Women's Health (Exam 3) - Postpartum Period

When physiologic changes of pregnancy return to non-pregnant state

postpartum

Postpartum can vary ____wks to _____mo after birth

6, 12

“postpartum blues”:

•Resolves within _____days

•Increases risk of ______

14, PPD

Postpartum Breast:

•“Milk comes in” ______days PP (typically _______ hours)

•Breast _____________ indicates onset

1-7, 24-72, engorgement

Uterine involution: from approximately umbilicus to nonpregnant size by _____weeks postpartum

6-8

C-section incision: keep clean, OK to shower w/in _______ if wound is well-approximated and closed

48hrs

Postpartum vaginal dryness due to _____________ state in breastfeeding

hypoestrogenic

Return to ovulation is typically ________ days PP in nonlactating pts

45-90

Postpartum Bleeding (lochia):

•Lochia _________: red/red-brown

•Lochia _________: watery, pinkish-brown

•Lochia _________: yellowish-white

rubra, serosa, alba

Avoiding intercourse for _______ PP

6wks

management of perineal pain postpartum

NSAIDs, acetaminophen

C section pain management

NSAIDs, acetaminophen, nerve block, neuraxial analgesia, opioids

Shivering immediately postpartum for up to _________

1hr

Hair loss (typically back to normal pattern ________ PP)

6-15mo

when to seek PP care:

•Excessive postpartum bleeding (eg, bleeding that saturates a peripad within _________).

•Any signs of ________

•New or worsening perineal or uterine ________

•Dysuria

•_________ problems

•Dyspnea, chest pain, leg pain or swelling

•Significant __________ disturbance

•Any ___________ Pain

1hr, sepsis, pain, breast, mood, severe

PPD onset can occur _________ or __________ pregnancy

before, during

S/Sx:

•Anger

•Delayed bonding

•Intrusive thoughts

•Poor hygiene

•Excessive crying

•Lack of interest in infant

PPD

PPD screening should be done at least once at a _____________ visit

postpartum

PPD risk factors:

•Prior h/o ___________ during or pre-pregnancy

•_________ age

•_________ marital status

•Multiparity

•Stressful life evets

•IPV

•______________ difficulties

depression, young, single, breastfeeding

Adverse consequences of PPD:

•Poor ___________ and health in the child

•Interference with _____________

•Delayed maternal-infant ___________

•Interference with _________ of children

•Discord in relationship with ____________

•Abnormal development in children

•___________ impairment in children

•Psychopathology in children

nutrition, breastfeeding, bonding, care, partner, cognitive

PPD med

zuranolone x14d

______________ Postnatal Depression Scale

Edinburgh

Rapid onset of psychotic symptoms, including:

•Hallucinations and delusions

•Bizarre behavior

•Disorganization

•Confusion

postpartum psychosis

Risk factors: bipolar disorder, schizophrenia, schizoaffective disorder, sleep deprivation

postpartum psychosis

Persistent severe insomnia is often 1st sign (most often onsets within 2 weeks of delivery)

postpartum psychosis

postpartum psychosis meds:

•__________ and ___________ if pt can tolerate oral meds

•___________ if needs parenteral

lithium, antipsychotic, haloperidol

PMADs (perinatal mood and anxiety disorders):

•Perinatal __________ disorder

•Perinatal __________

•Perinatal __________

•Perinatal __________ disorder

panic, OCD, PTSD, bipolar

Recommend exclusive breastfeeding for the first ______ of life, and continuing with solids food until at least _______

6mo, 12mo

Benefits of breastfeeding to mother:

•Short-term: accelerated _________ recovery, __________

•Long-term _______________ for breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, DMT2

uterine, contraception, reduction in risk

localized duct narrowing from edema due to high milk production with insufficient removal (Tight clothing can contribute to formation)

clogged ducts

Tender, painful, palpable lump without systemic symptoms

clogged ducts

Management of Clogged Ducts:

•Feed ___________ from breast but avoid completely __________

•__________ compress

•Very gentle ____________

•NSAIDs and acetaminophen for discomfort

frequently, emptying, cool, massage

Localized inflammation of the breast (Most often secondary to breastfeeding)

mastitis

S/Sx:

•Firm, red, tender area of the breast, and

•Systemic "flu-like" symptoms such as fever, malaise

mastitis

abx for mastitis

dicloxacillin OR cephalexin

Collection of pus in breast tissue, typically preceded by mastitis

breast abscess

MC pathogen of breast abscesses

s aureus

breast abscess tx:

•Drainage with _________ aspiration or __________ drainage

•abx

•Continue regular ___________

needle, surgical, breastfeeding

breast abscess abx

dicloxacillin OR cephalexin

Postpartum infection of the decidua

endometritis

Risk factors

•C-section

•Chorioamnionitis

•Prolonged labor

•Prolonged ROM

•GBS +

endometritis

S/Sx:

•Fever

•Uterine tenderness

•Tachycardia

•Midline lower abdominal pain

•Uterine or abdominal pain or tenderness without other identifiable cause

•Purulent drainage from uterus

endometritis

endometritis dx

clinical, blood cultures

inpatient tx of endometritis

clinda AND gent (IV)

outpatient tx of endometritis

augmentin (x14d)

Lack of expulsion of placenta within 30 minutes following birth of infant

retained products of conception

3 types of retained products of conception:

•_________ or ___________: placenta is separated but still in uterus b/c cervix has begun to close

•Placenta __________: placenta is adhered to uterine wall but easily removed manually

•Placenta ____________ spectrum

trapped, incarcerated, adherens, accreta

management of retained products of conception w severe bleeding

manual removal of placenta

management of retained products of conception w/o severe bleeding:

•Expectant management up to _______ post-delivery of infant

•____________ to relax uterus if contraction is preventing release

•Manual ___________ with regional or general anesthesia, prophylactic _______, and ___________ for bleeding

1hr, nitroglycerin, extraction, abx, oxytocin

management of retained products of conception following Incomplete or failed extractions:

•_________ removal

•D&C

•_____________ in emergency for placenta accreta spectrum

forceps, hysterectomy