Disorders of puerperium lecture:

Question 1

What is puerperium?

Answer 1

From delivery of the placenta to 6 weeks following birth

Question 2

List 3 minor and 3 severe post-natal problems:

Answer 2

Minor:
- PPH
- Fatigue
- Anaemia
Major:
- Sepsis
- Severe PPH
- Eclampsia
- Uterine prolapse

Question 3

What is maternal death defined as?

Answer 3

Death of a woman during or up to six weeks after the end of her pregnancy through causes related to or aggravated by the pregnancy

Question 4

What is the leading cause of direct maternal death?

Answer 4

Thombosis and thromboembolism

Question 5

What is the leading cause of indirect maternal death?

Answer 5

Cardiac disease

Question 6

What are the signs and symptoms of sepsis?

Answer 6

SIRS= 3Ts white with sugar

• Temperature (>38 or <36)
• Tachycardia (>90bpm)
• Tachypnoea (>20 breaths per minute)
• White blood cell count (<4 or >12)
• Sugar - blood glucose (>7.7 mmol in absence of DM)

Question 7

What is the management of sepsis in a mother?

Answer 7

1) Oxygen
2) blood cultures
3) IV Abx
4) Fluid resuscitation
5) serum lactate
6) Cathererise/fluid balance

(consider delivery and VTE prophylaxis)

Question 8

List the 4 psychiatric disorders surrounding pregnancy:

Answer 8

• Baby blues
• Postnatal depression
• Puerperal psychoses
• Post-traumatic stress syndrome following childbirth

Question 9

What is elevated in chances after childbirth?

Answer 9

Risk of developing serious mental illness after childbirth (particularly within the first 3 months).

Question 10

List 5 signs and symptoms of PND:

Answer 10

(normal symptoms of depression)

• Low mood/miserable all of the time
• Constantly feeling exhausted
• Feeling unable to cope
• Feeling guilty about not being able to cope
• Overwhelming anxiety about the baby
• Tearful for no reason
• Difficulty sleeping

Question 11

Outline the topics covered to assess for PND:

Answer 11

• Normal mental health history
• Attitudes towards pregnancy
• Womans experience of pregnancy
• Mother-baby relationship
• social networks

Question 12

List 4 consequences of PND:

Answer 12

Immediate:
- Physical morbidity
- Prolonged psych morbidity
Later:
- Social and cognitive effects on child
- Marital breakdown

Question 13

RF for postpartum psychosis:

Answer 13

• Primiparity
• Previous postpartum psychosis
• Previous bipolar illness
• FH

Question 14

List 3 ways which mental illness can be prevented:

Answer 14

• Counselling women with chronic mental health problems about pregnancy
• Maintain mental health medications
• assess all women at 6 weeks post natal to check fro PND

Question 15

What psych medications are teratogenic?

Answer 15

Mood stabilisers, lithium, carbamazepine and sodium valproate

Question 16

What is IUGR?

Answer 16

An unborn baby is smaller than is should be because it is not growing at a normal rate inside the womb = delayed growth

Question 17

List 4 complications of IUGR:

Answer 17

• Low birth weight
• Decreased oxygen levels
• Hypoglycaemia
• Low resistance to infection
• Low Apgar score
• Meconium aspiration
• trouble maintaining body temperature

Question 18

List 4 causes of IUGR:

Answer 18

• Diabetes
• High BP or heart disease
• Infections such as rubella, cytomegalovirus, toxoplasmosis and syphilis
• Malnutrition or anaemia
• Smoking

Question 19

List 2 signs of IUGR:

Answer 19

• Baby small for gestational age

- Umbilical cord thin and dull

Question 20

List 4 possible features of Foetal alcohol syndrome:

Answer 20

• Poor growth
• Cerebral palsy
• Learning difficulties
• ADHD/autism

Question 21

List 4 physical features of a baby with foetal alcohol syndrome:

Answer 21

• Small head
• Small eye openings
• Folds of skin between eyes and nose
• Flat upper part of nose
• Thin upper lip
• Smooth area between the nose and upper lip