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Human Development 2 > Maternal Post Partum Problems > Flashcards

Maternal Post Partum Problems Flashcards

1
Q

how long is the puerperium

A

= time from delivery until 6 weeks

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2
Q

what is the puerperium defined as 6 weeks after delivery

A

the time taken for the uterus to involute

END=most of the physiological changes of pregnancy have returned to the pre-pregnancy state

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3
Q

what two things can occur after the 6 weeks after delivery

A

However lactation and psychological strains continue after 6 weeks

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4
Q

what are the two causes of maternal death

A

Direct cause

Indirect cause

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5
Q

define the direct and indirect cause of maternal death

A

Direct cause of maternal death because of complications during pregnancy and after delivery
If the person had not been pregnant then this wouldn’t have happened

Indirect maternal death is due to prediagnosed medicial condition, would not have worsened and women would not have died if it wasn’t for the pregnancy

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6
Q

what are the most common cause of indirect maternal death

A

Cardiac death

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7
Q

what is the most common cause of direct maternal death

A
  1. thrombosis and thromboembolism

2. maternal suicide

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8
Q

what is cardiac death in material death increasing

A
  • increase in maturational age of mothers, therefore they are more likely to have an MI
  • migration and thus people with rheumatic fever enter the UK and not aware they have Rheumatic fever and therefore they die
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9
Q

What is a primary post partum haemorrhage

A

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

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10
Q

what is a secondary post part haemorrhage

A

abnormal bleeding from the genital tract, from 24 hours after delivery - 6 weeks

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11
Q

what is the indcidence of a primary post partum haemorrhage

A

5%

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12
Q

what are the 4 causes of primary PPH

A

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

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13
Q

describe how thrombin causes primary post partum haemorrhage

A

the tone, trauma and tissue can lead to the person bleeding profusely this leads to a disseminated coagulation state as there is a lack of coagulation factors left
- this prevents them from being able to stop bleeding

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14
Q

What are the predisposing factors to a primary PPH

A

Antepartum haemorrhage in this pregnancy

Placenta praevia (15x risk)

Multiple pregnancy (5x risk)

Pre-eclampsia (4x risk)

Nulliparity (3x risk)

Previous PPH (3x risk)

Maternal obesity (2x risk)

Maternal age (increases with age)

Multiparity (parity > 4)

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15
Q

what are the intrapartum risk factors for a PPH

A

Emergency Caesarean section (9x risk)

Elective CS (4x risk)

Retained placenta (5x risk)

Episiotomy (5x risk)

Operative vaginal delivery (2x risk)

Labour >12 hours (2x risk)
>4kg baby (2x risk)

Maternal pyrexia in labour (2x risk)

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16
Q

What do you do in a PPH

A

Call for help
Crash call code = 22 22
Airway, Breathing, Circulation.
Two large bore IV canula
Oxygen by mask(10-15 L/min)
Blood – FBC, Xmatch 4 units of blood, urea and electrolytes, clotting profile
SIMULTANEOUSLY: communication, resuscitation, monitoring and investigation, arresting the Bleeding

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17
Q

what is uterine atony

A
  • uterine is a tone cause of PPH

- it is when the uterine fails to contract after birth

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18
Q

How do you treat uterine atony

A
  • do a bimanual uterine massage and compression
  • this is when you put your fist inside the vagina and with the other hand you try and massage the uterus
  • then ask for oxytoxic agents such as syntometrine, syntocinon, prostaglandins
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19
Q

List some oxytocin agents

A

syntometrine
syntocinon
prostaglandins

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20
Q

list the uterotonics that can be used and what with

A
  • Syntometrine – drug that is commonly used (made up of oxytocin and ergometrine)

IVI syntocinon 40units in 500ml over 4 hours – drug that causes the uterus to contract (sometimes used in labour)

PGE1 misoprostol 800mg PR - give 4 or 5 tablets into the rectum and this can cause the uterus to go into contraction

PGF2α carboprost 250mcg IM - this causes the uterus to go into contraction, can give 8 doses every 15 minutes in order to control the bleeding

Give IV/IM ergometrine 500 mcg - this causes vasoconstriction

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21
Q

What are the two surgical procedures that can be used for PPH

A

Barki Balloon

B lynch

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22
Q

What is a Barki Balloon

A
  • this is advice that is placed in the uterus and is used for temporal control and reduction of bleeding
  • when it inflates it keeps the uterus contracted and stops the bleeding
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23
Q

What is a B Lynch

A
  • this is when you open the women up
  • put a brace suture in in the anterior and posterior way and tie it up so it holds and squeezes the uterus which helps control the bleeding
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24
Q

what happens in a uterine artery embolisation

A
  • this is used to help treat PPH
  • pellets are inserted into the femoral artery and then into the uterine artery and these block the blood supply to the uterine body
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25
Q

what other vascular approach can you use for PPH

A

Bilateral ligation of the uterine arteries or of the internal iliac arteries

26
Q

You should resort to a …

A

Resort to hysterectomy SOONER RATHER THAN LATER (especially in cases of placenta accreta or uterine rupture)

27
Q

in what cases should you especially resort to a hysterectomy

A

especially in cases of placenta accreta or uterine rupture

28
Q

Where does secondary PPH present

A
  • this commonly presents in the community as prolonged or excessive bleeding
29
Q

what are the causes of secondary PPH

A

Infection = endometritis

  • 1-3% after spontaneous vaginal delivery.
  • commonest cause of postnatal morbidity days 2 -10

tissue = retained products of conception

30
Q

How is secondary PPH investigated by

A 
FBC, CRP
Blood cultures
High/low vaginal swab
MSU
Ultrasound may be used if RPOC suspected
31
Q

