100. Post-partum Flashcards
What is peurperal pyrexia
> 38ºC in the first 14 days following delivery
Causes puerperal pyrexia
endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
Management puerperal pyrexia
if endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)
when should lochia settle
6 weeks
What should be avoided during lochia
tampons
Presentation post partum endometritis
Foul-smelling discharge or lochia
Bleeding that gets heavier or does not improve with time
Lower abdominal or pelvic pain
Fever
Sepsis
Investigations post partum endometritis
Vaginal swabs (including chlamydia and gonorrhoea if there are risk factors)
Urine culture and sensitivities
USS to rule out RPOC
Risk factor RPOC
placenta accreta
Invetsigation for RPOC
USS
Management RPOC
evacuation of retained products with curagette
Complications of surgery to remove RPOC?
ashermans
endometritis
Management post partum anaemia
Hb under 100 g/l – start oral iron (e.g. ferrous sulphate 200mg three times daily for three months)
Hb under 90 g/l – consider an iron infusion in addition to oral iron (e.g. Monofer, CosmoFer or Ferinject)
Hb under 70 g/l – blood transfusion in addition to oral iron
Contraindication to iron infusion
active infection, many pathogens “feed on iron”
Scoring post natal depression
Edinburgh scale
There are ten questions, with a total score out of 30 points. A score of 10 or more suggests postnatal depression.
