Podcast
Questions and Answers
What temperature indicates postpartum fever?
What temperature indicates postpartum fever?
What is the expected change in the uterus's position after delivery?
What is the expected change in the uterus's position after delivery?
Which factor increases the risk of metritis after vaginal delivery?
Which factor increases the risk of metritis after vaginal delivery?
What is a normal finding in the healing of the perineum postpartum?
What is a normal finding in the healing of the perineum postpartum?
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Which symptom suggests the possibility of an infection postpartum?
Which symptom suggests the possibility of an infection postpartum?
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What is expected regarding white blood cell levels immediately after birth?
What is expected regarding white blood cell levels immediately after birth?
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Which condition is NOT a differential diagnosis for postpartum fever?
Which condition is NOT a differential diagnosis for postpartum fever?
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Why might a mild temperature increase occur on days 2-3 postpartum?
Why might a mild temperature increase occur on days 2-3 postpartum?
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What is a common assessment tool for identifying infections in a hospital setting postpartum?
What is a common assessment tool for identifying infections in a hospital setting postpartum?
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Which of the following conditions may elevate the risk for chorioamnionitis?
Which of the following conditions may elevate the risk for chorioamnionitis?
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Which of the following symptoms is most indicative of mastitis?
Which of the following symptoms is most indicative of mastitis?
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What is commonly associated with a pelvic infection in the postpartum period?
What is commonly associated with a pelvic infection in the postpartum period?
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What treatment is first-line for mastitis?
What treatment is first-line for mastitis?
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What symptom differentiates acute pyelonephritis from a regular urinary tract infection?
What symptom differentiates acute pyelonephritis from a regular urinary tract infection?
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What is the primary management strategy for dehydration postpartum?
What is the primary management strategy for dehydration postpartum?
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Which bacteria is commonly associated with mastitis?
Which bacteria is commonly associated with mastitis?
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A post cesarean patient experiencing respiratory complications may be at risk for which of the following?
A post cesarean patient experiencing respiratory complications may be at risk for which of the following?
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What is NOT a symptom of endometritis?
What is NOT a symptom of endometritis?
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What is a common result of incorrect attachment of the baby to the breast?
What is a common result of incorrect attachment of the baby to the breast?
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Which of the following is NOT typically included in the treatment plan for an acute urinary tract infection?
Which of the following is NOT typically included in the treatment plan for an acute urinary tract infection?
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What is the recommended frequency for breastfeeding a term and healthy baby?
What is the recommended frequency for breastfeeding a term and healthy baby?
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What should a mother do if her baby cannot fully empty her breasts?
What should a mother do if her baby cannot fully empty her breasts?
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Which of the following is a sign that a baby is getting enough food?
Which of the following is a sign that a baby is getting enough food?
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To build and maintain milk supply, what is the target amount of breastmilk by the end of the first week?
To build and maintain milk supply, what is the target amount of breastmilk by the end of the first week?
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What is an appropriate way to wake a sleeping baby for breastfeeding?
What is an appropriate way to wake a sleeping baby for breastfeeding?
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What happens to stool frequency in a baby after the first month of life?
What happens to stool frequency in a baby after the first month of life?
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What is the optimal daily total of breastmilk by weeks 2 or 3?
What is the optimal daily total of breastmilk by weeks 2 or 3?
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How can mothers gradually reduce pumping during breastfeeding?
How can mothers gradually reduce pumping during breastfeeding?
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What is a breastfeeding crisis or growth spurt primarily characterized by?
What is a breastfeeding crisis or growth spurt primarily characterized by?
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What is a late sign of hunger in a baby?
What is a late sign of hunger in a baby?
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What should mothers do during the early days postpartum to support breastfeeding?
What should mothers do during the early days postpartum to support breastfeeding?
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At what ages are growth spurts most commonly expected in infants?
At what ages are growth spurts most commonly expected in infants?
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What should reassure a mother that breastfeeding is going well during growth spurts?
What should reassure a mother that breastfeeding is going well during growth spurts?
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What misconception may arise during a breastfeeding crisis?
What misconception may arise during a breastfeeding crisis?
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How do growth spurts benefit milk production?
How do growth spurts benefit milk production?
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What is an effect of introducing supplementary fluids or foods during perceived insufficient milk supply?
What is an effect of introducing supplementary fluids or foods during perceived insufficient milk supply?
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Which sign indicates that a breastfeeding baby is likely content during growth spurts?
Which sign indicates that a breastfeeding baby is likely content during growth spurts?
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Why might mothers mistakenly think they have a low milk supply during growth spurts?
Why might mothers mistakenly think they have a low milk supply during growth spurts?
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What behavior should mothers avoid when they suspect a breastfeeding crisis?
What behavior should mothers avoid when they suspect a breastfeeding crisis?
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What is the primary way to increase milk production in breastfeeding mothers?
What is the primary way to increase milk production in breastfeeding mothers?
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What should mothers consider if they notice sore, cracked nipples while breastfeeding?
What should mothers consider if they notice sore, cracked nipples while breastfeeding?
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How can skin-to-skin contact benefit a breastfeeding mother and her baby?
How can skin-to-skin contact benefit a breastfeeding mother and her baby?
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What is a good indicator that an infant is receiving enough milk?
What is a good indicator that an infant is receiving enough milk?
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Why is it important for breastfeeding mothers to ensure an effective latch?
