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Obstetrics and Gynaecology > Labour and Birth > Flashcards

Labour and Birth Flashcards

1
Q

What is the lie of the fetus? What are the types?

A

Relationship of fetal long axis to uterus long axis

Longitudinal
Oblique
Transverse

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2
Q

What is the presentation of the fetus? What are the types?

A

Fetal part that enters the maternal pelvis

Cephalic is the safest
Face, Brow, Breech, Shoulder

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3
Q

What is the vertex/position of the fetus?

A

Position of the fetal head as it exits the birth canal

Occipito-anterior is safest

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4
Q

How are malpresentation of the fetus managed?

A

Brow - C Section
Shoulder - C-section
Face - if chin anterior then normal labour possible, chin posterior then C Section

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5
Q

What happens in most malpositions?

A

90% spontaneously rotate to occipito-anterior as labour progress

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6
Q

What is the management if a malposition doesn’t rotate?

A

Rotation and operative vaginal delivery attempted

C Section can be performed

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7
Q

How common is breech presentation?

A

20% at 28 weeks

3-4% at term - majority spontaneously turn

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8
Q

What are the risk factors associated with breech presentation?

A

85% spontaneous

Uterine abnormality
Lax uterus - multiparty
Placenta praevia
Abnormal amniotic fluid

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9
Q

How is breech presentation identified?

A

Palpation of abdomen
Fetal heart auscultated higher in abdomen
USS

20% not diagnosed until labour - fetal distress or foot felt

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10
Q

What should happen if a breech is identified at 35/36 week scan?

A

Refer for scan and specialist opinion

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11
Q

What are the types of breech delivery?

A

Complete breech
Frank breech
Footling breech

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12
Q

How are breech babies delivered?

A

Try ECV first

C Section or Vaginal depending on woman and specific presentation
Footling breach - vaginal contraindicated

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13
Q

How is a breech baby delivered vaginally?

A

Hand off baby - traction can lead to neck hyperextension and head getting trapped

Flex fetal knees - deliver legs
Lovsetts - rotate body to deliver shoulders
MSV - flex head

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14
Q

What complications are associated with breech delivery?

A

Cord prolapse
Fetal head entrapment
Premature rupture of membranes
Birth asphyxia

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15
Q

When is external cephalic version carried out?

A

36 weeks if nulliparous - 40% success

37 weeks if multiparous - 60% success

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16
Q

What is the result of external cephalic version?

A

Reduce risk of non-cephalic birth or need for caesarian
Still higher risk of complications than spontaneous cephalic
Safe with no risk of intra-uterine death
<5% revert to breech

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17
Q

What are the CI’s for external cephalic version?

A 
APH within last week
Ruptured membranes
Major uterine abnormalities
Abnormal CTG
Multiple pregnancy
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18
Q

What are the complications associated with external cephalic version?

A

Placental abruption
Uterine rupture
Fetal-maternal haemorrhage
Fetal distress

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19
Q

What are the types of premature rupture of membranes?

A

Premature rupture of membranes - >1hr before onset of labour at >=37 weeks gestation

Pre-term premature rupture of membranes - rupture occur before 37 weeks gestation

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20
Q

How common is premature rupture of membranes?

A

10-15% of term pregnancies

Minimal risk to mother and fetus

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21
Q

How common is preterm premature rupture of membranes?

A

~2%

Higher rates of maternal and fetal complications

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22
Q

What are the risk factors associated with premature rupture of membranes?

A 
Multiple pregnancy
Lower GU infection
Smoking
Vaginal bleeding during pregnancy
Polyhydramnios
Cervical insufficiency
Invasive procedures - amniocentesis
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23
Q

What are the differentials for premature rupture of membranes?

A

Urinary incontinence
Loss of mucus plug
Normal vaginal secretions
Secretions associated with infection

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24
Q

What is the pathophysiology of premature rupture of membranes?

A

Normal weakening occurs earlier than normal due to:

  • Higher levels of apoptotic markers in amniotic fluid
  • Infection - cytokines weaken membrane
  • Genetic disposition
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25
Q

How is a premature rupture of membranes diagnosed?

A

Maternal history of rupture and positive examination findings

Sterile speculum examination - amniotic fluid draining from cervix and pooling in vagina when lying down for 30 mins

Reduced amniotic fluids suggestive

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26
Q

What is important to investigate if you suspect premature rupture of membranes and what should you avoid?

A

High vaginal swab done - look for group B strep

Avoid digital vaginal exam until in labour –> poss. intrauterine infection

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27
Q

What should be given if a woman has isolated group B strep?

