Maternal post partum problems Flashcards
What is puerperium?
Time from delivery until 6 weeks
Why is cardiac disease a prevalent cause of maternal death?
women who have previously had complications such as CHD are now able to survive and become pregnant
What is the most common cause of maternal death?
post partum haemorrhaging
What is the difference between primary and secondary post partum haemorrhage?
Primary: >500 ml of blood loss from genital tract within 24 hours
Secondary: abnormal bleeding from genital tract, 24 hours to 6 weeks
What are the main causes of primary post partum haemorrhage (PPH)?
Tone: uterus not contracting (70%)
Tissue: placenta/membrane left behind (20%)
Trauma: episiotomy/tear which keeps bleeding (9%)
Thrombin: clotting disorders that need to be corrected (1%)
What is uterine atony and how is it managed?
Uterus fails to contract after birth
Managed by bimanual uterine massage and compression and oxytocic agents
How is primary PPH managed?
Uterotonics: sytometrine (syntocinon - synthetic oxytocin - and ergemetrine - vasoconstriction)
- misoprostol (prostaglandin E1)
- carboprost (prostaglandin F2alpha)
Surgery: bakrj balloon - device that temporarily control and reduces PPH; inflates to keep uterus contracted and stop bleeding
B-lynch - mechanical compression of atonic uterus using sutures
Uterine artery embolisation: catheter delivers small particles to block blood supply to the uterine bosy
(resort to hysterectomy sooner rather than later)
How is secondary PPH caused?
Infection (endometriosis)
Tissue (retained products of conception)
How is secondary PPH treated?
broad spectrum IV antibiotics, evacuate RPOC after 24 hours of antibiotics
Why might a woman experience thromboembolic disease after pregnancy?
Towards the end of pregnancy there is increased clotting factors and reduced anticoagulants
(reduces risk of PPH)
What are the pre-existing and pregnancy-related risk factors for thromboembolic disease?
Pre-existing: >35 y/o Thrombophilia Previous VTE Sickle cell
Pregnancy-related: Sepsis Pre-eclampsia Excessive blood loss Dehydration
What are the symptoms of VTE?
Deep vein thrombosis (painful, redness, oedema)
Pulmonary embolism (sudden chest pain, breathlessness, dizziness, syncope, collapse, hypoxia)
Cerebral vein thrombosis (headache, seizures)
How is a thromboembolism managed?
Early mobilisation, good hydration, LMWH, avoid COCP
What is the post partum blues?
Predominant mood is happiness, but may experience tearfulness, lability, reactivity
This peaks 3-5 days after delivery
It is unrelated to environmental stressors and psychiatric illness
What is post partum/perinatal depression?
Extreme form of depression
Treatment is the same as it is for clinical depression
Occurs in 5-25% of new mothers
