Maternal Postnatal Problems

Question 1

Define ‘puerperium’

Answer 1

The time from delivery to 6 weeks. It is the time for the uterus to involute and when the physiological changes of pregnancy have returned to the pre-pregnancy state

Question 2

What are the main risks in the post-natal period?

Answer 2

Postpartum haemorrhage, thromboembolic disease, psychiatric disorders, pre-eclampsia, sepsis and cardiac disease

Question 3

What is primary postpartum haemorrhage?

Answer 3

Greater tha n 500ml blood loss from the genital tract within 24 hours of delivery

Question 4

What is secondary post-partum haemorrhage?

Answer 4

Abnormal bleeding from the genital tract from 24 hours after delivery to 6 weeks later

Question 5

What are the causes of primary postpartum haemorrhage (the 4 Ts)?

Answer 5

Tone - uterine atony
Tissue - retained placenta
Trauma - vulva or vaginal lacerations
Thrombin - a coagulopathy

Question 6

What is the most common cause of primary post-partum haemorrhage?

Answer 6

Issues with lack of tone and tissue being retained (placenta)

Question 7

What are the risk factors for postpartum haemorrhage?

Answer 7

Antepartum haemorrhage, pre-eclampsia, multiple pregnancy, placenta praaevia, surgery and maternal age

Question 8

When may uretotonics be given?

Answer 8

Form of oxytocics given to increase the tone of the uterus

Question 9

Name some examples of uretotonics

Answer 9

Syntometrine, syntocinon, misoprostol, ergometrine

Question 10

What are the common causes of secondary postpartum haemorrhage?

Answer 10

Infection (endometriosis) and retained products

Question 11

What is the leading cause of maternal death?

Answer 11

Thromboembolic disease

Question 12

Why are new mothers predisposed to a greater risk of thromboembolic disease?

Answer 12

To prevent excess blood loss in labour, clotting factors and increased and anticoagulants are reduced, and this predisposes women to thromboembolic disease

Question 13

What are the risk factors for developing postpartum thromboembolic disease?

Answer 13

BMI >30, previous VTE, thrombophilia or aged 35+

Question 14

What are the conditions encompassed by VTE?

Answer 14

Deep vein thrombosis (DVT), pulmonary embolism (PE) and cerebral vein thrombosis

Question 15

What are the symptoms of DVT?

Answer 15

Painful, swollen and oedematous lower limbs

Question 16

What are the symptoms of PE?

Answer 16

Sudden onset of chest pain and breathlessness as well as dizziness, syncope and hypoxia if left untreated

Question 17

What are ‘baby blues’?

Answer 17

Brief episode of misery & tearfulness that affects at least half of all women following delivery, especially those having their first baby. This lasts a few hours to several days in the immediate postnatal period

Question 18

What is puerperal psychosis?

Answer 18

An acute mental illness where there may be: loss of contact with reality, hallucinations, severe thought disturbance and abnormal behaviour

Question 19

What is the leading cause of DIRECT maternal death?

Answer 19

Cardiac disorders e.g. acute coronary syndrome, aortic dissection, cardiomyopathy