A

Clindamycin or Penicillin

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28
Q

What does premature rupture of membranes cause?

A

Amniotic fluid stimulate uterus and labour occur within 24-48 hours

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29
Q

If labour doesn’t occur following premature rupture of membranes, what should be done?

A

<34 weeks - aim for increased gestation

34 weeks + - induce labour

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30
Q

How should premature rupture of membranes before 36 weeks be managed?

A

Monitor for chorioamnionitis
Advise against sexual intercourse
Prophylactic erythromycin
Corticosteroids (dexamethasone) - fetal lung development

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31
Q

How should premature rupture of membranes >36 weeks be managed?

A

Monitor for chorioamnionitis

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32
Q

What are the complications of premature rupture of membranes?

A

Prematurity
Sepsis
Pulmonary hypoplasia

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33
Q

How can premature rupture of membranes be prevented?

A

Intravaginal progesterone and cervical cerclage - if history of Preterm-PROM

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34
Q

What is chorioamnionitis?

A

Result of ascending bacterial infection of amniotic fluid, membranes or placenta

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35
Q

What are the risk factors for chorioamnionitis?

A

Preterm premature rupture of membranes

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36
Q

How is chorioamnionitis managed?

A

Prompt delivery of foetus

IV antibiotics

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37
Q

How commonly is labour induced?

A

20% of pregnancies

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38
Q

What are the indications for induction of labour?

A 
Prolonged pregnancy
Premature rupture of membranes
Fetal growth restriction
Intrauterine fetal death
Maternal health problems - diabetes, hypertension, obstetric cholestasis
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39
Q

What are the methods of induction?

A

Vaginal prostaglandins
Membrane sweep
Amniotomy +- oxytocin

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40
Q

How do vaginal prostaglandins induce labour?

A

Ripen cervix and role in contractions

Taken as tablet, gel or pessary

Induction can take days

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41
Q

How does a membrane sweep induce labour?

A

Adjunct to induction

Gloved finger rotate against fetal membrane - aim to separate from decidua and release prostaglandins

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42
Q

Explain the use of an amniotomy to induce labour

A

Used if vaginal prostaglandins CI

Membranes ruptures using hook - release prostaglandins to stimulate labour

Oxytocin given to increase strength and freq. of contractions

Only performed once cervix is ripe

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43
Q

What are the absolute contraindications for induction of labour?

A 
Cephalopelvic disproportion
Major placenta praevia
Transverse lie
Vasa praevia
Cord prolapse
Active primary genital herpes
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44
Q

What are the relative contraindications for induction of labour?

A

Breech
Triplet or higher order pregnancy
2 or more previous low transverse C sections

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45
Q

What is the bishop’s score?

A

Scoring system used to assess cervical ripeness

Score >9 - labour likely commence spontaneously
Score <5 - labour unlikely to start without induction

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46
Q

Describe the factors in bishop’s score

A

Cervix: 0 points, 1 point, 2 point, 3 point

Position - posterior, midline, anterior, NA
Consistency - firm, medium, soft, NA
Effacement - 0-30%, 40-50%, 60-70%, >80%
Dilation - closed, 1-2cm, 3-4cm, >5cm
Station - -3, -2, -1 and 0, +1 and +2
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47
Q

What complications are associated with induction of labour?

A

Uterine hyperstimulation
Failure of induction - req. C Section
Uterine rupture
Cord prolapse - occur in amniotomy with rush of fluid
Intrauterine infection - prolonged membrane rupture and repeated vaginal examinations

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48
Q

What is uterine hyperstimulation associated with and how is it managed?

A

Fetal distress

Terbutaline - anti-contraction agent

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49
Q

What instruments can be used to aid delivery?

A 
Forceps
Vacuum extraction (Ventouse)
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50
Q

How can instrumental deliveries be categorised?

A

Classified by degree of fetal descent - lower they are, lower risk of complications

Outlet
Low
Midcavity

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51
Q

What does it mean if a instrumental delivery is classified as outlet?

A

Fetal scalp visible with labia parted
Fetal skull reached pelvic floor
Fetal head on perineum

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52
Q

What does it mean if a instrumental delivery is classified as Low?

A

Leading point at +2 station or lower

Subdivided depending on rotation - more or less than 45 degrees

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53
Q

What does it mean if a instrumental delivery is classified as midcavity?

A

Head 1/5 palpable abdominally
Leading point between 0 and +2
Subdivided depending on rotation - more or less than 45 degrees

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54
Q

What are the indications for instrumental delivery?

