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OB Post-Partum Care
OB Post-Part Care
| Question | Answer |
|---|---|
| Puerperium | The 6 to 8 week period after birth during which the reproductive tract returns to its normal, nonpregnant state. |
| Postpartum uterus | non-tender, globular and firm. (don't want it to be squishy: it means it's not contracting and the vessels are still open, risk of post partum hemorrhage) |
| 24 hours after delivery, fundus is near | umbilicus. returns to nl size 6-8 weeks postpartum |
| Lochia | Blood, necrotic membrane remnants & decidua shed from uterine cavity--decreases over several weeks.Discharge heavy for 2 to 3 days. Lochia resolves more rapidly in women who breastfeed |
| Lochia appearance | red (first few days), pink-brown (2-3 wks), white. Endometrium usually reestablished by 3 wks post partum |
| Cervix | <1cm at one week postpartum. Transverse, stellate slit associated with previous vaginal birth |
| Essential Wound care management of Episiotomies | ice relief of pain and swelling, sitz baths, donut cushions, baths okay (but most people prefer showers due to heavy lochia) |
| What kind of sutures are used in an episiotomy? | Reabsorbable (chromic and polysorb) |
| Ovarian fxn post partum (non-breast feeding) | Ovulation can occur as early as 4 to 5 weeks postpartum if not breastfeeding. Mean time 45 days. 50% of women ovulate by 90 days. Return of menses in 7-9 weeks. 25% of first menstruations are preceded by ovulation |
| Ovarian fxn post partum (breast feeding) | Time to first ovulation dependent on breastfeeding practices. Ovulation suppressed due to prolactin. Estrogen levels low |
| Vital signs post partum | BP and pulse. Can bleed and may be intrauterine |
| Squishy uterus | uterine atony |
| Examine postpartum for | uterine atony, excessive bleeding, over-distended bladder, dyspnea/pleuritic pain (PE due to hypercoaguable state), perineal infxn |
| Post Partum mngmnt: Iron supplement for hct< | 30. Pelvic rest for 4-6 weeks |
| Complications of the Post-partum period | Infxn: Endometritis, Wound Infxns, Mastitis |
| Endometritis | more common in C-sections than vaginal births. Diagnosis by clinical criteria: fever, uterine tenderness, foul lochia, and leukocytosis. occurs within 5 days of delivery. Polymicrobial. |
| Most common cause of malodorous lochia | retained gauze sponge |
| Endometritis Prevention | Assure removal of all placenta and associated membranes. Prophylactic abx reduce the rate of endometritis in high risk patients (C/section) |
| Wound Infxn | 2-20% of C-section. Risk factors: DM, obesity, poor nutrition, immunocompromised, long operative time, emergency surgery |
| Wound infxn tx | drainage, debridement of devitalized tissue, abx not sufficient without drainage |
| Separation and dehiscence | C/S infection uncommon, reduced by prophylactic abx |
| Incision infxn risk factors | Obesity, DM, immunocompromised, anemia, hematomas |
| Mastitis and Engorgement | Enlarged, tender breast postpartum. Let down feels like breasts are going to pop |
| lactogenesis | Results from withdrawal of estradiol & progesterone, tactile stimuli cause release of prolactin and oxytocin |
| Progesterone role | budding & development of acini at ends of ducts of mammary glands |
| Estradiol | promotes growth & branching of mammary gland ducts |
| Suppression of lactation | Tight bra, binder, heat or ice, avoid breast and nipple stimulation, bromocriptine no longer used. Even though releasing milk will release pain, it will defeat the purpose and create cycle |
| Mastitis Prevention | Nipple hygiene, Active care of cracks and fissures; lanolin or A&D ointment, Early dx and prompt abx therapy |
| Engorgement | after first onset then gradula, bilateral, generalized pain and swelling, no systemic symptoms, no fever |
| mastitis | Sudden onset, unilateral, localized swelling & pain/erythema, feels sick, fever, tx with abx that covers staph |
| Retained Placenta | Expulsion incomplete; greater risk: C/S, Fibroids |
| Placenta accreta: | Placental villi penetrate the uterine wall. |
| Placenta Percreta | complete invasion of the placenta through the uterine muscle |
| Placenta previa | placenta is over the cervix. Can't have a vaginal birth, automatic C-section or you will lose the baby |
| Things that increase risk of DIC | placental abruption, amniotic fluid embolism, severe preeclampsia |
| Contraception | Recommend delay of next pregnancy for 18 months. Progestin only in non-breast feeding women. Start oral contraceptives once lactations well established. Wait for COCPs until 2-4 wks postpartum |
| Diaphragms and cervical caps | must be refit after each pregnancy |
| Other considerations post partum | Rh-? Rhogam immediate postpartum period, immunizations (such as HPV), sexual activity 4-6 wks, pap test if needed, other health promotion, return to work, day care |
| Post partum visit | vital signs, thyroid, breasts, abdomen, external genitalia/perineum, vagina/cervix/uterus/adnexae, extremities, mood, contraception, medical conditions (ex: DM), feeding method, future visits |
| ______ is described by: feeling "down in the dumps", sadness, irritability, crying and anxiety. Mild. Onset 4-5th day postpartum, typically subsiding by the 10th day | Maternity Blues |
| Tx for Maternity Blues | Time, Support of Friends and Family |
| Post Partum Depression Sx: Depressed mood with clear evidence that the symptoms are substantially interfering with functioning. & at least 4 of the following: | appetite disturbance, sleep disturbance, agitation or psychomotor retardation, loss of interest, fatigue, self-depreciation or guilt, difficulty with concentration, suicidal ideation |
| Tx of Postpartum Depression | Dependent on severity of symptoms. Support from family & friends; Psychotherapy, perhaps medication. Professional assessment strongly recommended. |
| The strongest association with postpartum depressive symptomatology | Depression level during pregnancy |
| Postpartum Obsessive Compulsive Disorder | Symptoms mostly of disabling intrusive thoughts to harm the baby, typically within two weeks postpartum. Responsive to SSRIs |
| Questions for Pediatricians to ask new moms include: "How are you?", "How are things going in your family?", "Are you getting enough rest?", "Are you enjoying the baby?" and | "Is the baby easy or difficult to care for?", "Who helps you care for the baby?" |
Created by:
ltm12