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HD CC > Maternal Post-Partum Problems > Flashcards

Maternal Post-Partum Problems Flashcards

1
Q

Puerperium

A

Time from delivery until 6 weeks

Time taken for uterus to involute

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2
Q

End of puerperium

A

Most of physiological changes of pregnancy have returned to pre-pregnancy state
However, lactation + psychological strains continue after 6 weeks

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3
Q

Post Partum Haemorrhage

A

Excessive bleeding following delivery

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4
Q

Primary PPH

A

> 500ml blood loss from genital tract within 24h delivery

Commoner

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5
Q

Secondary PPH

A

Abnormal bleeding from genital tract, from 24hr after delivery –> 6 weeks

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6
Q

PPH Incidence

A

5%

Leading worldwide cause of maternal death

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7
Q

PPH Causes

A 
4 Ts
Tone (70%)
Trauma (20%)
Tissue (9%)
Thrombin (1%)
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8
Q

PPH Predisposing factors

A 
Antepartum haemorrhage in pregnancy
Placenta praevia (15x risk)
Multiple pregnancy
Pre-eclampsia
Nulliparity
Previous PPH
Maternal obesity
Maternal age (increases with age)
Multiparity
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9
Q

Intrapartum Haemorrhage RFs

A 
Emergency C section
Elective CS
Retained placenta
Episiotomy
Operative vaginal delivery
Labour > 12hrs
>4kg baby
Maternal pyrexia in labour
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10
Q

Uterine Atony

A

Most common cause PPH
Initial step- bimanual uterine massage and compression
Oxytocic agents- syntometrine, syntocin, prostaglandins

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11
Q

Uterotonics

A 
Syntometrine
IVI syntocinon 40 units in 500ml over 4 hours
Misoprostol
Carboprost
Ergometrine
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12
Q

Surgery PPH

A 
Examination under anaesthetic
Check placenta
Suture tears
Insert intrauterine balloon
Uterine artery embolization
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13
Q

Hysterectomy PPH

A

Sooner rather than later

Especially in cases of placenta accrete or uterine rupture

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14
Q

Secondary PPH causes

A

Infection- endometritis

Tissue- retained products of conception

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15
Q

PPH investigations

A 
FBC
Blood culture
High/low vaginal swab
MSU
Ultrasound if RPOC suspected
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16
Q

Secondary PPH treatment

A

Broad spectrum IV antibiotics

90% cases treated improve within 48-72 hours

17
Q

Thromboembolic disease

A

Main protective psychological change against PPH is increasing clotting factors and reducing anticoagulants
–> BUT predisposes to TED

18
Q

Thromboembolic disease pre-existing factors

A 
Previous VTE
Thrombophilia
35+
Obesity
Gross varicose veins
Sickle cell
Paraplegia
Inflammatory disorders
19
Q

Thromboembolic disease Pregnancy related RFs

A 
Surgical procedure
Dehydration
Sepsis
Pre-eclampsia
Excessive blood loss
Prolonged labour
Immobility after delivery
20
Q

DVT symptoms

A

Painful swollen leg
Redness/oedema
Pain- left iliac fossa/groin/buttock
Non-specific lower abdo pain

21
Q

PE symptoms

A 
Chest pain
Breathlessness
Dizziness
Syncope
Hypoxia
22
Q

Cerebral VT symptoms

A

Headache

Seizures

23
Q

Thromboembolic disease management

A 
Early mobilisation
Good hydration
TEDs
LMW heparin prophylaxis
Avoid COCP
24
Q

Thromboembolic disease treatment

A

LMWH 1mg/kg
Safe if breastfeeding

Warfarinise

25
Q

Postpartum “blues”

A

Tearfulness, reactivity
Peaks 3-5 days after delivery
Present in 50-80% of women

26
Q

Perinatal depression

A

During pregnancy + first postpartum year

5-25% pregnant women + new mothers

27
Q

Puerperal psychosis

A 
Loss of contact with reality
Hallucinations
Severe thought disturbance
Abnormal behaviour
Often no insight
Sudden
Usually within first 10 days following birth
Mania, depressive or atypical psychosis
0.1-0.2% new mothers
28
Q

Mania psychoses

A

Excited, over-talkative, uninhibited and intensely overactive

29
Q

Depression psychoses

A

Differ from postnatal depression in the great severity of their symptoms and the presence of features like confusion, delusions and stupor

30
Q

Atypical psychoses

A

Confusion or perplexity, catatonic features, thought disorder, auditory hallucinations and delusions

31
Q

Pregnancy induced hypertension

A

Gestational hypertension- late onset hypertension, without proteinuria
Pre-eclampsia- hypertension with proteinuria after 20 weeks pregnancy
Eclampsia- pre-eclampsia + convulsions

32
Q

Post natal Pre-eclampsia treatment

A

Urinary reagent-strip test at postnatal review (6-8 weeks after birth)
If proteinuria persists at postnatal review, further review at 3 months to test for kidney function
–> referral to kidney specialist

33
Q

Eclampsia

A

One or more convulsions in association with pre-eclampsia

34
Q

Control of Eclampsia fits

A 
Loading dose- 4g MgSO4 infused over 20 mins
Maintenance dose- 1-2g MgSO4/hr
Maintain 24hrs post delivery
Pulse Oximetry
Therapeutic levels 2-4mmol/litre
35
Q

Cardiac

A 
Leading cause of direct maternal deaths
Sudden adult death syndrome
Aortic dissection
Acute coronary syndrome
Cardiomyopathy
36
Q

Connective tissue disease

A 
Systemic lupus erythematosus (SLE)
Antiphospholipid syndrome (APS)

HD CC (22 decks)

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