A 
Maternal
- Inadequate progress of 2nd stage of labour
- Exhaustion
- Hypertensive crisis
- CVS disease
- Myasthenia gravis and spinal cord injury
Fetal
- Compromise
- Protect head during breech
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55
Q

What is considered inadequate progress of 2nd stage of labour?

A

Nulliparous - 2 hours of active pushing

Multiparous - 1 hour of active pushing

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56
Q

When should instrumental delivery be abandoned for C Section?

A

No descent seen in 3 pulls

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57
Q

What are the contraindications for instrumental delivery?

A

Bleeding or fracture predisposition of fetus
Face delivery
<34 weeks if ventouse

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58
Q

What are the requirements for instrumental delivery?

A 
Fully dilated cervix
Occipito-anterior position
Ruptured membranes
Cephalic presentation
Engaged presenting part
Pain relief adequate
Sphinter (bladder) empty
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59
Q

What maternal complications are associated with instrumental delivery?

A

Maternal mental health - can develop tocophobia
Urinary and faecal incontinence
3rd/4th degree tears
Pelvic organ prolapse

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60
Q

What fetal complications are associated with instrumental delivery?

A

Cephalhaematoma
Facial bruising
Retinal haemorrhage

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61
Q

What is the difference between caput seccedaneum and cephalhaematoma?

A

Caput secumdum

  • Soft puffy swelling due to oedema
  • Present at birth, cross the midline and resolve within days

Cephalhaematoma

  • Bleeding between periosteum and skull
  • Present within hours, doesn’t cross midline and resolve within months
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62
Q

What are the complications of a prolonged second stage of labour?

A

Chorioamnionitis
3rd and 4th degree tears
Uterine atony

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63
Q

What are the conditions where the placenta is retained?

A

Placenta adherens
Trapped placenta
Partial accreta

64
Q

What happens in placenta adherens?

A

Myometrium fair to contract behind placenta

65
Q

What happens in trapped placenta?

A

Detached placenta trapped behind closed cervix

66
Q

What happens in partial accreta?

A

Part of placenta adhered to myometrium

67
Q

What are the complications associated with retained placenta?

A

PPH

Infection

68
Q

What are the signs the placenta has separated?

A

Sudden rush of blood
Fundus move higher and become more rounded
Increase length of visible umbilical cord
Raising fundus doesn’t cause cord to decrease in length

69
Q

What should be done if a placenta has separated?

A

Deliver placenta by rubbing up uterus

Push towards vagina with expulsion of placenta and membranes

70
Q

What should be done if the placenta can’t be removed?

A

Vaginal exam - assess if detached

71
Q

What should be done if the placenta hasn’t detached?

A

IV access - oxytocin if excess bleeding

Manual removal under general anaesthesia

72
Q

Define a post partum haemorrhage

A

Loss of >=500ml blood per vagina within 24 hours of delivery

73
Q

What is the difference between a major and a minor post partum haemorrhage?

A

Minor - 500-1000ml

Major - >1000ml

74
Q

Broadly, what causes a post partum haemorrhage?

A

Tone - failure of uterus to contract
Thrombin - coagulopathies and vascular abnormalities
Trauma
Tissue - retention of placenta

75
Q

What are the risk factors for the uterus failing to contract post delivery?

A 
Age >40
BMI >35
Asian
Uterine over-distention - multiple pregnancy, macrosomia, polyhydramnios
Prolonged labour
Placenta praevia or abruption
76
Q

What are the risk factors for thrombin/trauma related post partum haemorrhage?

A 
Placental abruption
Hypertension
Pre-eclampsia
Coagulopathies
Instrumental vaginal delivery
Epsiotomy
C-Section
77
Q

How should a post partum haemorrhage be managed?

A

Simulataneous:

Teamwork - range of specialists
Resus - 2L warmed colloids, O-ve blood until X-matched blood available
Investigations and monitoring - FBC, X match, Coag, U&E, vitals
Medication

78
Q

What medication can be given in a post partum haemorrhage?

