10. Maternal post partum problems Flashcards
Define peurperium
This is the time from delivery to 6 weeks after birth
This it the time taken for the uterus to involute
What are the main risks/problems that can occur during the puerperium postnatally?
Postpartum haemorrhage Thromboembolic disease Psychiatric disorders Pre-eclampsia Sepsis Cardiac disease
What is a postpartum haemorrhage (PPH) and what are the different types?
This is excessive bleeding following delivery
Primary - more than 500ml blood loss from the genital tract within 24 hours of delivery (more common)
Secondary - abnormal bleeding from the genital tract from 24 hours after delivery to 6 weeks after delivery
What are the causes of primary PPH?
80%:
Uterine atony (tone)
Retained placenta or fragments of the placenta
20%
Vulval or vaginal lacerations
Coagulopathy
What are the predisposing risk factors to a primary PPH?
Antepartum haemorrhage Placenta praevia Multiple pregnancy Pre-eclampsia Previous PPH maternal obesity Maternal age
What are the intrapartum risk factors for primary PPH?
C-section Retained placenta Episiotomy Labour longer than 12 hours Baby >4kg Maternal pyrexia
What is the management for a primary post-partum haemorrhage?
IV access Oxygen by mask IDC - empty the bladder Bimanual compression of the uterus Uterotonic Surgery
Describe the surgery that would be carried out for a primary PPH
EUA - examination under anaesthetic
Check the placenta
Suture any tears
May insert intrauterine balloon
Uterine artery emvolisation
Litigation of uterine or internal iliac arteries
Hysterectomy may be considered if there is uterine rupture
What is a uterotonic?
Aka. emvolic
This is used to induce contraction or greater tonicity of the uterus
What are the causes of a secondary postpartum haemorrhage?
Infection - endometritis
Tissue - retained products of conception (RPOC)
What investigations are carried out for a postpartum haemorrhage?
Full blood count - c reactive protein
Blood cultures
High/low vaginal swab
Ultrasound may be used if RPOC is suspected
What is the treatment for postpartum haemorrhages?
Broad spectrum IV antibiotics - increased risk of infection
If RPOC, evacuate after 34 hours of antibiotics
What is thromboembolic disease and why is this common in pregnancy?
Formation of a blood clot that can break off and block another blood vessel
Increasing clotting factors and a reduction of anticoagulants is the normal physiological changes against PPH
What are the pre-existing risk factors for thromboembolic disease?
Previous venousthromboemboism Thrombophilia - congenital or acquired Age over 35 years Obesity Parity > 4 (parity is the number of times you have given birth) Gross varicose veins Sickle cell veins Inflammatory disorders
What are the pregnancy related risk factors for thromboembolic disease?
Surgical procudures Dehydration Sepsis Pre-eclampsia Excessive blood loss Prolonged labour Immobility after delivery
