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40 Cards in this Set

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this is the time from delivery of placenta and membranes to the return of reproductive system to non pregnant condition
pp
when do nonlactating women return of menses
at 6-8 weeks - 45% and at 12 weeks by 75% and within 6 months 100%
when do lactating women return of menses
as early as 12 weeks or not until 18 weeks
what hormone depends on ovulation
prolactin - lactating women have fewer cycles and are anovulatory of first few cycles
when does ovulation occur in nonlacting women PP
50% by 90 days; average is 10 weeks
what is needed in 6 week check ups
complete history, physical and pelvic exam
size of uterus
eval pelvic muscle tone
eval episiotomy
what questions do you ask at the PP visit
Number weeks PP
delivery - type, issues, HTN, DM, weight of baby, GBS

any issues with baby, feelings toward baby
resumption of intercourse, stitches
Breasts: BF, engorgement, how long, diastasis recti
this is a bacterial cellulitis of the breast
mastitis
what are the causes of mastitits
invasion of bacteria - staph or ecoli
trauma - cracked nipples
poor hygiene
what are signs and symptoms of mastitis
fever, malaise, chills, flu-ike symptoms, shooting pain, mild pain in one segment of the breast, worse with nursing

unilateral erythema, tender, warm, swelling, hard lump
what is the medication treatment for mastitis
doxi or cephalexin
what are non-pharmacological treatments for mastitis
continue BF or get worse
supportive bra
rest
fluid intake
tylenol
cabbage leaves
how long to follow up with mastitis
1 week
when does a late PPH occur
after 6 weeks, retained placenta fragements
what are causes of PPH
infection
previously undiagnosed laceration
hematoma
subinvolution t/r thrombosed vessels
inherited coagulopathy
what are s/sx of PPH
pelvic or back pain
uterine tender, boggy, soft
bleeding >2 weeks
heavy foul lochia
fever
open cervical os
how do you manage PPH
consult
CBC, US, lochia culture
Methergine 0.2mg every 4 hours x 3 days
Broad spectrum - doxi or augmenting
FU in 2 weeks
what is subinvolution
delay or incomplete return of uterus size
should be completed by 3d week PP except at placental line - 6 weeks
diagnosed at 6 week visit
what do you see on exam in subinvolution
soft boggy uterus
does not decrease in size
fundal height remains stationary
lochia profuse, reddish brown or heavy bld
need culture of lochia
tenderness - think infection
Uterus should be to symphysis pubis at 9 days
what is treatment for subinvolution
methergine 0.2 every 4 hours for 3 days and broad spectrum abx
when does PP blues occur
2-4 weeks PP
transient, emotional, disturbance
how long does PP blues occur
1-14 days
mild depression
feel overwhelmed unable to cope, fatigue, tearful
what is PP depression
meets criteria for major depression
2-3 weeks PP to one year PP
has to be after 2 weeks PP
what are symptoms of PP depression
slow insidious, over several weeks, begin 2-3 weeks PP
what are RF for PP depression
history of previous
depression
life stress
child care
prenatal anxiety
lack social support
50% has history of PP depression
what is the treatment for PP depression
welbutrin
paxil - cross BM
zoloft

do cross BM
how do you make diagnosis if PP depression
must be around 3 months, not accurate if less than 3 weeks PP
Use Edinburgh PP scale - if >10 score - have depression in 90% of cases
this is a severe PP psychiatric disorder, intense depression and SI
PP psychosis
what symptoms occur in PP psychosis
perception, behavior changes
disorientation
within a few weeks PP to 3 months
requires hospitalization
What are RF for gestational DM II to develop into DM type II
non-caucasian
prepregnancy BMI
increased weight gain during pregnancy
higher PP waist circa
diagnosed with gestational DM before 24 weeks
FH of DM
insulin needed in pregnancy
high FBS
higher OGTT readings
what is the follow up if GDM is diagnosed
at 6 week visit needs FBS and OGTT 75grams
FBS >126 or OGTT >200
if borderline retest yearly
if normal retest every 3 years
what increases RF for PP thyroiditis
DM type I
FH thyroid or autoimmune disorder
Pernicious anemia
Vitiligo
Addisons disease
how is diagnosis made for PP thyroiditis
abnormal TSH and FT4 or antimicrosomal or peroxidase antibody
50% have goiter
when does phase I occur in PP thyroiditis and what are symptoms
1-3 months PP
usually fatigue and palpitations
67% will return euthyroid
when does phase II occur in PP thyroiditis and what are the symptoms
4-9 months
thyroidmegaly and associated symptoms of hypothyroidism
treat medically for at least 12 months
20% will require life long treatment
what are symptoms of thyroid storm
fever
tachy
mental status change
vomit
diarrhea
arrythmia
seizure
coma
what are the labs in thyroid storm
increased FT4 and very low TSH
what are precipitating factors of thyroid storm
labor
infection
pre-eclampsia
CS
noncompliant with meds
what is the treatment for thyroid storm
PTU - block synthesis of T4 to T3
Dexamethasone - decrease TSH release and conversion of T4 to T3
Propanolol - inhibit adrenergic effect of TSH
suppportive - IVF, antipyretics, O2
this occurs in infants of mothers with Graves disease
16% infant mortality
Fetal HR >160 and goiter
neonatal thyrotoxicosis