A

Syntocinon (1st line)
Ergometrine (1st line)
Carboprost
Misoprostol

79
Q

Describe the MOA, side effects and CI’s for syntocinon

A

Synthetic oxytocin - stimulate myometrium contraction

SE - N&V, headache, hypertension

CI - hypertonic uterus, severe CVS disease

80
Q

Describe the MOA, side effects and CI’s for ergometrine

A

Alpha adrenergic, dopamine and serotonin receptor action to stimulate contraction of uterus

SE - Hypertension, nausea, bradycardia

CI - Hypertension, eclampsia, vascular disease

81
Q

Describe the MOA, side effects and CI’s for carboprost

A

Prostaglandin analogue

SE - bronchospasm, pulmonary oedema, HTN, cardiovascular collapse

CI - Cardiac/pulmonary disease

82
Q

Describe the MOA, side effects and CI’s for misoprostol

A

Prostaglandin analogue

SE - diarrhoea

83
Q

What is the definitive management for a post partum haemorrhage due to failure of the uterus to contract?

A

Pharmacological measures and bimanual compression

Intrauterine balloon tamponade

Surgical measures - uterine or internal iliac ligation, hysterectomy

84
Q

What is the definitive management for a post partum haemorrhage due to retained placenta?

A

IV oxytocin

Manual removal of placenta

85
Q

What is the definitive management for a post partum haemorrhage due to trauma?

A

Repair lacerations

If uterine rupture - repair or hysterectomy

86
Q

How can a post partum haemorrhage be prevented?

A

Active management of 3rd stage of labour reduce risk by 60%

Vaginal - prophylactic 5-10 units IM oxytocin
C-Section - 5 units IV oxytocin

87
Q

What is a secondary post partum haemorrhage?

A

Excessive bleeding in period between 12hr post delivery and 12 weeks post partum

88
Q

How may secondary post partum haemorrhages present?

A

Usually spotting
Gush of blood or major haemorrhage possible

Endometritis - fever, lower abdomen pain, foul smelling lochia
Retained products - fundus felt on examination

89
Q

What is lochia?

A

Discharge from childbirth

90
Q

What can cause a secondary post partum haemorrhage?

A

Uterine infection - RF inc. C-Section, PROM, long labour
Retained placental fragments or tissue
Abnormal involution of placental site

91
Q

How would you investigate a secondary post partum haemorrhage?

A

Speculum exam
High vaginal swab
Blood cultures
Pelvic USS - retained products

92
Q

How is a secondary post partum haemorrhage managed?

A

If major then same as primary

Abx - clindamycin and metronidazole
+gentamicin in endomyometritis or sepsis

Uterotonics - syntocinon, ergometrine, carboprost etc.

93
Q

What should you be aware of if surgical evacuation of retained products is required for a secondary post partum haemorrhage?

A

Higher risk of uterine perforation due to uterus being softer and thinner

94
Q

Generally when is an emergency c-section carried out?

A

Failure to progress through labour

Fetal compromise

95
Q

How can emergency c-sections be characterised?

A

1 - immediate threat to life of mother or fetus, 20-30 mins
2 - maternal or foetal compromise that isn’t immediately life threatening 60-75mins
3 - No maternal or foetal compromise but need early delivery
4 - elective

96
Q

Why may an elective c-section be planned?

A

Usually after 39 weeks

  • malpresentation
  • twins or higher order pregnancy
  • placenta praevia
  • uterine abnormality
  • cephalo-pelvic disproportion
  • maternal condition - can’t cope with pregnancy
  • herpes simplex in trimester 3
  • HIV
  • fetal weight estimated >4.5kg
97
Q

What should be done before a C-Section is carried out?

A

G&S - usually 500-1000ml blood loss
Prescribe ranitidine - lying flat with gravid uterus increase risk of gastric content aspiration
VTE assessment - stockings and LMWH

98
Q

What anaesthesia is used for a c-section?

A

Epidural or Spinal

General if CI to regional or category 1 emergency

99
Q

How is the woman position in a c-section?

A

Left lateral tilt of 15 degrees - reduce risk of supine hypotension due to aortocaval compression

100
Q

What is done in the operating theatre prior to incision in a c-section?

A

Catheter - drain bladder so less likely to be injured

Abx administered

101
Q

What incision is used for a c-section?

A

Pfannenstiel - transverse lower abdominal

102
Q

What layers must you dissect through in a C-section?

A

Skin
Camper’s fascia - superficial subcutaneous fat
Scarpa’s fascia - deep membranous layer of subcutaneous tissue
Rectus sheath and muscle
Abdominal peritoneum - parietal

103
Q

What happens to the visceral peritoneum in a c-section?

A

Incised

Pushed down to reflect bladder

104
Q

Where is the uterine incision in a c-section?

A

Lower uterine segment beneath line of peritoneal reflection

105
Q

How is the baby delivered in a c-section?

