OB Post-Part Care
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| Puerperium | The 6 to 8 week period after birth during which the reproductive tract returns to its normal, nonpregnant state.
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| 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)
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| 24 hours after delivery, fundus is near | umbilicus. returns to nl size 6-8 weeks postpartum
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| 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
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| Lochia appearance | red (first few days), pink-brown (2-3 wks), white. Endometrium usually reestablished by 3 wks post partum
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| Cervix | <1cm at one week postpartum. Transverse, stellate slit associated with previous vaginal birth
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| 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)
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| What kind of sutures are used in an episiotomy? | Reabsorbable (chromic and polysorb)
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| 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
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| Ovarian fxn post partum (breast feeding) | Time to first ovulation dependent on breastfeeding practices. Ovulation suppressed due to prolactin. Estrogen levels low
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| Vital signs post partum | BP and pulse. Can bleed and may be intrauterine
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| Squishy uterus | uterine atony
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| Examine postpartum for | uterine atony, excessive bleeding, over-distended bladder, dyspnea/pleuritic pain (PE due to hypercoaguable state), perineal infxn
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| Post Partum mngmnt: Iron supplement for hct< | 30. Pelvic rest for 4-6 weeks
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| Complications of the Post-partum period | Infxn: Endometritis, Wound Infxns, Mastitis
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| 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.
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| Most common cause of malodorous lochia | retained gauze sponge
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| Endometritis Prevention | Assure removal of all placenta and associated membranes. Prophylactic abx reduce the rate of endometritis in high risk patients (C/section)
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| Wound Infxn | 2-20% of C-section. Risk factors: DM, obesity, poor nutrition, immunocompromised, long operative time, emergency surgery
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| Wound infxn tx | drainage, debridement of devitalized tissue, abx not sufficient without drainage
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| Separation and dehiscence | C/S infection uncommon, reduced by prophylactic abx
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| Incision infxn risk factors | Obesity, DM, immunocompromised, anemia, hematomas
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| Mastitis and Engorgement | Enlarged, tender breast postpartum. Let down feels like breasts are going to pop
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| lactogenesis | Results from withdrawal of estradiol & progesterone, tactile stimuli cause release of prolactin and oxytocin
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| Progesterone role | budding & development of acini at ends of ducts of mammary glands
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| Estradiol | promotes growth & branching of mammary gland ducts
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| 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
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| Mastitis Prevention | Nipple hygiene, Active care of cracks and fissures; lanolin or A&D ointment, Early dx and prompt abx therapy
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| Engorgement | after first onset then gradula, bilateral, generalized pain and swelling, no systemic symptoms, no fever
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| mastitis | Sudden onset, unilateral, localized swelling & pain/erythema, feels sick, fever, tx with abx that covers staph
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| Retained Placenta | Expulsion incomplete; greater risk: C/S, Fibroids
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| Placenta accreta: | Placental villi penetrate the uterine wall.
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| Placenta Percreta | complete invasion of the placenta through the uterine muscle
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| Placenta previa | placenta is over the cervix. Can't have a vaginal birth, automatic C-section or you will lose the baby
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| Things that increase risk of DIC | placental abruption, amniotic fluid embolism, severe preeclampsia
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| 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
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| Diaphragms and cervical caps | must be refit after each pregnancy
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| 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
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| 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
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| ______ 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
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| Tx for Maternity Blues | Time, Support of Friends and Family
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| 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
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| Tx of Postpartum Depression | Dependent on severity of symptoms. Support from family & friends; Psychotherapy, perhaps medication. Professional assessment strongly recommended.
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| The strongest association with postpartum depressive symptomatology | Depression level during pregnancy
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| Postpartum Obsessive Compulsive Disorder | Symptoms mostly of disabling intrusive thoughts to harm the baby, typically within two weeks postpartum. Responsive to SSRIs
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| 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?"
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Created by:
ltm12