RECTI (separation of abdominal rectus muscles) Increased joint mobility/Waddling gait Due to increased progesterone/relaxin Widened pubis symphysis Facilitates baby into pelvis High bone remodeling/turnover

Answer 2

Increase pituitary gland size = increased intrasellar pressure = increased risk of postpartum infarction (SHEEHAN SYNDROME) in the setting of PP Hem. Increased PTH (meets cal/ needs of fetal skeleton) Hypercortisolism: Increased need for estrogen, cortisol = increased glucocorticoid from adrenal glands = supports fetal somatic reproductive growth “Diabetogenic State” of pregnancy Increased need for glucose/insulin production = hypertrophy/hyperplasia of pancreatic beta cells DECREASED TSH = increased T3/T4 and gland enlarges Reproductive hormones: HCG from placenta Estrogen, progesterone from Corpus Luteum (in 1st/2nd tri) and from Placenta (3rd) Suppressed FSH, LH due to feedback from estrogen, progesterone, inhibin DECREASED Oxytocin throughout pregnancy = INCREASED at Labor Onset and POS. FEEDBACK REALLY INCREASED during 2nd (push) stage of labor

Answer 3

Add 300 cals Expect ~ 25-35 pounds added 11lb (placenta, fetus, fluid), 2lb (uterus), 4lb (INCREASED BLOOD VOLUME), 3lb (breast), 5-10 (maternal reserves) **** 600 mcg FOLIC ACID RBC synthesis, growth, DECREASED RISK OF NEURAL TUBE DEFECTS **** 1,000-1,300 mg CALCIUM 60g of PROTEIN 27mg IRON = increased RBC

Answer 4

→ PRENATAL CARE SCHEDULE: 4-28 weeks = MONTHLY 28-36 weeks = TWICE MONTHLY >36 weeks = WEEKLY

Answer 5

Prenatal Vitamins FOLIC ACID CALCIUM IRON VITAMIN A (teratogenic in early preg) VITAMIN D

Answer 6

→ Full physical exam at first visit → Every visit after record: Weight BP = ACOG HTN >140/90 UA = Glucose and Protein (24 hr protein is gold standard) Fundal height Fetal HR → 12 WEEKS = AUDIBLE Fetal Position → 36 WEEKS = palpable

Answer 7

1st day of LMP + 7 days - 3 months + 1 year 1st day of LMP = 1st day of bleeding

Answer 8

*** First Visit = 6 weeks after LMP *** HR with US detected around 5-6 weeks (1-2 wks after missed cycle) HCG PAP CHAL/GON CULTURE CBC RUBELLA SYPHILIS HEP B

Answer 9

FIRST TRIMESTER SCREEN: → 11-14 WEEKS: US for NUCHAL TRANSLUCENCY PAPP-A and hCG Low PAPP-A associated with Down Syndrome

Answer 10

Cell Free Fetal DNA: → ~10 WEEKS: Fetal DNA in Maternal Blood Trisomies 13, 18, 21 + tests followed by CVS (Chorionic Villus Sampling) or Amniocentesis

Answer 11

Chorionic Villus Sampling: → 11-14 WEEKS: Placental Tissue to test for chromosomal and genetic abnormalities

Answer 12

→ 16-18 WEEKS: AFP, HCG, ESTRIOL, Inhibin A Increased AFP = neural tube/ab. Wall. Increased hCG + Inhibin + Decreased AFP and Estriol = Down Syndrome Decreased AFP, hCG, and Estriol = Edwards Syndrome

