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HD2 > Maternal Post-Partum Problems > Flashcards

Maternal Post-Partum Problems Flashcards

1
Q

What is puerperim?

A
  • time from delivery until 6 weeks

- time taken for uterus to involute

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2
Q

What does puerperim end?

A
  • most of physiological changes of pregnancy return to pre-pregnancy state
  • only lactation and psychological strains continue after 6 weeks
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3
Q

What is the most prevalent cause of maternal death?

A
  • cardiac disease

obesity, older age, increased immigrant populations

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4
Q

What is post-partum haemorrhage?

A
  • excessive bleeding following delivery
  • 5% incidence
  • most common cause of maternal deaths
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5
Q

What is primary post-partum haemorrhage?

A

> 500ml blood loss from genital tract within 24 hours of delivery

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6
Q

What is secondary post-partum haemorrhage?

A

Abnormal bleeding from genital tract

From 24 hours after delivery to 6 weeks

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7
Q

What are the causes of primary post partum haemorrhage?

A

Tone (uterus not contracting - 70%)
Tissue (placenta/membranes left behind - 20%)
Trauma (episiotomy/tear which keeps bleeding - 9%)
Thrombin (clotting disorders that need to be corrected - 1%)

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8
Q

What are the pre-disposing factors of primary post partum haemorrhage?

A 
Antepartum haemorrhage
Placenta praevia
Multiple pregnancy
Pre-eclampsia
Previous PPH
Maternal obesity
Maternal age
Multiparity
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9
Q

What is the significance of uterine atony?

A
  • felt at umbilicus if pregnancy, cricket ball consistency when contracted
  • cause of PPH
  • uterine fails to contract after birth
  • managed by bimanual uterine massage and compression and oxytocic agents if not contracted enough
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10
Q

How is primary PPH managed?

A
  • call for help/crash call/ABC/IV canula/oxygen by mask/FBC/transfusion/urea and electrolytes/clotting profile
  • uterotonics
  • surgery
  • uterine artery embolisation
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11
Q

What is uterotonics?

A
  • syntometrine (oxytocin synthetic and ergomtrine for vasoconstriction)
  • misoprostol (PG E1)
  • carboprost (PG F2alpha)

(increase contraction of uterus)

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12
Q

How does surgery treat PPH?

A
  • bakri balloon (device used for temporary control and reduction of PHH, inflates keeping uterus contracted stopping bleeding) and continue syntometrine drip
  • B-lynch (mechanical compression of atonic uterus using sutures)
  • check placenta is fully removed and try to remove some with hands manually if you think it has not
  • uterine artery embolisation
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13
Q

How can uterine artery embolization be used for PPH?

A
  • catheter to deliver small particles blocking blood supply to uterine body relieving blood loss
  • resort to hysterectomy sooner rather than later (especially if placenta accrete where vessels grow too deeply to uterine wall = uterine rupture)
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14
Q

What is secondary PPH?

A

Commonly presents as prolonged/excessive bleeding

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15
Q

What are the causes of secondary PPH?

A
  • infection (endometritis)

- tissue (retained products of conception)

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16
Q

What is the commonest cause of postnatal morbidity during days 2-10?

A

Endometritis

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17
Q

How is secondary PPH treated?

A
  • broad spectrum IV antibiotics (90% cases)

- RPOC (retained products of conception) -> evacuate after 24 hours of antibiotics

18
Q

What are the 4 key haemorrhage messages?

A
  • anticipate avoid
  • early recognition
  • prompt effective resuscitation
  • control bleeding quickly
  • human factors
19
Q

What is the most common direct cause of maternal deaths?

A

Thromboembolic disease

20
Q

What are pre-existing risk factors of thromboembolic disease?

A
  • previous VTE/gross varicose veins
  • thrombophilia (congenital/acquired)
  • age over 35 years
  • obesity
  • paraplegia
  • sickle cell disease
  • inflammatory conditons
21
Q

What are pregnancy related risk factors of thromboembolic disease?

A
  • surgical procedures
  • dehydration
  • sepsis
  • pre-eclampsia
  • excessive blood loss
  • prolonged labour
  • immobility after delivery
22
Q

What are the symptoms of deep vein thrombosis?

A
  • painful swollen leg
  • redness/oedema of leg
  • pain in groin/buttock
23
Q

What are the symptoms of pulmonary embolism?

A
  • chest pain (sudden onset)
  • breathlessness (sudden onset)
  • dizziness/syncope/collapse tachycardia
  • hypoxia
24
Q

What are the symptoms of cerebral vein thrombosis?

A
  • headache

- seziures

25
Q

How is thromboembolism managed?

A
  • early mobilisation
  • good hydration
  • TEDs
  • LMW heparin
  • avoid COCP
26
Q

How is thromboembolism investigated?

A
  • history
  • examination
  • tests to exclude other diseases (ABG, CXR, ECG)
27
Q

How is thromboembolism treated?

A
  • LMWH 1mg/kg (safe if breastfeeding)

- warfarin once INR is at normal level, teratogenic, but can give post natally switching from LMWH

28
Q

What are the symptoms of postpartum blues?

A
  • tearfulness/inability/reactivity
  • predominant mood of happiness
  • peaks 3-5 days after delivery
  • unrelated to environmental stressors or psychiatric history
29
Q

What are the symptoms of postpartum/perinatal depression?

A
  • common affliction among women during pregnancy
  • 5-25% of pregnant women and new mothers
  • treatment largely same as for clinical depression in general
30
Q

What are the symptoms of postpartum psychosis?

A

acute mental illness

  • loss of contact with reality
  • hallucinations
  • severe thought disturbance
  • abnormal behaviour
  • mania
  • depression (confusion, delusions, stupor)
  • atypical psychoses
  • first 10 days following childbirth
31
Q

What is mania?

A

excited
over-talkative
uninhibited
intensely overactive

32
Q

What is the 2nd leading cause of direct maternal deaths?

A

hypertensive disorders

33
Q

What are the types of pregnancy-induced hypertension?

A
  • gestational hypertension
  • pre-eclampsia
  • eclampsia
34
Q

What is gestational hypertension?

A
  • late onset without proteinuria
35
Q

How is gestational hypertension managed?

A
  • antenatal antihypertensive treatment continue if 149/99 or over
  • consider reducing antihypertensive if bp falls below 140/90, reduce if below 130/80
36
Q

What is pre-eclampsia?

A

hypertension with proteinuria and after 20 weeks of pregnancy

  • urinary reagent strip test at postnatal review (6-8 weeks after birth)
  • if persistent further review 3 months after birth (kidney function)
37
Q

What is eclampsia?

A

Pre-eclampsia and convulsions

38
Q

How are fits controlled?

A
  • loading dose: 8ml MgSO4 over 20 minutes
  • maintenance dose: (1-2g/hr)
  • therapeutic levels: 2-4mmol/L
39
Q

What types of cardiac problems are there?

A
  • sudden adult death syndrome
  • aortic dissection
  • acute coronary syndrome
  • cardiomyopathy
  • other cardiac conditions
40
Q

What are direct and indirect causes of maternal death?

A

Direct - only due to pregnant state

Indirect - due to other factors than pregnancy

41
Q

What are the intrapartum risk factors of primary PPH?

A 
Emergency C section
Retained placenta
Episiotomy
Operative vaginal delivery
Labour >12 hours

HD2 (22 decks)

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