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33 Cards in this Set
- Front
- Back
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When is breast engorgement most commonly noted postpartum and what are symptoms and tx…
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w/in 1st week. Breast pain and induration and maybe low grade fever. Tx with feedings around the clock. Tx: breast binders, ice packs, analgesics
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In what week does PP mastitis occur, S/S and tx…
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2-4 week. S/S: malaise, fever, chills, tachycardia, red/tender/swollen breast and NO fluctuance (that means abscess). Tx: anti-staph med like dicloxacillin and continue breast feeding to prevent abscess
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S/S worrisome of PP breast abscess… diagnosis and tx…
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Fever for >48hrs after initiation of abs. US performed to diagnose and drainage and abs for tx.
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How tell between a galactocelle and other breast pathology…
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In post partum period you see a non-erythematous fluctuant breast mass
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Contraindications to breast-feeding:
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Classic galactosemia, mothers with untreated TB or HIV, others receiving diagnostic or therapeutic doses of radiation, mothers receiving antimetabolits or chemo, street drugs, herpes lesions of breast
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Best treatment for cracked nipples..
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Air dry and avoid harsh soap
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Tx of thyroid storm…
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Beta blocker, corticosteroids (prevent T4—T3), and PTU. Avoid KI drops (which are usually used) in pregnancy because they can affect fetal thyroid
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S/S of thyrotoxicosis and diagnosis…
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Tachycardia, heat intol, N, wt loss, thyromegaly, thyroid bruit, termor, exophthalmos, systolic HTN. Diagnosis based on elevated free thyroxine w/ low TSH levels
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Why is methimazole not used to tx hyperthyroid in pregnancy…
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While both PTU and MM cross placenta somewhat, MM is associated w/ aplasia cutis (skin or scalp defects).
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S/S of thyroid storm…
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AMS, hyperthermia, HTN, diarrhea
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What is hyperthyroid effect on heart…
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Thyroxine can cause CHF
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Failure to identify fetal thyrotoxicosis can result in… how is fetal hyperthyroid or hypothyroid prevented…
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Can result in nonimmune hydrops and fetal demise. Mom should be tx with PTU or injection of intraamniotic thyroxine if hypothyroid
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How does pregnancy effect thyroid status and why…
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Due to estrogen, increases thyroid binding globulin and total T4 but does NOT change active or free T4 or TSH
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What is most common cause of hyperthyroidism in postpartum period…
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Destructive lymphocytic thyroiditis, caused by drop in high corticosteroid levels in pregnancy that were suppressive to antibodies
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In testing woman for chlamydia, what is test of choice and why…
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DNA test because cultures and more expensive
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Erythromycin eye ointment given at birth protects against…
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Gonorrhea conjunctivitis but NOT Chlamydia. Chlamydia is txd w/ amoxicillin, azithromycin, or erythromycin and testing is done in 3rd trimester
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What is the most common cause of conjunctivitis in the 1st month of life… what is responsible for most late postpartum endometritis…
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Chlamydia and Chlamydia. Note: Chlamydia is NOT responsible for preterm labor or prematurity
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Gonococcal cervicitis is associated w/ what in pregnancy and how differ from Chlamydia..
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Abortion, preterm labor and PPROM, chorioamnionitis, neonatal sepsis. All these are usually not caused by gonorrhea. Also, topical erythromycin ointment for babies does tx gonorrhea but NOT Chlamydia.
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Most common mode of transmission of HIV in women…
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Heterosexual spread. 2nd is IV drug use
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Goal of viral load of HIV in pregnancy of inflicted…
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Under 1000RNA copies per mL
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Characteristics of Chlamydia and its infxn…
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Not usually seen on gram stain cuz its obligate intracellular organism. Has propensity for columnar and transitional epithelium, leading cause of preventable blindness worldwide
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When does C-sxn need to be performed to prevent transmission of HIV in infected mother… if no C-sxn, then what is next line of therapy…
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Prior to ROM and labor. If labor already begun then give IV ZDV and minimize trauma to baby (no scalpe electrode or intrauterine pressure catherters for forceps. Give oral ZDV syrup to baby
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How does parvovirus infxn differ between adult and child..
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Adult has fever, reticular lacy rash that comes and goes and myaglias. Kids will have high fever and red cheeks
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MOA, S/S, diagnosis, and tx of parvoB19 infxn in pregnancy…
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Virus causessuppression of erythrocyte prodxn leading to anemia of fetus. Hydramnios devops cuasing incr uterine size w/ fetal parts difficult to palpate. Often a sinusoidal HR pattern shows up. US shows fetal and amnio fluid defects and serology makes diagnosis. Tx is intrauterine transfusions
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What is incubation time of parvovirus and what shows up after this time…
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20 days, IgM should show up
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Fetal hydrops…
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Excess fluid in body cavities such as ascites, skin edema, pericardial effusion, pleural effusion
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Causes of fetal anemia… what is a characteristic of this on monitoring
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Parvovirus infxn, isoimmunization (Rh- woman), large fetal-maternal hemorrhage, thalassemia. Sinusoidal wave is characteristic as it is for asphyxiation
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Causes of hydramnios…
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Fetal CNS abnorms, fetal GI tract malformation, fetal chromosome abnorms, fetal nonimmune hydrops, maternal diabetes, isoimmunization, multiple gestation, syphilis
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RFs for PP endomyometritis…
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Long labor, intrauterine pressure catheter, numerous vaginal exams
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Classical picture of endomyometritis…
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Fever after C-sxn with no other focus of infxn
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S/S, MOA, diagnosis and tx of endomyometritis…
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Fever 24 hrs post C-sxn. Caused by ascending infxn of mixedbacteria (esp anaerobes like bacteroides), patient complains of abd pain and foul smelling lochia w/ uterine tenderness. Tx w/ IV gentamicina nd clinda. If fever persists after 48 hrs then start ampicillin to cover enterococci
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MOA, S/S, diagnosis and tx of septic pelvic thrombophlebitis…
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Bacterial infxn speading from placental implantation site into thrombosed uterine vein. Get hectic fever but look well, sometimes have palpable pelvic mass. Diagnosis by CT or MRI. Tx with antimicrobials and maybe heparin
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In case of post-Csxn fever that is unresponsive to gent + clinda after 48 hrs then also unresponsive to addition of ampicillin for enterococci, what is possible etiology and next step…
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Consider CT to assess for abscess, infected hematoma, or septic pelvic thrombophlebitis
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