Answer 13

→ 15-20 WEEKS: Collect Amn. Fluid to Dx Chromosomal AbnormalitieS

Answer 14

→ 24-28 WEEKS: 75 g 1 hr glucose challenge If abnormal = Repeat 3 hr

Answer 15

→ 35-37 WEEKS: Swab vagina and rectum

Answer 16

SYMPTOMS OF PREGNANCY: → AMENORRHEA → NAUSEA → Increased urinary frequency → Breast engorgement ** CHADWICK’s Sign → blue discoloration of the vagina, vulva, cervix → Cervical Softening DX: Urine Preg. Test (UPT) Detects hCG or B subunit Sensitive to 1-2 weeks Ultrasound: Most accurate method to detect fetal size GESTATIONAL SAC = 5 WEEKS YOLK SAC = 6 weeks FETAL IMAGE = 6-7 weeks CARDIAC ACTIVITY = 8 weeks

Answer 17

GESTATIONAL SAC = 5 WEEKS YOLK SAC = 6 weeks FETAL IMAGE = 6-7 weeks CARDIAC ACTIVITY = 8 weeks

Answer 18

FIRST TRIMESTER (week 1-12) → Visit every 4 weeks (monthly) Evaluate for: Wt changes, BP, PEDAL EDEMA, FUNDAL HEIGHT Urine dip for GLYCOSURIA and PROTEINURIA Trace glucose is normal due to increased GFR Trace PROTEIN is NOT NORMAL (thinking preeclampsia) CELL FREE FETAL DNA = 10 weeks or greater Fetal DNA in Maternal Blood Can confirm with CVS or Amniocentesis Very sensitive/specific CHORIONIC VILLUS SAMPLING (CVS) = 10-13 weeks Small samples of placenta is taken to do genetic testing on (DNA analysis, cyotgenetics) INDICATIONS: >35, prior genetic d/o, carriers for genetic d/o, if first US shows congenital anomaly, abn. Aneuploidy screening RISKS: Maternal Alloimmunization or Vertical transmission of infx (HIV) Complications: Misscarrage, AM. Fluid Leakage

Answer 19

SECOND TRIMESTER (WEEKS 13-26) *** Continue visits every 4 weeks → 15-18 weeks: TRIP MARKER SCREEN (hCG, AFP, Estriol) = Neural Tube Defects/Trisomies → 16-20 weeks: Amniocentesis IF >35 → 17 weeks: Movement Documented → 24 weeks: GLUCOSE SCREENING → 25-28 weeks: Repeat HCT

Answer 20

THIRD TRIMESTER ( week 27-Birth) *** Every 4 weeks UNTIL 28 weeks → Then every 2 weeks until 36 → Then EVERY WEEK *** → UA, Blood Glucose → 28-30: GIVE RHOGAM (if Rh -) → 28-32: Pre-gestational diabetes = TWICE WEEKLY NON-STRESS TESTING UNTIL DELIVERY → 35-37: GROUP B STREP (strep agalactiae) → 36-40 weeks: IF needed cervical chlamydia and gonorrhea

Answer 21

ABORTION: - Pathophysiology: → Loss of pregnancy before 20 weeks → RF: CHROMOSOMAL ABNORMALITIES (MC: Trisomy, Monosomy X) → FR from MOM: SMOKING, Previous Abortions, Infx, anatomy, Ashermans, BMI <18.5/>25 TYPES + PRESENTATION: ** VAGINAL BLEEDING + PAIN +/- TISSUE PASSING FROM VAGINA ** → Spontaneous: <20 weeks (Fetal HR present in Threatened, Inevitable, and Incomplete → NO FHR = Complete or Missed) Threatened: VIABLE PREGNANCY Bloody D/C <20 weeks + CLOSED CERVIX + Retained POC (without passage of tissue) Inevitable: OPEN CERVIX + Retained POC (without passage of tissues) Incomplete: OPEN CERVIX + some but not all POC passed (may be stuck in os/vagina) Complete: CLOSED CERVIX + Complete passage of fetal parts + placenta MISSED: NON-VIABLE PREG. Undetected fetus (No heartbeat) before 20 weeks but POC remain NO BLEEDING SEPTIC: infx of uterus before or after abortion → Medical Abortion (induced) - Diagnosis: → QUANT. B-HCG, CBC, **BLOOD TYPE** (Must know to give Rhogam or not) → Ultrasound Will show if Cervical Os is open or closed Will show if the POC have passed - Treatment: → EXPECTANT MANAGEMENT <13 weeks (allow for complete abortion to occur) → >13 weeks = MEDICAL ABORTION MISOPROSTOL (prostaglandin) or MIFEPRISTONE (antiprogestin) → 1st Trimester = D&C → 2nd Trimester = Dilation & Evacuation → SURGERY if ineffective/excessive blood loss

