PP

pp

at 6-8 weeks - 45% and at 12 weeks by 75% and within 6 months 100%

as early as 12 weeks or not until 18 weeks

prolactin - lactating women have fewer cycles and are anovulatory of first few cycles

50% by 90 days; average is 10 weeks

complete history, physical and pelvic exam
size of uterus
eval pelvic muscle tone
eval episiotomy

Number weeks PP
delivery - type, issues, HTN, DM, weight of baby, GBS

any issues with baby, feelings toward baby
resumption of intercourse, stitches
Breasts: BF, engorgement, how long, diastasis recti

mastitis

invasion of bacteria - staph or ecoli
trauma - cracked nipples
poor hygiene

fever, malaise, chills, flu-ike symptoms, shooting pain, mild pain in one segment of the breast, worse with nursing

unilateral erythema, tender, warm, swelling, hard lump

doxi or cephalexin

continue BF or get worse
supportive bra
rest
fluid intake
tylenol
cabbage leaves

1 week

after 6 weeks, retained placenta fragements

infection
previously undiagnosed laceration
hematoma
subinvolution t/r thrombosed vessels
inherited coagulopathy

pelvic or back pain
uterine tender, boggy, soft
bleeding >2 weeks
heavy foul lochia
fever
open cervical os

consult
CBC, US, lochia culture
Methergine 0.2mg every 4 hours x 3 days
Broad spectrum - doxi or augmenting
FU in 2 weeks

delay or incomplete return of uterus size
should be completed by 3d week PP except at placental line - 6 weeks
diagnosed at 6 week visit

soft boggy uterus
does not decrease in size
fundal height remains stationary
lochia profuse, reddish brown or heavy bld
need culture of lochia
tenderness - think infection
Uterus should be to symphysis pubis at 9 days

methergine 0.2 every 4 hours for 3 days and broad spectrum abx

2-4 weeks PP
transient, emotional, disturbance

1-14 days
mild depression
feel overwhelmed unable to cope, fatigue, tearful

meets criteria for major depression
2-3 weeks PP to one year PP
has to be after 2 weeks PP

slow insidious, over several weeks, begin 2-3 weeks PP

history of previous
depression
life stress
child care
prenatal anxiety
lack social support
50% has history of PP depression

welbutrin
paxil - cross BM
zoloft

do cross BM

must be around 3 months, not accurate if less than 3 weeks PP
Use Edinburgh PP scale - if >10 score - have depression in 90% of cases

PP psychosis

perception, behavior changes
disorientation
within a few weeks PP to 3 months
requires hospitalization

non-caucasian
prepregnancy BMI
increased weight gain during pregnancy
higher PP waist circa
diagnosed with gestational DM before 24 weeks
FH of DM
insulin needed in pregnancy
high FBS
higher OGTT readings

at 6 week visit needs FBS and OGTT 75grams
FBS >126 or OGTT >200
if borderline retest yearly
if normal retest every 3 years

DM type I
FH thyroid or autoimmune disorder
Pernicious anemia
Vitiligo
Addisons disease

abnormal TSH and FT4 or antimicrosomal or peroxidase antibody
50% have goiter

1-3 months PP
usually fatigue and palpitations
67% will return euthyroid

4-9 months
thyroidmegaly and associated symptoms of hypothyroidism
treat medically for at least 12 months
20% will require life long treatment

fever
tachy
mental status change
vomit
diarrhea
arrythmia
seizure
coma

increased FT4 and very low TSH

labor
infection
pre-eclampsia
CS
noncompliant with meds

PTU - block synthesis of T4 to T3
Dexamethasone - decrease TSH release and conversion of T4 to T3
Propanolol - inhibit adrenergic effect of TSH
suppportive - IVF, antipyretics, O2

neonatal thyrotoxicosis