time period following childbirth when the mother's uterus shrinks and the other functional and anatomic changes of pregnancy are resolved
How long is the puerperium?
6-8weeks
Indications for a puerperium us?
RPOC
postpartum hemorrhage
inflammatory complications
ovarian vein thrombophlebitis
C-section incision survey (hematomas/abscess)
assess uterine involution for obese patients
Postpartum endometrial measurements:
5-13mm
10 days past 3-6
puerperium uterus measurements
14-25 cm X 7-10cm X 7-14cm
How many ligaments support the uterus?
8
Is there a difference in regression size of uterus with breastfeeding and bottle-feeding mothers?
NO
You see echogenic material and some fluid in the endometrium 1 week post delivery. What may you think?
RPOC
may appear complex mass / may have some blood flow
Postpartum hemorrhage would be defined as bloodloss > __________?
500ml
What is the most lethal puerperium complication?
postpartum hemorrhage
35% of maternal deaths
Common causes of puerperium hemorrhage? (7)
uterine atony
vag/cx tears
RPOC
placenta previa
placenta accreta
uterine rupture
hereditary blood clotting abnormalities
2 types of pp hemorrage?
delayed
acute (first 24 hrs)
Define: Lochia
substance discharged from the vagina (cellular debris and mucus and blood) that gradually decreases in amount during the weeks following childbirth
Acute hemorrhage usually caused by:
RPOC
Define: secudines
The afterbirth
Causes of delayed hemorrhage?
secudines
subinvolution
Define: uterine atony
Uterine atony is a loss of tone in the uterine musculature.
Define: subinvolution
Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size.
Define: puerperal infection
The term puerperal infection refers to a bacterial infection following childbirth.
Define: Endometritis
inflammation of the lining of the uterus (of the endometrium)
caused by retained secudines or vag microorganisms
Define: thrombophlebitis
phlebitis in conjunction with the formation of a blood clot (thrombus)
_________% ovarian vein thrombophlebitis are __________ sided.
90%
Right
(usually occurs 1st few days after delivery)
CT & MRI exams of choice
Other postpartum complications: Uterine & Parauterine collections: HULA
hematoma
urinoma
lymphocele
abscess
Name common types of hematomas post C-section: (4)
1. incisional
2. rectus sheath
3. subfacial
4. bladder flap (potential space between uterus & bladder)
Define: febrile
of or relating to or characterized by fever
Where is the MC site of uterine rupture?
previous C-section scar
When the puerperium endometrium is >________ you being to call it bulky.
14
Define: VBAC
vaginal birth after C-section
What is the fastest incision to get a baby out?
vertical
Define: encarcerated uterus
In a small percentage of cases, the growing uterus is 'snagged' on pelvic bone ( usually the sacrum). This condition is known as 'incarcerated uterus'.
Pursestring sutures aka?
Shirdokar
Define: Lithotomy position
a position lying on your back with knees bent and thighs apart; assumed for vaginal or rectal examination