Postpartum Care And Complications

Front 1

3 concerns after vaginal delivery

Back 1

1. pain control (NSAIDS, acetaminophen, low dose opioids)
2. perineal care - ice packs for pain,edema, make sure episiotomy repair intact and o hematomas

hemerrhoids

Front 2

Routine post c/s care

Back 2

1. wound care - infections, abscess, separations
2 pain control w/opioids - can contribute to ileus or constipation (give stool softeners, laxatives)
3. 1st or second gen cephalo for infection prophylaxis

Front 3

Breastfeeding

when does letdown occur

Back 3

24-72 hrs postpartum

breasts become warmer, firmer, more tender

Front 4

recommended options for homonal contraceptives in patients who are breastfeeding

effect of OCPs

Back 4

progesterone-only mini pill, depo-provera, or implantable progestogenic agents

decrease milk production

Front 5

6 common complications to vaginal delivery

Back 5

postpartum hemorrhage
vaginal hematoma
cervical laceration
retained POCs
mastitis
postpartum depression

Front 6

common complications to c/s

Back 6

postpartum hemorrhage
surgical blood loss
wound infection
endymyometritis
mastitis
postpartum depression

Front 7

Postpartum complications
a. first 24 hrs
b. first week-10days
c. 1-2 weeks, breastfeeding

Back 7

a. postpartum hemorrhage
b. endomyometritis and wound complications
c. mastitis

Front 8

postpartum hemorrhage

a. defn
b. early
c. late or delayed
d. common causes
e. treatment

Back 8

a. 500 mL blood loss (vaginal) or 1000 mL (c/s)
b. first 24 hrs
c. after 24hrs
d. uterine atony, retained POCs, accreta, cervical/vaginal lacerations
e. fluids, prepare for transfusion

Front 9

Conditions associated with postpartum hemorrhage

Back 9

coagulopathy (if you lose 2-3 L blood), Sheehan (pituitary infarct)

Front 10

Retroperitoneal hematoma
a. presenting symptoms
b. diagnosis
c. treatment if signs worsen

Back 10

a. lower back pain or rectal pain + drop in Hct
b. ultrasound or CT
c. embolize bleeding, surgical ligation

Front 11

Cervical lacerations

common cause

Back 11

rapid dilation of the cervix during stage 1 of labor or maternal expulsive efforts prior to complete dilation of the cervix

Front 12

THe leading cause of postpartum hemorrhage

risk factors

Back 12

uterine atony

chorioamnionitis, mag sulfate, mult gestations, macrosomic fetus, polyhydramnios, prolonged labor, history of atony, multiparous

Front 13

dx uterine atony

treatment

Back 13

soft, enlarged, boggy uterus on palpation

-IV oxytocin, uterine massage
-If atony continues, methylergonovine (contra in HTN)
-If still, Hemabate (PGF2a contra in asthma)
-if still, D&C
-uterine packing with a baloon or occlusion of pelvic vesels

Front 14

Endomyometritis
a. increased in what instances
b. dx

Back 14

chorioamnionitis, meconium, prolonged ROM

b. fever, WBCs, uterine tenderness, higher suspcian after c/s 5-10 days afterdelivery --> Ultrasound

Front 15

Endomyometritis

Treatment

Back 15

broad spectrum IV antibiotics, triple antibiotics

If retained POCs, D&C

Front 16

Wound infections

cellulitis dx

rx

Back 16

local erythema around surgical site (c/s, perineal laceration, episiotomy), tender/warm, or if erythema expands over 12 -24 hrs

broad spectrum Abs

Front 17

What if suspected cellulitis does not respond to Abs, pus from wound, or palapble collection within the incision

dx.

treat?

Back 17

wound abscess

I&D, wound cleaning, packing, antibiotcis

Front 18

one hallmark sign of necrotizing facciiitis secondary to cellulitis

Back 18

pain goes away but lesion looks the same (nerve damage)

--> surgical resection of necrotic tissue