Disorders post-partum Flashcards
What is the puerperium?
from the delivery of the placenta to six weeks post birth
What changes happen to the woman in the puerperium?
Involution of the uterus (uterus contracts down fully and is felt at the level of the umbilicus) and GU tract
Muscle- ischaemia, autolysis and phagocytosis to return to normal thickness
Endocrine Changes- Profound decrease in serum levels of placental hormones (human placental lactogen, hcg, oestrogen and progesterone), Increase of prolactin
The decidua is shed as lochia: rubra, serosa and alba
Describe the lochia rubra, serosa and alba
rubra (day 0-4) contains blood, decidua, fetal membrane, meconium (fetal stool) and vernix waxy stuff that covers baby post birth)
serosa (day 4-10) contains mucus, exudate, WBC and micro-organisms
alba (day 10-28) contains cholestrol, fat, micro-organisms, leukocytes and epithelial cells.
Describe the physiology of breast feeding
At birth the woman produces colostrum from her breast which contains antibodies and growth factors but has less carb, lipids and K+ than mature milk.
Lactogenesis II starts once pregnancy hormones decrease
Lactoferrin is present in breast milk and has antibacterial properties.
What hormones are in control of breastfeeding?
prolactin -milk production
oxytocin- milk ejection
What is the difference between sepsis, spetic shock and severe sepsis?
Sepsis= infection plus systemic manifestations of infection
Severe sepsis= sepsis plus organ dysfunction/ low tissue perfusion
Septic shock= hypoperfusion continues despite fluid replacement
What are risk factors for sepsis?
obesity, DM, aneamia, amniocentesis, prolonged SROM, trauma
What are causes for sepsis?
Infections such as endometritis, UTI, mastitis, pneumonia, gastroenteritis, epidural related
What are two mneumonics for sepsis?
BUFALO (plus 2 in obstetrics) and 3 Teas with White Sugar
Explain 3 Teas with White Sugar
3Ts = temperature(<36 or >38), tachycardia (HR >90), tachypnoea (RR >20)
White= raised WCC
Sugar= hyperglycaemia
Explain BUFALO
- Bloods cultures ( also so FBC, U+Es, LFTs, clotting, glucose, crp, ABG)
- Urine output
- Fluid Resuscitation (bolus of Hartmann’s or saline)
- Antibiotics (broad spectrum)
- Lactate (>2 is serious)
- Oxygen
Plus 2 = delivery and VTE prophylaxis
What is primary post-partum haemorrhage?
> 500ml loss post birth
What is the difference between minor and major post-partum haemorrhage?
Minor- <1500mls
Major-1500mls +
What is secondary post-partum haemorrhage?
Secondary= excess bleeding between 24hrs and 12 weeks postpartum
What are the causes of PPH?
Endometritis, retained products of conception, subinvolution of the placental implantation site (delayed closure and sloughing of the spiral arteries at the placental site), atonia, blood disorders, trauma eg baby big or c-section, Av malformations
What are the investigations for PPH?
Bacteriology screen or U/S for retaine dproducts can be done but main focus is on management
What are the risk factors for VTE?
Risk increases with age of gestation- reaches height post-birth
Other risks: age, weight, parity of 3+, smoking, c-section, Fhx, varicose veins, pre-eclampsia, infection, immobile, stillbirth, PPH, 24 hour+ labour, premature, thrombophilia, antithrombin deficiency, surgery in the puerperium.
What is the leading cause of maternal death?
VTE
How many risk factors do you need for VTE prophylaxis?
two
What is used for prophylaxis of VTE?
LMWH
What can happen post epidural?
Post-Dural puncture headache due to CSF leak leading to decrease in pressure
What type of headache is a post epidural one and what are the other associated symptoms?
headache which increases with sitting and standing, neck stiffness, photophobia
What is the management of a post-dural headache?
Management: lie flat – which also relieves pain, analgesia, epidural blood patch (aim is that blood seals the hole in the dura and stops leakage of fluid), fluids, caffeine
How soon after birth should a woman be able to micturate?
6 hours
What are the risk factors for urinary retention post-birth?
epidural, prolonged labour, extensive laceration, forcep/ventouse use
What mental health problems may affect the woman in the post-partum period?
post-partum depression, PTSD, post-partum psychosis
What are the complications of post-partum mental health problems?
Women may delay or avoid future pregnancies
Request caesarean sections to avoid vaginal delivery
Avoidance of intimate physical relationships
Impact on breastfeeding
Poor bonding with baby
What is homans sign?
discomfort behind the knee upon forced dorsiflexion of the foot - if positive sign of DVT
What is the mx for a DVT if the wells score says one is likely vs if it doesnt?
likely: U/S — if cannot be carried out within 4 hours of being requested, D-dimer testing, interim therapeutic anticoagulation, US after 24 hrs offered instead
unlikely: D-dimer