A

Fundal pressure

De Lee’s incision (lower vertical) if lower uterine incision poorly formed

106
Q

What are the final steps of a c-section after delivery?

A

IV oxytocin - aid delivery of placenta
Placental delivery by controlled cord traction
Uterine cavity emptied
Closure

107
Q

What are the main benefits of a c-section?

A 
Lower risk of:
Perineal trauma 
Incontinence
Uterovaginal prolapse
Late stillbirth
108
Q

What are the immediate complications associated with a c-section?

A 
PPH
Bladder/bowel trauma
Wound haematoma
Transient tachypnoea of newborn
Laceration of fetus
Need for hysterectomy
109
Q

What are the intermediate complications associated with c-sections?

A

VTE
UTI - catheter
Endometritis

110
Q

What are the late complications associated with c-sections?

A 
Subferility
Dehiscence of scar in next labour
Regret/psychological
Placenta praevia
Ectopic pregnancy on scar
111
Q

How successful/safe is vaginal birth after a C-Section?

A

Clinically safe for majority of women with 1 lower segment c-section

75% success rate
90% success rate if previous vaginal birth after c-section

112
Q

What are the contraindications for vaginal birth after a c-section?

A

Previous uterine rupture
Classical caesarian scar
Relative CI - >2 lower segment caesarians or complex uterine scars

113
Q

What are the advantages of vaginal birth after caesarian?

A

Shorter hospital stay
Lower risk of maternal death
Lower risk of neonatal respiratory difficulties

114
Q

What are the risks to vaginal birth after a c-section?

A

Uterine rupture
Anal sphincter injury
Risks of waiting for spontaneous labour

115
Q

How is perineal injury classified?

A

1st degree - injury to skin
2nd degree - injury to perineal muscles but not anal sphincter
3a - <50% of external anal spincter
3b - >50% external anal sphincter
3c - internal anal sphincter
4 - injury to perineum inc. anal sphincter and epithelium

116
Q

What are the risk factors for perineal injury?

A 
Primigravida
Large babies
Precipitant labour
Shoulder dystocia
Forceps delivery
117
Q

What is the relative risk of perineal trauma to women with a history of severe perineal trauma?

A

Risk not increased

118
Q

When/how is an episiotomy done?

A

If clinical need - instrumental delivery or fetal compromise

Mediolateral approach originating at vaginal fourchette directed to right

119
Q

Why should a perineal tear be repaired as soon as possible?

A

Minimise risk of infection and blood loss

120
Q

What is shoulder dystocia?

A

Shoulders stuck following delivery of the head

121
Q

What are the types of shoulder dystocia?

A

Anterior shoulder impacted on maternal pubic symphysis

Posterior shoulder impacted on sacral promontory (less common)

122
Q

What are the risk factors associated with shoulder dystocia?

A 
Macrosomia
Maternal diabetes
Maternal BMI >30
Previous Hx of shoulder dystocia
Induction of labour
Prolonged labour
123
Q

What are the risks of shoulder dystocia?

A

Fetus

  • Delay in delivery - hypoxia
  • Brachial plexus injury - traction to head
  • Humerus/clavicle fracture

Mum

  • Perineal tears
  • PPH
  • Pelvic floor weakness
124
Q

What should be immediately done if the shoulders get stuck in delivery?

A

Call for help
Stop pushing
Avoid downward traction - only apply axial traction
Consider episiotomy

125
Q

What is the first line management for shoulder dystocia?

A

McRoberts manoeuvre - hyperflex maternal hips (knees to chest)
+ suprapubic pressure - apply pressure behind anterior shoulder

126
Q

What is the second line management for shoulder dystocia?

A

Insert hand into sacral hollow and grasp posterior arm

Internal rotation - corkscrew manoeuvre - turn shoulders 180 degrees

127
Q

What is the last resort for shoulder dystocia?

A

Cleidotomy - fracture fetal clavicle

Symphysiotomy - cut pubic symphysis

Zavenelli - return fetal head to pelvis for C-Section

128
Q

What are the types of cord prolapse?

A

Occult - cord drop alongside baby but may not be seen in advance

Overt - cord come before baby’s head can come out

129
Q

How does fetal hypoxia occur in cord prolapse?

A

Occlusion - fetus press on umbilical cord occluding blood flow

Arterial vasospasm - exposure of cord to cold atmosphere results in umbilical arterial vasospasm

130
Q

What are the risk factors for cord prolapse?

A 
Breech
Artificial rupture of membranes
High fetal station
Polyhydramnios
Prematurity
Long umbilical cord
131
Q

How may cord prolapse present?