Answer 22

- Pathophysiology: → Embryo implants outside of the uterus MC = FALLOPIAN TUBE (Ampulla) → MCC: OCCLUSION OF TUBE due to ADHESIONS RF: HX of ectopic, previous salpingitis (caused by PID), previous abd./tubal surgery, IUD, assisted reproductive, smoking - Patient Presentation: → Bleeding + Abdominal Pain + Adnexal Mass in Pregnant Pt - Diagnosis: → POSITIVE HCG PREGNANCY TEST (>1,500) BUT NO FETUS IN UTERO Get serial HCGs (if they are rising but NOT DOUBLING - probs an EP) → US = RING OF FIRE SIGN = RING OF VASCULARITY - Treatment: → METHOTREXATE (if HCG < 5,000) Indications = Stable pt, <5,000, Mass<3.5, no fetal heart beat C/I: Breastfeeding, pulm.ds, immunodef. FOLIC ACID ANTAGONIST → Inhibits DNA replication → Surgery → Laparoscopy Salpingostomy = if ruptured or CI for Methotrexate *** MUST FOLLOW UP *** - PEARLS: → RUPTURED: (medical emergency) SEVERE ADB. or SHOULDER PAIN, peritonitis (guarding), tachycardia, syncope, ortho. HTN

Answer 23

- Pathophysiology: → Pregnant pt with abnormal glucose tolerance → MC diagnosed in 2nd or 3rd trimester if it was not clearly present prior to pregnancy → RF: Obesity, Hx of impaired glucose tolerance, FHx DM, Maternal age > 30 Given birth to baby >9lb, PCOS, Non-white → MC Complication = MACROSOMIA - Patient Presentation: - Asymptomatic (may have typical DM symptoms) - Diagnosis: → Random Glucose in ALL pregnant women the 1st Prenatal visit!!!! REPEAT at 24-28 weeks → 1 hour Glucose Tolerance Testing @ 24-28 weeks Non-fasting 50-g glucose challenge test followed by serum glucose level 1 hour later > 130 → Do 3 hr glucose test 100g 3 Hour Glucose Test: if 2 or more of these levels are positive = Positive Dx Fasting: 95 1 hr: >180 2 Hr: >155 3 Hr: >140 - Treatment: → Daily glucose checks (fasting overnight and after each meal) → Insulin if fasting > 105 mg (TX of Choice) → GLYBURIDE (Only oral hypoglycemic that DOESN’T CROSS PLACENTA – BUT – Higher risk of Eclampsia) → EARLY DELIVERY = C-SECTION AT 38 WEEKS (if child is macrosomic) → Weekly fetal HR

