Questions and Answers
What is the primary definition of postpartum infections?
What is a common symptom of endometritis?
What is the management protocol for treating postpartum infections?
Which of the following is a common reason for wound infections in postpartum women?
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What is the occurrence rate of urinary tract infections in postpartum women?
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Which condition can cause fever but is not considered a true infection?
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What is the primary characteristic of mastitis in postpartum women?
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What is a major cause of morbidity and mortality in obstetric care worldwide?
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Which of the following factors may contribute to pain associated with breastfeeding?
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What is a major complication that can arise from breastfeeding?
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Which condition is a contraindication for breastfeeding?
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When does engorgement typically occur after childbirth?
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How can one effectively treat engorgement?
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Which of the following is not a recommended practice for infected breastfeeding mothers?
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Breastfeeding is generally considered safe even if the mother has which illness?
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What breastfeeding position involves holding the baby under the arm?
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What should be avoided when handling the placenta after childbirth?
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What is the first step in management of postpartum hemorrhage (PPH)?
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Which of the following is a predisposing factor for mastitis?
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In cases of mastitis, which symptom is NOT typically associated?
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What is the purpose of emptying the bladder during PPH management?
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What medication is typically NOT used to treat mastitis?
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Which surgical intervention is NOT indicated for PPH?
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What is a common complication associated with infants born to diabetic mothers?
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Which action is essential for preventing infection in the postpartum period?
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Which condition is characterized by subcutaneous edema over the presenting part of a neonate's head?
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Which of the following is NOT a consequence of hyperinsulinemia in neonates?
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What is the primary risk associated with macrosomia in neonates?
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Which factor is usually responsible for increased bilirubin levels in newborns of diabetic mothers?
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What distinguishes cephalhematoma from caput succedaneum?
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What is the primary purpose of emptying the bladder during treatment for postpartum hemorrhage?
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Which medication is known for potentially causing explosive diarrhea as a side effect?
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What is a surgical intervention for addressing postpartum hemorrhage?
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What are the 4 T's that are commonly referenced as causes of postpartum hemorrhage?
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What is the recommended approach for managing obstetric hemorrhage according to safety bundles?
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What does subinvolution of the uterus refer to?
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Which of the following is NOT a nursing intervention for managing postpartum hemorrhage?
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What might be a sign of subinvolution of the uterus?
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Study Notes
Postpartum Infections
- Puerperal infection is any genital tract infection occurring within 28 days after pregnancy-related events like miscarriage or childbirth.
- Fever of 38° C (100.4° F) in the first 10 days postpartum, excluding the first 24 hours, indicates possible infection.
- Endometritis is the most common postpartum infection, characterized by uterine lining infection, fundal tenderness, and fever.
- Management includes IV broad-spectrum antibiotics like Gentamicin and Clindamycin, treatment for 24 hours afebrile.
- Wound infections develop post-discharge, particularly after cesarean births, with infection rates at 3% to 5%.
- Urinary Tract Infections (UTIs) occur in 2% to 4% of postpartum women, presenting as dysuria and suprapubic pain.
Postpartum Hemorrhage (PPH)
- Major cause of obstetric morbidity and mortality globally; leading reason for ICU admissions.
- Immediate interventions include calling for help, using the hemorrhage cart, and starting isotonic IV fluids.
- Uterotonics such as Pitocin, Hemabate, Methergine, and Cytotec are critical for managing PPH.
- Assessment and management involve CBC testing, bladder emptying, physical pressure techniques, and possible surgical intervention.
- The "4 T's" of PPH causes include Tone, Trauma, Tissue, and Thrombin, with Tone referring to uterine contractions.
Causes and Management of PPH
- Subinvolution of the uterus leads to delayed return to nonpregnant state; signs include boggy uterus and excessive lochia.
- Inversion of the uterus is a rare, life-threatening condition where the uterus turns inside out during delivery.
- Essential management steps include firm uterine massage, IV fluids, and administration of uterotonics.
Best Practices and Protocols
- Institutions should have standardized protocols for managing obstetric hemorrhage and conduct regular emergency drills.
- Early recognition and treatment of PPH are critical for patient safety.
- The California Maternal Quality Care Collaborative provides a safety bundle that includes readiness, recognition, response, and reporting.
Mastitis
- Symptoms include flu-like symptoms, localized breast pain, and redness, typically occurring 2-4 weeks postpartum.
- Predisposing factors include inadequate breast emptying and cracked nipples, which allow bacteria to enter.
- Treatment involves bed rest, antibiotics (dicloxacillin, cephalexin), and continued breastfeeding.
- Preventive education on recognizing mastitis signs is crucial for new mothers.
Contraindications to Breastfeeding
- Galactosemia in newborns and maternal infections like HIV, untreated brucellosis, active tuberculosis, and herpes lesions are contraindications.
- In developing countries, the benefits of breastfeeding may outweigh the risks of HIV.
Breastfeeding Positions and Engorgement
- Proper breastfeeding positions can reduce pain; options include football hold, across the lap, cradle, or side-lying.
- Engorgement results from temporary congestion of vessels and can be managed with ice packs and cabbage leaves.
- Engorgement typically resolves within 24 hours with appropriate intervention.
Complications for Infants of Diabetic Mothers
- Infants may experience hyperinsulinemia, congenital anomalies, respiratory distress, and hypoglycemia.
- Increased risks of hyperbilirubinemia and polycythemia due to elevated red blood cell count in diabetic mothers.
Assessment of the Neonate’s Head
- Caput succedaneum presents as subcutaneous edema from birth pressure; it crosses sutures.
- Cephalhematoma is a subperiosteal blood collection, not crossing suture lines.
- A subgaleal hemorrhage is significant bleeding into the potential space, which can contain up to 240 mL of blood.
General Care Measures
- Strict adherence to aseptic techniques during childbirth and postpartum is vital for preventing infections.
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Description
This study guide focuses on postpartum infections, also known as puerperal infections, which can occur within 28 days following birth, miscarriage, or abortion. It highlights key signs such as fever and increased heart rate, as well as the importance of monitoring the mother's health during the postpartum period.
