Kawasaki syndrome is a diagnosis of exclusion.

Treatment for this diagnosis may include IVIG and high dose aspirin therapy to prevent which condition?

Choice A rationale

Bright red lochia with large clots suggests uterine atony, which is a failure of the uterine muscles to contract properly. This indicates that the oxytocin is not effective in promoting uterine contraction, which is necessary to control postpartum bleeding. Uterine atony is a leading cause of postpartum hemorrhage, and this finding is a sign of an ongoing bleeding problem, not a sign of effective medication.

Choice B rationale

A firm fundus indicates the uterine muscles are contracting effectively, which compresses blood vessels and prevents excessive bleeding. Oxytocin is a synthetic analog of the naturally occurring hormone oxytocin, and it works by stimulating these smooth muscle contractions in the uterus. Therefore, a firm fundus is the desired therapeutic effect and indicates the medication is working as intended.

Choice C rationale

A boggy fundus signifies a relaxed, poorly contracted uterus. This allows for blood vessels to bleed freely, increasing the risk of postpartum hemorrhage. This is the opposite of the desired effect of oxytocin and indicates that the medication is not effectively promoting uterine contraction to control bleeding.

Choice D rationale

Absent lochia postpartum is not a normal finding and may indicate an issue such as uterine retention of placental fragments or a blood clot, or an abnormal uterine position. The normal progression of lochia (a vaginal discharge after childbirth) is a physiological process that should occur regardless of medication effectiveness. Absent lochia does not demonstrate a normal physiological response to oxytocin.

Choice A rationale

Insomnia is a common symptom of postpartum depression, often characterized by difficulty falling or staying asleep, or waking up early. This sleep disturbance, when coupled with other symptoms such as persistent sadness, loss of interest in activities, and fatigue, is a key diagnostic criterion for the condition.

Choice B rationale

Intermittent crying in the first week postpartum, now resolved, is a common symptom of the "baby blues.”. The baby blues are a transient condition, typically resolving within the first two weeks. Postpartum depression, in contrast, involves more severe and persistent symptoms lasting longer than two weeks.

Choice C rationale

Delusions are a symptom of postpartum psychosis, a rare and severe mental health condition that is distinct from postpartum depression. Postpartum psychosis involves a break from reality and is a psychiatric emergency. Delusions are not characteristic of postpartum depression.

Choice D rationale

Induced vomiting is a symptom associated with eating disorders, such as bulimia nervosa. While eating disorders can coexist with postpartum depression, induced vomiting is not a defining symptom of postpartum depression itself. It is a separate clinical finding.