A

Fetal heart rate abnormal - subtle decelerations on contraction and bradycardia

Cord felt vaginally

Presence of blood suggest alternate diagnosis

132
Q

How is cord prolapse managed?

A

Avoid handling cord - avoid vasospasm
Knee-chest position for mother
Manually lift presenting part by digital vaginal exam
Tocolysis - terbutaline - relax uterus and stop contractions
Delivery - usually emergency c-section
If fully dilated - can encourage vaginal/instrumental delivery

133
Q

What is uterine rupture?

A

Full thickness disruption to uterine muscle and overlying serosa

134
Q

What are the risk factors for uterine rupture?

A

Anything that makes the uterus wall weaker:

  • previous c-section
  • previous uterine surgery
  • induction with prostaglandins
  • multiple pregnancy
135
Q

How does uterine rupture present?

A

Sudden severe abdominal pain - persist between contractions
Shoulder tip pain
Vaginal bleeding
Regression of presenting part
Palpable fetal parts on abdominal examination
Fetal distress
Maternal hypovolaemic shock

136
Q

What are the differentials for uterine rupture?

A

Placental abruption

Placenta and vasa praevia - usually painless

137
Q

How is uterine rupture managed?

A

Resuscitate
Deliver fetus by c-section
Repair uterus or hysterectomy

138
Q

What is an amniotic fluid embolism?

A

Fetal cells/amniotic fluid enters maternal blood stream causing a reaction

139
Q

How does an amniotic fluid embolus present?

A

Sudden onset

Hypoxia
Hypotension
Shock
DIC
Seizures
140
Q

How is an amniotic fluid embolus diagnosed?

A

Focus on resus not diagnosis

Definitive diagnosis made post mortem - fetal squamous cells and debris found in pulmonary vasculature

141
Q

How is an amniotic fluid embolus managed?

A

ABCDE

  • high flow o2
  • fluid resuscitation
142
Q

How should stillbirth’s be managed?

A

Allow parents time and space for reflection away from normal ward
Allow to dress and spend time with child
Hospital protocols - wrap baby, offer to hold, photos, hair and palm prints
Funeral arrangements
Hospital counsellors and chaplains - comfort to families
Bereavement midwives
Consent for post mortem
Inform GP practice

143
Q

What us puerperium?

A

6 week period following birth where body reverts to non-pregnant state

144
Q

When do the CVS adaptations of pregnancy revert?

A

Within 2 weeks

145
Q

What happens to the vagina in the puerperium?

A

Regain tone within 2 weeks

Initially swollen and blue

146
Q

What happens to the uterus in the puerperium?

A

Initial - drop to size at 20 weeks
Day 12 - non-palpable
Week 6 - only slightly larger than original

147
Q

What changes occur to lochia in the puerperium?

A

First 3 days - mostly blood and trophoblastic tissue remnants

4-12 days - Colour change from reddish-brown to yellow

148
Q

What are the common complaints in puerperium and how are they managed?

A

Painful perineum - analgesia and sit on rubber ring
Urinary retention - catheter
Stress incontinence - pelvic floor exercises
Constipation - stool softeners
Haemorrhoids - normally disappear in few weeks
Dyspareunia - examine perineum and encourage lubricants
Backache - analgesia
Anaemia - iron

149
Q

When do women require contraception after pregnancy?

A

After day 21

150
Q

When can the progesterone only pill be taken after delivery?

A

Day 21 onwards with additional cover for first 2 days

Some progesterone enter breast milk but not harmful

151
Q

What is the guidance on COCP after pregnancy?

A

Not for 6 weeks post partum if breastfeeding - unacceptable health risk

If not breastfeeding, can start after 21 days but req. 7 days additional cover

VTE risk

152
Q

When can the IUD/IUS be inserted post delivery?

A

Within 48 hours or

After 4 weeks

153
Q

What is the lactational amenorrhoea method of contraception?

A

98% effective contraception for fully breast-feeding women that are amenorrhoeic and <6 months post partum

154
Q

What is puerperal pyrexia?

A

Temp >38 within first 14 days

155
Q

What can cause puerperal pyrexia?

A 
Endometritis - most common cause
UTI
Wound infections - perineal tear/c-section
Mastitis
VTE
156
Q

How is puerperal pyrexia managed?

A

Endometritis suspected then pt. should be referred to hospital for IV Abx - clindamycin and gentamicin until afebrile for >24hrs

Obstetrics and Gynaecology (21 decks)

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