Answer 24

→ Proliferation of Placental Cells → RF: < 20/>35, Previous Molar Preg. → Benign (Molar Preg/Hydatidiform Mole) → Malignant (Invasive Moles & Choriocarcinoma) ****** EXTREMELY HIGH HCG >100,000 *** → MOLAR PREGNANCY: Premalignancy (HYDATIDIFORM MOLE) COMPLETE MOLE: HUGE HCG >100, 000 + missed periods, + preg. Test, vaginal bleeding, syms of hyperthyroidism, UTERUS is LARGER THAN EXPECTED “Grape-like” mass or SNOW-STORM on US INCOMPLETE MOLE: More than usual HCG (not as much as Complete), Uterus is NOT larger than normal, most result in spontaneous abortion →Malignant → INVASIVE MOLE: Derives from benign mole ALWAYS AFTER MOLAR PREG> → CHORIOCARCINOMA: PLACENTAL CANCER occuring in the absence of a molar pregnancy Can develop after a normal or molar pregnancy Diagnosis: → HCG > 100,000 → Transvaginal US: “Snowstorm” / “Swiss Cheese” → ECHOGENIC pattern from the abnormal placenta villi and clots Complete Mole: THECA LUTEIN CYSTS Incomplete Mole: Fetal Parts may be visible - often Oligohydramnios → Invasive and Choriocarcinoma: Dx made bc HCG Levels PLATEAU Invasive US = ANECHOIC & high vascular flow Choriocarcinoma = Single Mass distending the uterus and is HETEROGENEOUS bc it has areas of necrosis and hemorrhage ORDER Chest X-RAY & CT head, abd., pelvis for Metastases!!!! Stage 1: ONLY uterus Stage 2: Tubes, Ovaries, Vagina Stage 3: LUNGS Stage 4: Any organs other than lungs or genitals Treatment: → Complete/Incomplete: UTERINE EVACUATION via SUCTION CURETTAGE Follow up & measure HCG weekly until gone for 3 weeks then once a month for 6 months (use contraceptives) HCG rises or plateaus, there may be an invasive mole or choriocarcinoma → Choriocarcinoma: RESECT, METHOTREXATE, CHEMO 0-6 = low risk >6 = high risk + Chemo (EMA-CO) ** Remission = 3 consecutive undetected HCGs **

Answer 25

- Pathophysiology: → SPONTANEOUS, premature DILATION or SHORTENING of the Cervix during the 2nd or early 3rd trimester (up to 28 weeks) → RF: H/o of cervical insufficiency, hx of injury, surgery, colonization, etc. - Patient Presentation: *** RECURRENT 2nd TRI. MISCARRIAGES *** → PAINLESS dilation (>2cm) and effacement, minimal contractions until 4cm → bleeding or vaginal d/c - Diagnosis: → Transvaginal US = “Funneling of the cervix” → 18-22 weeks = US focuses on abnorm. → NORMAL CERVIX LENGTH = 30mm → CERVICAL WEAKNESS = <25mm before 24 wks (<2.5cm) - Treatment: → CERVICAL CERCLAGE @ 12-14 weeks Removed @ 36-38 weeks → Culture for GBS before inserting + confirm viable pregnancy

Answer 26

- Pathophysiology: → Placenta detaches from the Uterus too early >20 weeks causing hemorrhage → MCC OF 3rd TRIMESTER BLEEDING → RF: Trauma, Smoking, HTN, Preeclampsia, Cocaine - Patient Presentation: → PAINFUL 3rd Trimester Bleeding + severe abdominal pain + frequent small contractions + FIRM, TENDER UTERUS - Diagnosis: → CLINICAL **BLOOD STAINED AMNIOTIC FLUID** → US may show Retroplacental Blood Collection - Treatment: → DELIVERY = Definitive Blood type, Crossmatch, Coag. studies + LARGE BORE IV Corticosteroids as needed = Enhance Fetal Lung Maturity

Answer 27

- Pathophysiology: → Placenta lies LOW in the uterus and covers the cervix → RF: Prior C-Section, Multiple Gestations, Multiple Induced Abortions, Advanced Maternal Age → NORMAL LOCATION: FUNDUS, which is the top, rounded part of the uterus “Low-Lying” Placenta: Implanted in the lower uterus, NOT extending to the internal os “Marginal” Previa: EDGE of placenta reaches the margin of the os “Partial” Previa: Placenta covers PART of the internal os “Complete” Previa: Placenta completely covers the internal os VASA PREVIA: Fetal vessel lies over the cervix ** FETAL COMPLICATIONS: Preterm Delivery, Preterm PROM, IUGR, Vasa Previa, etc. - Patient Presentation: → PAINLESS bleeding after 28 weeks Thinning of the lower uterus segment in the 3rd trimester → No pain or cramping - Diagnosis: → Do NOT do VAGINAL Exam (can cause further separation) → TRANSVAGINAL ULTRASOUND - Treatment: → STRICT PELVIC REST + NO INTERCOURSE Type and Screen incase the need for transfusion C-Section = Preferred If Rh- = Give Rhogam

