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18 Cards in this Set
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3 concerns after vaginal delivery
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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 |
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Routine post c/s care
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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 |
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Breastfeeding
when does letdown occur |
24-72 hrs postpartum
breasts become warmer, firmer, more tender |
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recommended options for homonal contraceptives in patients who are breastfeeding
effect of OCPs |
progesterone-only mini pill, depo-provera, or implantable progestogenic agents
decrease milk production |
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6 common complications to vaginal delivery
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postpartum hemorrhage
vaginal hematoma cervical laceration retained POCs mastitis postpartum depression |
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common complications to c/s
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postpartum hemorrhage
surgical blood loss wound infection endymyometritis mastitis postpartum depression |
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Postpartum complications
a. first 24 hrs b. first week-10days c. 1-2 weeks, breastfeeding |
a. postpartum hemorrhage
b. endomyometritis and wound complications c. mastitis |
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postpartum hemorrhage
a. defn b. early c. late or delayed d. common causes e. treatment |
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 |
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Conditions associated with postpartum hemorrhage
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coagulopathy (if you lose 2-3 L blood), Sheehan (pituitary infarct)
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Retroperitoneal hematoma
a. presenting symptoms b. diagnosis c. treatment if signs worsen |
a. lower back pain or rectal pain + drop in Hct
b. ultrasound or CT c. embolize bleeding, surgical ligation |
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Cervical lacerations
common cause |
rapid dilation of the cervix during stage 1 of labor or maternal expulsive efforts prior to complete dilation of the cervix
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THe leading cause of postpartum hemorrhage
risk factors |
uterine atony
chorioamnionitis, mag sulfate, mult gestations, macrosomic fetus, polyhydramnios, prolonged labor, history of atony, multiparous |
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dx uterine atony
treatment |
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 |
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Endomyometritis
a. increased in what instances b. dx |
chorioamnionitis, meconium, prolonged ROM
b. fever, WBCs, uterine tenderness, higher suspcian after c/s 5-10 days afterdelivery --> Ultrasound |
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Endomyometritis
Treatment |
broad spectrum IV antibiotics, triple antibiotics
If retained POCs, D&C |
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Wound infections
cellulitis dx rx |
local erythema around surgical site (c/s, perineal laceration, episiotomy), tender/warm, or if erythema expands over 12 -24 hrs
broad spectrum Abs |
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What if suspected cellulitis does not respond to Abs, pus from wound, or palapble collection within the incision
dx. treat? |
wound abscess
I&D, wound cleaning, packing, antibiotcis |
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one hallmark sign of necrotizing facciiitis secondary to cellulitis
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pain goes away but lesion looks the same (nerve damage)
--> surgical resection of necrotic tissue |