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Terms in this set (124)

B Bleeding associated with signs or symptoms of hypovolemia within 24 hours of delivery


Explanation:
Up to 3% of all deliveries in the United States are complicated by postpartum hemorrhage; of these, more than half require blood transfusion. The most common cause of postpartum hemorrhage is uterine atony (when the uterus does not effectively contract after placental delivery), but it can also be due to uterine trauma, abnormal placentation, or coagulopathy. In 2017, the American College of Obstetricians and Gynecologists (ACOG) updated the diagnostic criteria for postpartum hemorrhage. The diagnostic criteria is cumulative blood loss ≥ 1 000 mL regardless of mode of delivery or bleeding associated with signs or symptoms of hypovolemia within 24 hours of delivery. Thus, though she does not meet the estimated blood loss threshold for postpartum hemorrhage, she qualifies due to her pale appearance, hypotension, and tachycardia. Prior to 2017, ACOG defined postpartum hemorrhage by an estimated blood loss ≥ 500 mL after vaginal delivery or ≥ 1 000 mL after cesarean delivery. This diagnostic threshold was problematic for multiple reasons: the mean estimated blood loss after vaginal delivery is 400 to 600 mL and after cesarean delivery is 1 000 mL. Also, maternal blood is often mixed with amniotic fluid at delivery (falsely increasing the subjectively or objectively reported estimated blood loss). The new criteria were created to decrease the rate of false diagnoses of postpartum hemorrhage.
C Doxycycline

Lymphogranuloma venereum is an uncommon, sexually transmitted disease caused by Chlamydia trachomatis. It is rare in industrialized countries, but it has been increasingly seen in women who are engaged in unprotected anal sex and men who have sex with men. Infection occurs after direct contact with the skin or mucous membranes of the infected partner. The organism travels to the regional lymph nodes and causes systemic disease. The disease is characterized by painless genital papules or ulcers that are self-limited, followed by painful inguinal or femoral lymphadenopathy. Patients with this condition may also present with rectal ulcerations and symptoms of proctitis. Lymphogranuloma venereum occurs in three stages. The first stage involves a rapidly healing, painless genital papule or ulcer. The second stage involves painful inguinal lymphadenopathy (appearance of "grooves sign" or large bubo) that usually occurs two to six weeks after the primary lesion. Constitutional symptoms may include fever, chills, myalgias, and malaise. This stage is when most men are diagnosed. The third stage is characterized by proctocolitis and symptoms include bloody purulent discharge, rectal pain, and tenesmus. This stage may occur many years after the original infection. Women are more likely to be diagnosed in the third stage because they usually lack symptoms in the first or second stage. Doxycycline is the drug of choice in patients who are not pregnant. Erythromycin should be used in patients who are pregnant or lactating. Sexual partners who had contact with the patient within the past 60 days should be treated for exposure with doxycycline or azithromycin.