Answer 28

- Gestational HTN: → BP >150/90 after 20 weeks into pregnancy that resolves 12 weeks postpartum ****NO PROTEINURIA**** -Chronic HTN: → BP>140/90 PRIOR TO 20 wks Gestation that persists >6 weeks postpartum ***NO PROTEINURIA*** → Monitor every 2-4 weeks and weekly at 34-36 weeks - Treatment: → Gestational = May withhold meds (Hydralazine or Labetalol are safe if needed) → Chronic = > 150/100 = TREAT (severe) Labetalol or Nifedipine Oral Hydralazine added if needed Methylodopa (safe alternative, but hard to use) AVOID ACE/DIURETICS

Answer 29

- Pathophysiology: → Mothers blood type is Rh (-) → Risk baby being born with Rh (+) blood which can cause ANTIBODIES AGAINST THE BABY’S BLOOD **** 1st pregnancy = always UNAFFECTED - Diagnosis: → ALL pregnant women: - ABO Blood Group - RH-D Type - Indirect Erythrocyte Ab Screen - Indirect Coombs Test → Fetal Monitoring in 2nd Trimester - Treatment: → Give RHOGAM at 28 weeks, within 72 hours of delivery AND during any uterine bleeding throughout pregnancy Or if assumption of abortion Given if Rh- mom and Father is Rh+ or unknown RISK: Hydrops Fetalis → large amount of fluid builds up in babies tissues and organs causing extensive swelling (not a good survival rate)

Answer 30

- Pathophysiology: → Fetus is not head down = “Bottom-first” → DECREASED likelihood with increased gestational age - Patient Presentation: → 3 Type: FRANK: MC → Both Hips are Flexed and both knees are extended COMPLETE: Both hips extended + knees bent INCOMPLETE: One hip flexed, one extended + knee bent FOOTLING: both legs and knees extended - Diagnosis: → PHYSICAL EXAM → US Confirms: Observe and Repeat US at 37 weeks - Treatment: → ECV (external cephalic version) Technique: @ 37 weeks → Head down, pillow under knees, IV TOCOLYTIC, trying to lift breech from pelvis (other practitioner on head) → Trial of Vaginal Delivery → if persistent → C-Section

Answer 31

- Pathophysiology: Obstructed Labor → Obstruction of Labor **SHOULDER DYSTOCIA: Failure of the shoulders to deliver spontaneously after the delivery of the head → RF: Macrosoma from Gestational DM, Ab. Positioning, small pelvis → Complications: Baby = Hypoxic Mom = infx, uterine rupture, PP Bleeding 3 Categories: POWER: uterine contraction PASSENGER: macrosomia, shoulder dystocia PASSAGE: uterus or soft tissue abnormalities - Patient Presentation/DX: ** TURTLE SIGN: HEAD DELIVERS AND SUDDENLY RETRACTS AGAINST PELVIS → US = Predicts malpresentation - Treatment: → Change Positioning of Mom → May require C-Section or Vacuum Extraction (possible surgical symphysiotomy) **SHOULDER DYSTOCIA: 1st line = NON-MANIPULATIVE MANEUVERS McRoberts Maneuver = Flexion of maternal hips 2nd line = Manipulative Maneuvers: Wood’s Corkscrew: Rotation of fetal shoulder 180 degrees Delivery of posterior arm 3rd = Push fetal head back in and immediate C-Section with Zavanelli Maneuver