Why is it important for breastfeeding mothers to ensure an effective latch?
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Which foods are commonly considered galactagogues to promote milk production?
Which foods are commonly considered galactagogues to promote milk production?
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What might be a side effect of taking domperidone for milk production?
What might be a side effect of taking domperidone for milk production?
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What is the recommended frequency of breastfeeding during the early weeks for optimal milk production?
What is the recommended frequency of breastfeeding during the early weeks for optimal milk production?
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What is the effect of supplementation with formula on a mother's milk supply?
What is the effect of supplementation with formula on a mother's milk supply?
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What is the recommended action if there is no increase in milk production by day five postpartum?
What is the recommended action if there is no increase in milk production by day five postpartum?
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Study Notes
Postpartum Fever
- Definition: Body temperature above 38°C (100.4°F) on at least two occasions.
History Taking and Clinical Assessment
- Vital Signs: Temperature range 36.5-37.5°C, heart rate 60-100 bpm, blood pressure 100/60-140/90 mmHg.
- Pain and Comfort: Mild afterpains, pain at perineal trauma site, abdominal pain.
- Uterus: Firm at umbilicus, reducing by 1 cm daily, non-tender. Retained placenta is a possibility.
- Bleeding/Discharge: Non-malodorous, reducing lochia (from rubra to serosa).
- Wound Healing: Perineum: mild edema and redness, well-approximated; incision: dry, intact, no discharge;
- Bladder and Bowel function, genitourinary tract: Mild urinary incontinence, delayed bowel.
- Breasts and Nipples: Minor temperature elevation possible during milk production (day 2-3 postpartum), but rarely exceeding 38°C.
- Specific Questions for Client: Chills, dysuria, flank pain, erythema, wound drainage, respiratory issues, perineal/abdominal pain, foul-smelling discharge, breast engorgement.
Potential Infections Timeline and Risk Factors
- Infection Risk Increases: Varies depending on the infection; some more likely in the first 24 hours (potentially serious pelvic infection).
- White Blood Cells: Expected increase at birth.
- Diagnostic Testing: Complete blood count (CBC) useful in hospital setting, but not always necessary outside.
- Delivery Route: Vaginal delivery increases risk for metritis and perineal infection; Cesarean section also carries risks.
- Labor Duration: Prolonged labor increases metritis risk.
- ROM Duration: >24hrs increases risk.
- Cervical Examinations: Increased frequency of examinations increases risk of infection.
- Fetal Monitoring: Internal fetal monitoring increases risk.
- Socioeconomic Factors may contribute.
- Maternal Age: Young maternal age is a risk factor.
- Nulliparity: First-time mothers are at higher risk.
- Labor Induction: Prolonged labor induction increases risk.
- Chorionamnionitis (Chorioamnionitis): Potential risk.
- Obesity: Increased risk.
- Group B Streptococcus (GBS) status: Important factor.
- Meconium Stained Amniotic Fluid: Indicative of potential fetal distress.
- Placental conditions: Assess properly.
Differential Diagnoses
-
Intrauterine Infections: Endometritis, endomyometritis, and parametrite are possible.
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Breast Infections: Breast engorgement is common postpartum (particularly with non-breastfeeding); mastitis.
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Mastitis: Inflammation of the breast caused by milk stasis. Redness, tenderness, flu-like symptoms (fatigue, headache, muscle aches), fever, chills likely.
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Urinary Infection/Acute Pyelonephritis: Associated with normal postpartum diuresis.
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Perineal/Wound Infections: Episiotomies, lacerations, incision sites are common sites for infection (especially MRSA).
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Pelvic Infection: Vagina, uterus, fallopian tubes infections are possible, especially with high fever (>39°C) in first 24 hours, potentially severe (Streptococcus group A).
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Dehydration: Fever with headaches, fatigue; treated with oral/IV hydration, analgesics, and rest.
Treatment and Management
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Mastitis (S. Aureus): Symptoms include breast tenderness, erythema, flu-like symptoms, fever.
- Treatment: Frequent breastfeeding/pumping for affected breast, warm compresses, over-the-counter pain relievers, rest, fluids, antibiotics (Cephalexin, Cloxacillin, Clindamycin, Amoxicillin-clavulanic acid) if symptoms persist.
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Acute UTI/Pyelonephritis: Symptoms: pelvic pressure, dysuria, pyrexia, chills, malaise.
- Treatment: Antibiotics, anti-pyretics, hydration, increased urination (frequent urination).
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Postpartum Wound Infection (perineal or C-section): Symptoms:
- Treatment: Antibiotics, anti-pyretics, hydration, open air.
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Endometritis: Symptoms: tender, soft, subinvoluted uterus, chills, malaise, foul-smelling lochia.
- Treatment: Antibiotics, anti-pyretics, hydration.
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Dehydration: Symptoms: headache, fatigue.
- Treatment: Oral/IV hydration, analgesics, rest.
Important Diagnostics
- CBC (Complete Blood Count): May indicate leukocytosis (15,000-30,000 cells/µL).
- Other Lab Tests: Cytokines (interleukins, lymphokines), lactoferrin, and sIgA levels may also be evaluated.
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Description
This quiz covers the clinical assessment and history taking for postpartum fever. It includes vital signs, pain management, and evaluations of the uterus, bleeding, and wound healing. Test your knowledge on recognizing and addressing complications in the postpartum period.