How do you treat secondary PPH

A
  • Broad spectrum IV antibiotics

- if RPOC (retained products of conception) evacuate after 24 ours of antibiotics

32
Q

what are the 5 key haemorrhage messages

A
  1. Anticipate Avoid
  2. Early recognition
  3. Prompt Effective Resuscitation
  4. Control bleeding quickly
  5. Human Factors.
33
Q

what is the main protective physiological change against PPH and what does this predispose us in

A
  • main protective physiological change against PPH is increasing clotting factors and reducing anticoagulants this predispose us to thromboembolic disease
34
Q

what is the leading cause of direct maternal death

A

Thromboembolic disease

35
Q

What are pre-exisitng risk factors for thromboembolic disease

A 
1, Previous VTE
2, Thrombophilia Congenital /Acquired
3, Age over 35 years
4, Obesity (BMI >30)
5, Parity >4
6, Gross varicose veins
7, Paraplegia
8, Sickle cell disease
9, Inflammatory disorders
36
Q

What are the pregnancy related risk factors for thromboembolic disease

A 
1, Surgical procedure eg LSCS, MROP
2, Dehydration
3, Sepsis e.g. pyelonephritis
4, Pre-eclampsia
5, Excessive blood loss
6, Prolonged labour
7, Immobility after delivery
37
Q

What are the symptoms of deep vein thrombosis

A

 Painful swollen leg (lower leg/whole leg)
 Redness/oedema of leg
 Pain: LIF/groin/buttock.

38
Q

What are the symptoms of pulmonary embolism

A

 Chest pain (sudden onset)
 Breathlessness (sudden onset).
 Dizziness/syncope/collapse tachycardia
 Hypoxia.

39
Q

what are the symptoms of cerebral vein thrombosis

A
  • headache

- seizures

40
Q

What is the management of thromboembolism

A 
Early mobilisation
Good hydration
TEDs
LMW heparin prophylaxis
Avoid COCP
41
Q

Why do you not give warfarin

A

tetrogenicity and it is difficult to control the coagulation as it needs active dose management therefore it would be even more difficult with pregnancy

42
Q

What investigations do you use for thromboembolism

A

History

Examination

Investigations
ABG
USS
CXR
V/Q SCAN &/or CTPA
ECG
(MRV)
43
Q

How do you treat thromboembolism

A

LMWH 1mg/kg
Safe if breastfeeding

Warfarin – don’t do this

Follow up

44
Q

almost a 1/4 of women who died between 6 weeks and 1 year after pregnancy died from..

A

mental health related causes

45
Q

What are the signs of mental health problems after pregnancy

A

Postpartum blues

Postpartum depression

Postpartum psychosis

46
Q

describe postpartum blues

A 
o Tearfulness, lability, reactivity.
o Predominant mood: happiness.
o Peaks 3-5 days after delivery.
o Unrelated to environmental stressors
o Unrelated to psychiatric history.
47
Q

describe postpartum depression

A

o Common affliction among women during pregnancy
o 5-25% of pregnant women and new mothers
o Treatment largely the same as for clinical depression in general.

48
Q

What are the symptoms of postpartum psychosis

A

 Loss of contact with reality.
 Hallucinations.
 Severe thought disturbance.
 Abnormal Behaviour.
 Mania
 Excited, over-talkative, uninhibited and intensely overactive.
 Depression.
 Differs from PND in the great severity of their symptoms and the presence
of features like confusion, delusions and stupor.

 Atypical Psychoses
 Confusion/perplexity, catatonic features, thought disorder, auditory
hallucinations and delusions.
o Usually first 10 days following childbirth.

49
Q

define mania

A
  • excited, over-talkative, uninhibited and intensely overactive
50
Q

what is depression

A

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

51
Q

What is atypical psychoses -

A

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

52
Q

When do you admit the mother to the baby unit

A

Mother has any of the following:

  • rapidly changing mental state,
  • suicidal ideation (particularly of a violent nature),
  • pervasive guilt or hopelessness,
  • significant estrangement from the infant,
  • beliefs of inadequacy as a mother,
  • evidence of psychosis.
53
Q

what are the causes of pregnancy induced hypertension

A

a, Gestational hypertension: Late onset hypertension, without proteinuria

b, Pre-eclampsia: Hypertension with proteinuria and after 20 weeks of pregnancy

c. Eclampsia: Pre-eclampsia + convulsions.

54
Q

define gestational hypertension

A

Late onset hypertension, without proteinuria

55
Q

How do you manage gestational hypertension

A

 Continue use of antenatal antihypertensive treatment if 149/99 or over.
 Consider using reducing antihypertensive treatment if their blood pressure falls
below 140/90mmHg, reduce if below 130/80.

56
Q

define pre-eclampsia

A

hypertension with proteinuria and after 20 weeks of pregnancy.

57
Q

how do you treat pre-eclampsai

A 
Women who with pre-eclampsia who have given birth, carry out a urinary reagent-strip test at the
postnatal review (6-8 weeks after the birth). If persistent:
 Further review 3 months after birth (kidney function).
58
Q

what is eclampsia

A

Eclampsia is defined as one or more convulsions in association with pre-eclampsia.

44% Post natal
38% Antenatal
18% Intrapartum

59
Q

How do you control fits

A

 Loading Dose: MgSO4 (8mls + 12mls saline) over 20 minutes

 Maintenance Dose: 1-2g MgSO4/hr (20 + 30).
o Maintain for 24 hours post-delivery.

 Therapeutic Levels: 2-4mmol/litre.

60
Q

What different causes of cardiac death

A 
o Sudden adult death syndrome
o Aortic dissection
o Acute coronary syndrome
o Cardiomyopathy
o Other cardiac Conditions

Human Development 2 (34 decks)

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