Answer 32

NORMAL Fetal HR: 120-160 → >160 for 10 mins = BRADY → <120 fro 10 mins = TACHY NONSTRESS TESTING: → Records movement, heartbeat, and contractions → GOOD = REACTIVE NST >2 accelerations in 20 mins Accels = increase in FHR of at least 15 bpm from baseline, which lasts > 15 seconds → BAD = NONREACTIVE NST No FHR acceleration OR < 15 bpm increasing lasting longer than 15 secs If this occurs get a contraction stress test *** DECELS = BAD *** CONTRACTION STRESS TEST: → Measures fetal response to stress at times of contraction GOOD = NEGATIVE CST No late decelerations in the presence of 2 contraction in 10 minutes BAD = POSITIVE CST Repetitive late decelerations in the presence of 2 contractions in 10 minutes APGAR Score: → Appearance, Pulse, Grimace, Activity, Respirations >7 = Normal, <3 = Critically Low

Answer 33

- Pathophysiology: → Rupture of membranes greater than or equal to 37 weeks aka “water broke” → RISK = Infection or Cord Prolapse - Patient Presentation: → Gush of fluid (clear or pale yellow) from vagina after 37 weeks - Diagnosis: → Nitrazine Test: BLUE (elevated pH = > 7.1 = positive amniotic fluid) → Microscopic Exam: FERNING Crystallization of amniotic fluid (+ estrogen) - Treatment: → >34 weeks: Induce Labor → 32-34 weeks: Collect fluid + check for lung maturity → Induce → <32 weeks: STOP contractions + 2 doses of steroid injx → DELIVER GIVE ABX

Answer 34

- Pathophysiology: → Born < 37 weeks (Normal = 40) → Earlier the baby is born, the greater risk of complications (especially to the respiratory system) → Earliest possible with 50% survival rate is 24 weeks → RF: Smoking, cocaine, uterine malformations, cervical incompetence, infection, low pregnancy weight - Patient Presentation: → Contractions occurring more often than every 10 minutes OR leaking of fluid from the vagina → “Coordinated Contractions” every 3 mins (example) - Diagnosis: → FETAL FIBRONECTIN: (22-34 weeks) Differentiates women who are high risk for preterm than others Used in women with symptoms of preterm labor by measuring the level in secretions form the vaginal/cervix → Placental Alpha Microglobulin-1 (PAMG-1) - - Biomarker that identifies PROM → Obstetric US: Short cervix preterm = indesirable <25mm at or before 24 weeks = Cervical Incompetence = risk of preterm - Treatment: → TOCOLYSIS: Delay Delivery NSAIDS, CCB, Beta Mimetics, or Atosiban Relax the uterus GOAL: Delay onset of labor until STEROIDS can be administered <34 weeks CCBs: NIFEDIPINE and Oxytocin Antagonist can delay delivery by 2-7 days B2 Agonist delay delivery by 48 hrs Magnesium Sulfate: DOES NOT WORK (but decreases risk of cerebral palsy) → At risk ⇒ Progesterone (if taken during pregnancy) may prevent preterm birth → Give steroids < 34 weeks (24-37)

Answer 35

- Pathophysiology: * Emergency * → Umbilical cord comes out before the baby → Risk: Fetal Hypoxia, Brain Damage, Death → RF: Malpresentation and ROM - Patient Presentation/Diagnosis: → SUDDEN & SEVERE DECREASE in FHR Does not immediately resolve → On Fetal HR Tracing (NST): VARIABLE DECELERATIONS - Treatment: EMERGENT C-SECTION → Place patient in Knee-Chest Position and MANUALLY ELEVATE the CORD → get to delivery room for emergent delivery

