Disorders of the Puerperium Flashcards by Maria Keriakos

definition of puerperium

From the delivery of the placenta to six weeks following the birth

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What hormonal changes occur in the pueperium?

hCG, oestrogen and progesterone, human placental lactogen decrease
prolactin increases

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What happens to the uterus in the pueperium?

involution of the uterus by ischaemia, autolysis and phagocytosis

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What happens to the decidua in the pueperium?

shed as lochia rubra, lochia serosa and lochia alba

endometrium regenerates

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What is the lochia rubra made of?

blood
discharge
decidua
fetal membrane

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What is the lochia serosa made of?

cervical mucus
WBCs
fetal membrane

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What is the lochia alba made of?

cholesterol
fat
mucus
WBCs

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What two hormones are involved in lactogenesis and what do they do?

Prolactin – milk production

Oxytocin – Milk ejection reflex

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What does the colostrum contain?

protein
vitamin A
growth factors - stimulate development of the gut
antimicrobial factors - passive immunity
lactoferrin - helps in iron absorption, reduces infection

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Where is prolactin produced?

anterior pituitary gland

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Where is oxytocin produced?

posterior pituitary gland

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What are the health benefits of breastfeeding?

Mother
- reduced risk of breast cancer

Infant

reduced GI disease
reduced resp disease
reduced otitis media
necrotising enterocolitis

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List some relatively minor postnatal problems

infection 
PPH 
mastitis 
baby blues 
stress incontinence

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list some major postnatal problems

sepsis 
severe PPH 
pre-eclapsia/eclampsia 
thrombosis 
uterine prolapse 
post dural puncture headache 
breast abscess 
depression/psychosis

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who is normally involved in post natal care?

midwives
breast feeding support workers
nursery nurses
doulas - provide emotional support and information to pts during antenatal and post natal periods

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What is used to record observations in the post-partum period?

MEOWS

Modified early obstetric warning score

what are the risk factors for obs sepsis?

obesity 
diabetes 
prolonged SROM 
vaginal trauma or C-section 
ethnic minorities

What are the causes of obs sepsis?

Endometritis
Skin and soft tissue infection
Mastitis
UTI
Pneumonia
Infection related to epidural/spinal

What are the signs of sepsis?

teperature 
tachycardia
tachypnoea 
raised WCC 
hyperglycaemia

3 Ts white with sugar

What are the symptoms of obs sepsis?

PROM/offensive liquor
Offensive lochia
dysuria
Headache + neck stiffness
Cellulitis/wound infection
D and V
Breast redness or pain
Cough, sputum, chest pain
Abdominal pain

How many red flag markers of sepsis do you need to start the sepsis 6?

one

what is the sepsis 6?

BUFALO  plus 2
blood cultures 
urine output 
give fluids 
antibiotics IV within 1 hour
lactate 
oxygen

consider delivery (evacuation of retained products of conception) and VTE prophylaxis

what amount of blood loss is considered post partum haemorrhage?

> 500 ml

Minor PPH - < 1500mls and no clinical signs of shock

Major PPH - ≥ 1500mls and continuing to bleed OR clinical shock

what is secondary PPH?

abnormal/XS bleeding from birth canal 24hrs-6 weeks post natally

What are the causes of secondary PPH?

endometritis retained products of conception subinvolution of the placental implantation site = delayed closure of the spiral arteries

What investigations would you do for secondary PPH?

Assess blood loss Assess haemodynamic status eg BP Bacteriological testing (HVS and endocervical swab) Pelvic ultrasound

is VTE risk higher antepartum or post-partum

much higher post-partum up to 6 weeks after delivery

who is high risk for post natal DVT and what is done about this post-natally

high risk if: - previous VTE - antental LMWH - thrombophilia - low risk and FH give 6 weeks LMWH post-partum

what would you do if someone was high, intermediate or low risk to avoid VTE post-partum?

HIGH - give 6 weeks LMWH post-partum INTERMEDIATE - 10 days LMWH LOW - early mobilisation and avoid dehydration

what is a post dural puncture headache?

puncture of the dura when entering the epidural space | leakage of CSF and reduced pressure around the brain

What are the symptoms of a post dural puncture headache

Headache worse on sitting or standing Starts 1-7 days after spinal/epidural sited Neck stiffness Dislike of bright lights

How do you treat a post dural puncture headache?

Lying flat! Simple analgesia Fluids and caffeine - incrases CSF pressure to relive the headache from the leak Epidural blood patch

what are the symptoms of urianry retention after delivery?

having not urinated for 6 hours after delivery | aching or achless inability to empty bladder completely

What are the risk factors for urinary retention after delivery?

epidural analgesia prolonged second stage of labour forceps of ventouse perineal tears

What proportion of mothers will get post-natal depression?

10%

what are the risk factors for post-natal psychosis?

- family history of mental health problems, particularly postpartum psychosis. - a diagnosis of bipolar disorder. - traumatic birth or pregnancy.

define maternal death

The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

what are the causes of maternal death

``` PPH Sepsis suicide pre-eclampsia VTE death from pre-existing disease or disease that devloped in pregnancy eg heart disease ```