Module 12 - Postpartum problems Flashcards
When and how much FFP do you give in an MOH?
FFP at a dose of 12-15 ml/kg should be administered after 4 units of red cells during major obstetric haemorrhage until haemostatic results are known
What levels of PT and APTT do you want to achieve in MOH during transfusion?
Aim to maintain prothrombin time (PT) and activated partial thromboplastin time (APTT) ratios at < 1.5 times normal
What guides further FFP administration after the initial has been given?
Subsequent FFP transfusion guided by clotting screen
When and how much Cryoprecipitate do you give in an MOH?
Standard dose of two 5 unit pools should be administered early in major obstetric haemorrhage
What guides further Cryoprecipitate administration in MOH?
Subsequent cryoprecipitate transfusion should be guided by fibrinogen results.
Aim for fibrinogen levels > 2.0g/l.
What is the incidence of genital haematoma requiring surgical intervention?
1 in 1,000
1 in 1000 deliveries will require surgical intervention for a puerperal genital haematoma
What proportion of UK mothers breastfeed?
73%
What proportion of UK mothers are exclusively breastfeeding at 3 months?
17%
What are the benefits to the neonate of breastfeeding?
- Passive immunity with IgA transfer
- Improved response to infection
- Reduces risk of childhood leukaemia
- Reduces risk of sudden infant death syndrome
- Reduces risk of Type II DM in later life
- Reduces risk of cardiovascular disease in later life
- Reduces risk of obesity in later life
What are the benefits to the mother of breastfeeding?
1) Reduces risk of osteoporosis
2) Reduces risk of cardiovascular disease
3) Reduces risk of ovarian cancer
4) Reduces risk of breast cancer
5) Reduces risk of obesity
A patient sustains an obstetric anal sphincter injury during labour. She is reviewed 6 weeks postnatally as she still has some fecal incontinence. She would like to know her prognosis. What percentage of patients will have some degree of fecal incontinence at 12 months post obstetric anal sphincter injury?
30%
60-80% will be asymptomatic 12 months post OASIS injury
What is the overall incidence of OASIS in the UK?
3%
The overall incidence OASIS in the UK is 2.9% with an incidence of 6.1% in primiparae compared with 1.7% in multiparae
What is the incidence of obstetric anal sphincter injury in primiparae in the UK?
6.1%
What percentage of women with PP (Postpartum Psychosis) will not have any risk factors that place them at high risk?
50%
50% of patients who develop postpartum psychosis will have no pre-existing history to class them at high risk
What percentage of women with PP (Postpartum psychosis) will develop symptoms within day 1-3?
50%
50% have symptoms onset on days 1-3
Majority within 2 weeks of delivery
What is the incidence of PP (Postpartum Psychosis)?
1-2 in 1,000 births
Women with bipolar have an increased risk of PP (Postpartum psychosis). What is it?
1 in 4
Women with a history of bipolar disoder and a personal or family history of postpartum psychosis have what risk of PP during this pregnancy?
> 1 in 2 risk
What is the incidence of suicide after childbirth?
1 in 100,000 - very rare
Although is the 2nd leading cause of death from 6 weeks - 1 year. And is the leading direct cause of death from 6 weeks - 1 year
Women at high risk of developing PP (postpartum psychosis) should be followed up for how long?
Women at high risk of developing PP should be followed up for a minimum of 3 months
What is the overall incidence of 3rd/4th degree perineal tears?
3%
What is the incidence of 3rd/4th degree tears in multiparous women?
1.5-1.7%
What is the incidence of 3rd/4th degree tears in nulliparous women?
6%
What is the incidence of 3rd/4th degree tears in subsequent delivery if you had one previously?
7%
What is the definition of a late maternal death?
Maternal death occuring >6 weeks
In 2013-2015 MBRRACE, 8.8 women per 100,000 died during pregnancy or up to 6 weeks after giving birth.
What is the proportion of these women who have died, whom had pre-existing physical or mental health problems?
65%
A woman is offered trial of instrumental delivery in theatre because of a prolonged second stage of labour.
What is the risk of 3rd/4th degree perineal tear?
10%
What proportion of pregnancies does ‘baby blues’ affect, and when does this normally present?
30-80%
Usually presents in the 1st week
What is the proportion of stillbirths in the UK?
1 in 200 births
1 in 1,000 after 39 weeks
What is the incidence of 3rd/4th degree tears with forceps without episiotomy?
22%
What is the incidence of 3rd/4th degree tears with forceps with episiotomy?
6%
What is the incidence of endometritis following CS?
Reports of up to 30%
What is the incidence of endometritis following vaginal delivery?
1-3%
12 months after a 3rd degree tear what proportion of patients are symptomatic?
20-40%
12 months after a 3rd degree tear what proportion of patients are asymptomatic?
60-80%
Woman presents 4cm with undiagnosed breech at 27+4 weeks gestation. She is requesting to continue with vaginal delivery. You discuss the risk of head entrapment, what figure do you quote?
Risk of head entrapment in vaginal breech <28/40 is 10%
A patient wants to restart her combined contraceptive pill following the delivery of her child. She is not breastfeeding. When would you advise the patient to start taking their contraceptive pill?
3 weeks post-partum
21 days - If you are not breastfeeding and no risk factors for VTE
When can you insert the IUS/IUD after delivery?
Within 48 hours of delivery or after 4 weeks
When can you start using the diaphragm/cap for contraception post-delivery?
After 6 weeks
What is the risk of persistent wound and abdominal discomfort in the first few months following CS?
9 per 100 (common)
What is the risk of readmission to hospital following CS?
5 in 100 (common)
How many deaths occur each year in the UK due to puerperal sepsis?
10 deaths per year
What is the mortality rate with severe sepsis?
20-40%
What is the mortality rate with septic shock?
60%
You are asked to speak to a 29 year old patient following a stillbirth delivery. She asks you what will happen regarding post-mortem and how likely it will provide a cause of death?
46%
Autopsy alone provides classification of death in 45.9% of cases of stillbirth
What is the incidence of stillbirth in the UK?
1 in 200
Which antibiotic do you avoid postpartum to mothers? What problems does it cause to the baby if she breastfeeds?
Avoid nitrofurantoin for 1 month postpartum
It can cause haemolysis
Also avoid in neonates with G6PD deficiency
What is the risk of PPH >1L with physiological 3rd stage of labour?
29 in 1,000
What is the risk of requiring a blood transfusion with physiological 3rd stage of labour?
40 in 1,000
What is the risk of PPH >1L with active 3rd stage of labour?
13 in 1,000
What is the risk of requiring a blood transfusion with active 3rd stage of labour?
14 in 1,000
Which women after OASIS would you recommend for a CS in future pregnancy?
1) Symptomatic with incontinence
2) EAS defect of >30 degrees or incremental squeeze pressure <20mmHg
Which hormone causes peripartum cardiomyopathy?
Prolactin
