Maternal Postnatal Problems Flashcards
Define ‘puerperium’
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
What are the main risks in the post-natal period?
Postpartum haemorrhage, thromboembolic disease, psychiatric disorders, pre-eclampsia, sepsis and cardiac disease
What is primary postpartum haemorrhage?
Greater tha n 500ml blood loss from the genital tract within 24 hours of delivery
What is secondary post-partum haemorrhage?
Abnormal bleeding from the genital tract from 24 hours after delivery to 6 weeks later
What are the causes of primary postpartum haemorrhage (the 4 Ts)?
Tone - uterine atony
Tissue - retained placenta
Trauma - vulva or vaginal lacerations
Thrombin - a coagulopathy
What is the most common cause of primary post-partum haemorrhage?
Issues with lack of tone and tissue being retained (placenta)
What are the risk factors for postpartum haemorrhage?
Antepartum haemorrhage, pre-eclampsia, multiple pregnancy, placenta praaevia, surgery and maternal age
When may uretotonics be given?
Form of oxytocics given to increase the tone of the uterus
Name some examples of uretotonics
Syntometrine, syntocinon, misoprostol, ergometrine
What are the common causes of secondary postpartum haemorrhage?
Infection (endometriosis) and retained products
What is the leading cause of maternal death?
Thromboembolic disease
Why are new mothers predisposed to a greater risk of thromboembolic disease?
To prevent excess blood loss in labour, clotting factors and increased and anticoagulants are reduced, and this predisposes women to thromboembolic disease
What are the risk factors for developing postpartum thromboembolic disease?
BMI >30, previous VTE, thrombophilia or aged 35+
What are the conditions encompassed by VTE?
Deep vein thrombosis (DVT), pulmonary embolism (PE) and cerebral vein thrombosis
What are the symptoms of DVT?
Painful, swollen and oedematous lower limbs
What are the symptoms of PE?
Sudden onset of chest pain and breathlessness as well as dizziness, syncope and hypoxia if left untreated
What are ‘baby blues’?
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
What is puerperal psychosis?
An acute mental illness where there may be: loss of contact with reality, hallucinations, severe thought disturbance and abnormal behaviour
What is the leading cause of DIRECT maternal death?
Cardiac disorders e.g. acute coronary syndrome, aortic dissection, cardiomyopathy
