Intra 1
These are the 4 Ps of Labor
What are Power, Passenger, Passageway, Psyche
Most common breech presentation
Frank breech
A common mood disorder that does not require treatment and is limited to 1-2 weeks postpartum period
What is Baby Blues
Lactogenesis II is initiated by these 3 processes
1. Delivery of placenta
2. ↓ in progestin
3. ↑ in prolactin hormone concentration
A postpartum patient presents with fever, tachycardia, malodorous lochia, and uterine tenderness. What is the likely diagnosis?
What is endometritis?
Incision from posterior fourchette at a 45 degree angle through transverse perineal and bulbocavernosus muscles.
Mediolateral episiotomy
Bonus: Benefits of mediolateral incision vs midline?
A: less risk of 3rd / 4th degree lac, better for patients with short perineums.
One chorion, two amnions is known as this type of twin pregnancy
What is Mo-Di Twins
Disorganized thinking, hallucinations, and delusions are all symptoms of this postpartum disorder?
And what is the prevalence?
What is Postpartum Psychosis
Prevalence—1 to 2 cases per 1,000 births
Pt 10w PP comes in for help with lactation. She says after feeding, her nipples become incredibly painful and look bruised for about half an hour. She has met with lactation, and they assessed the baby's latch and checked for a tongue tie. There seemed to be no issues, and a good milk transfer was happening. What is a possible alternative diagnosis based on this information?
Raynaud’s phenomenon
Methergine dose and route (and any contraindications)
0.2mg IM
CI in setting of hypertension
Abrupt (<30 sec from onset to nadir), periodic, or non periodic decrease in FHR; >15bpm lasting >15 seconds but <2 min
Variable deceleration
Associated with uteroplacental insufficiency, maternal hypotension, fetal hypoxia, medications. or placental abruption.
Late decelerations
Your G1P1 25yo patient is 5 months PP and exclusively breastfeeding, but they tell you they are thinking of switching to formula at night. They ask about trying to get pregnant again, stating, "I know it's soon, but we really want them close together. We have been trying for the last two months and nothing is happening. When will I be fertile again?" You question if they have had a period and are told they think there has been some spotting but nothing significant.
What answer would you give about fertility?
Possible Facts
-Exclusive breastfeeding only 1-3% chance of ovulation in first 6 months
-generally, ovulation occurs 14-30 days after weaning
- average time for ovulation to return is about 7 months for breastfeeding parents due to introduction of solid foods.
- adding formula at night will increase your chances of ovulating but there is a decent chance it will occur in the next 3 months
At a 2-week PP visit, you ask a patient about their future birth control plans. The patient says they really want to avoid all hormones and asks about how to use breastfeeding to avoid pregnancy. What counseling do you give?
The failure rate of Lactational Amhenorhea is 2% perfect use but typically can up to 19%
Must meet all conditions to be effective:
1. Full breastfeeding/chestfeeding- no supplement
2. Feeding an average of every 4 hours during the day / every 6 hours at night
3. Has not substituted solid foods for any meals
4. Infant less than 6 months old
6. No menses
Bonus question: Ari’s favorite!
Most common therapeutic rest medication(s), dosage(s), and route(s).
Morphine 10mg IM + Promethazine (Phenergan) 25mg PO (or IM)
What are the 3 parts of active management of third stage of labor?
Controlled cord traction (once pulsation stops)
Use of uterotonic agent
Fundal massage following placental delivery
A patient presents to your clinic and reports an LMP of November 5, 2024. Using Naegle’s rule, what’s her EDD?
August 12, 2025
(add 7 days to the first day of LMP and subtract 3 months)
The three stages of postpartum lochia discharge are known as?
Bonus point for listing how long each lasts
Rubra- first 3-7 days
Serosa- days 14-21
Alba- Until cessation of flow ~4–6 weeks PP
Name one of the two galactagogue (lactation stimulants) medication
Domperidone
or
Metoclopramide
A G2P2 patient presents to their 2-week PP appt; upon entering the room, the pt is in visible pain and guarding their right breast; they report severe pain and chills x2 days. Vitals are 134/86, HR 88, temp 103.4F. The first-line antibiotic you will prescribe is likely this?
What is Dicloxacillin or flucloxacillin 500 mg PO QID × 10–14 days
or
Cephalexin (Keflex) 500 mg QID × 10–14 days
Cardinal movement of labor following Engagement and Descent
Flexion
Denominator in face presentation
Mentum
You assess a patient 2 weeks PP who presents with a fundus that is palpable 4 below the umbilicus, prolonged lochia rubra, and continued uterine tenderness. What is the most likely cause?
What is retained placental fragements?
Bonus: causing subinvolution of the uterus
At 2 weeks PP lochia should be serosa, fundus should not be palpable and no tenderness should be noted.
You received call from nurse about G1P1 patient approximately 48hr PP from SVD, they are complaining about breast engorgement and difficulty/pain with latching. Vital signs are 138/86, HR 86, temp 98.8F. PP labs show an elevated WBC count of 16.9 (normal range listed 3.5-9.1). What is your assessment of the clinical picture?
- Breast engorgement is normal 2-4 days PP
- Improper latch is not uncommon in newly chest/breastfeeding parents and can cause pain; assess latch.
-transient increase in BP is normal ~4 days PP
-Leukocytosis is also normal in first 48 hr, WBC of 16.9 is still considered normal range
Name the time period that each stage of Lactogensis occurs in
Lactogenesis I- Early pregnancy to day 3 PP
Lactogenesis II- Days 2–4 PP
Lactogenesis III- Begins between 7-14 days PP - until weaning
Lactogenesis IV- Begins when breast stimulation stops, lasts ~6 weeks