Answer 36

- Pathophysiology: → Inflammation of the endometrium from bacteria → MC infx after childbirth → Causes: birth, procedures, IUD, Chlamydia, Gonorrhea → Risks: C-section, PROM, Vaginal delivery, D&C, Pelvic exams → Acute (Symptoms), Chronic (Asymptomatic) → COMPLICATIONS: Myometritis (bacteria spreads into myometrium) or Parametritis (spreads into parametrium) Salpingitis or Oophoritis Chronic can lead to Asherman Syndrome (Intrauterine Adhesions) - Patient Presentation: → Fever, Tachy → Possible vaginal bleeding (FOUL-smell) 2-3 Days post-c-section, post-abortion - Diagnosis: → Clinical → Endometrial Biopsy = Helps Diagnosis → Histology = Neutrophils in the endometrium - Treatment: → AFTER CHILDBIRTH: CLINDAMYCIN + GENTAMICIN → REMAINING PLACENTAL/FETAL TISSUE/POST-ABORTION: D&C → CHLAMYDIA/GONORRHEA: DOXY + CEFTRIAXONE - PEARLS:

Answer 37

- Pathophysiology: → Significant loss of blood after delivery Greater than or equal to 1,000mL in the first 24 hours after birth Decreased Hmt 10%, changes in HR, BP, O2 * #1 reason for maternal death worldwide * → 4 MC Causes: “4 Ts” Tone: UTERINE ATONY (MC) Boggy, Enlarged Uterus Doesn’t contract after to stop clotting Trauma: Forceps, vacuum, precipitous labor Tissue: Incomplete separation of placenta from uterine wall or expulsion of placenta isn't complete Thrombin: Coagulation D/O Prevents blood clots from forming naturally (von Willie, eclampsia, placenta abruption, DIC) *DIC = severe preeclampsia, amniotic fluid embolism, placental abruption* - Treatment: → Uterine Atony = FUNDAL MASSAGE + (oxytocin IV, misoprostol = helps contract) → Genital Trauma = >2cm = Surgically Repaired → Retained Placental Tissue = Placenta Accreta Placenta grows too deeply into uterine wall Hysterectomy

Answer 38

→ Last ~ 6 weeks Immediate: first 24 hrs (acute postanesthetic/post-delivery complications) Early: extends until first week Remote: period of time required for the genital organs and return of menses to occur (~6 weeks(

Answer 39

→ Uterine Involution: First week → decreased to size of 12 week gestation & is palpable at pubis symphysis → Placental Implantation Site Changes: Immediate contraction of the placental site to the size less than half the diameter → leads to hemostasis NORMAL POSTPARTUM DISCHARGE aka LOCHIA RUBRA: blood, shreds of tissue, and decidua → over 3 days it changes to brown d/c 5th/6th week PP = Lochial secretions stop

Answer 40

Cervix gradually closes → by the end of the 1st week it is back down to ~1cm The vagina returns to its antepartum condition by ~3rd week OVULATION occurs as early as 27 days after delivery, but average: 70-75 days in non-lactating 6 months in lactating Changes in the pelvis = widened symphysis and SI Joints Pelvic floor gradually regain tone Tearing/overstretching of the muscles can lead to prolapses and hernias Overdistension of abd. Walls can result in striae, diastasis of the rectus muscles 6-7 of no vigorous exercise

Answer 41

Immediate PP = bladder mucosa is edematous and there is an INCREASED BLADDER CAPACITY Overdistention and incomplete emptying of bladder + residual urine Urinary stasis until ~ 12 weeks PP Increase UTI risk if distended Mild Proteinuria for 1-2 days Increased GFR until about 8 weeks Creatinine clearance returns normal ~8 weeks

Answer 42

2-4 days hospitalization PP RETURN home safely 2 days after normal vaginal delivery Optimal = 4th day home nurse visit ACTIVITY = out of bed as soon as tolerated if uncomplicated delivery Exercise does not compromise lactation of neonate weight gain Decreases anxiety and PPD DIET = regular diet is permissible asap Protein rich food, fruits, veggies, high fluid intake 500kcals per day more than non pregnant/non lactating women SEX: when bleeding stop and perineum is comfortable Median time is 6 weeks and normal sex response 12 weeks Bathing: ASA Ambulatory

Answer 43

Normal cleaning/showers Immediately after delivery: cold compresses to decrease edema Gently cleaned with plain soap once or twice per day and after voiding to keep clean and avoid infection

Women's Health OB Flashcards

(67 cards)