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Phase 3a Medicine > Obs and gynae > Flashcards

Obs and gynae Flashcards

1
Q

What are baby blues?

A

Brief period of feeling emotional and tearful 3-10 days after giving birth

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2
Q

How common is baby blues?

A

Majority (67%)

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3
Q

Potential causes of baby blues

A
  • Significant hormonal changes
  • Recovery from birth
  • Fatigue and sleep deprivation
  • Responsibility ofcaring for neonate
  • Establishing feeding
  • All the other changes and events around this time
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4
Q

Risk factors for baby blues

A

First-time mother

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5
Q

Presentation of baby blues

A

3-10 days after birth, peaking at day 5
* Mood swings
* Low mood
* Anxiety
* Irritability
* Tearfulness

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6
Q

Management of baby blues

A

Self-limiting and resolves within 2 weeks of delivery
Reassurance and support

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7
Q

How common is depression in pregnant and postnatal women?

A

12%

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8
Q

Which antidepressant is prefered in pregnancy?

A

SSRIs (fluoxetine) preferable to tricyclic antidepressants

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9
Q

What is puerperal psychosis?

A

Acute onset of a manic or psychotic episode shortly after childbirth, usually developing in the first 2 weeks following birth

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10
Q

How common is puerperal psychosis?

A

2 in 1000

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11
Q

Risk factors for puerperal psychosis

A
  • First-time mother
  • Family history of puerperal psychosis/bipolar affective disorder
  • Personal history of puerperal psychosis
  • Bipolar affective disorder
  • Schizophrenia
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12
Q

Presentation of puerperal psychosis

A

Abrupt onset of psychotic symptoms days to weeks following delivery
* Hallucinations
* Delusions, usually about the baby (deformed, evil, otherwise affected)
* Insomnia
* Tearfulness
* Agitation
* Rapidly changing mental state
* Depression
* Mania
* Confusion
* Thought disorder

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13
Q

Management of puerperal psychosis

A

!Psychiatric emergency!
* Mental health liaison/crisis team
* Admission to mother and baby unit with one-to-one care
* Tranquiliser
* ECT
* Psychotherapy and relapse prevention
* Contraception

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14
Q

Complications of puerperal psychosis

A
  • Suicide
  • Mother killing baby
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15
Q

Prognosis of puerperal psychosis

A

Full recovery
25% recurrence in subsequent pregnancies
65% develop bipolar affective disorder in later life

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16
Q

Side effects of antidepressants on baby

A
  • Short-term withdrawal response
  • Possibly longer-term neurodevelopmental effects
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17
Q

What is sepsis?

A

Large immune response to infection, causing systemic inflammation and affecting the functioning of the organs in the body

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18
Q

When should infection be suspected in mothers after giving birth?

A

Rise in temperature to 38 or more, maintained for 24 hours
Recurring temperature from first to 10th day after childbirth or abortion

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19
Q

What are the most common types of infections postpartum?

A
  • Chorioamnionitis (chorioamniotic membranes and amniotic fluid)
  • UTI
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20
Q

What are the most important pathogens in severe postpartum infections?

A
  • Group A streptococcus
  • Staphylococcus
  • E. Coli
21
Q

Risk factors for infection after giving birth

A
  • Obesity
  • DM
  • History of pelvic infection
  • Prolonged rupture of membranes
  • Cervical cerclage
  • Trauma: vaginal, c-section, wound haematoma
  • Retained placental tissue
  • Group A streptococcus infection in close contacts
  • Impaired immunity
22
Q

Presentation of chorioamnionitis

A
  • Fever > 38
  • Offensive lochia
  • Abdominal pain
23
Q

Presentation of sepsis

A
  • Fever > 38
  • RR > 25
  • Systolic BP < 90
  • Purpuric rash
  • Lactate > 2
  • HR > 130
  • V or less on AVPU
  • Requires oxygen
  • Reduced urine output
24
Q

What examinations would you do if you suspected an infection in someone who has recently given birth?

A
  • Abdomen (wound infection after c-section, enlarged tender uterus)
  • Breasts (mastitis)
  • IV access sites
  • Chest
  • Legs
25
Q

What investigations would you do if you suspect sepsis?

A
  • Blood cultures
  • Blood gas (lactate, pH, glucose)
  • FBC (WBC, neutrophils)
  • U&E
  • LFT
  • CRP (inflammation)
  • Clotting (DIC)
26
Q

What investigations would you do to find the source of infection in a person who has recently given birth?

A
  • Urine cultures
  • High vaginal swab
  • Throat swab
  • Sputum culture
  • Wound swab
  • Lumbar puncture (meningitis, encephalitis)
27
Q

What should you suspect in someone with pyrexia who has recently given birth?

A
  • Infection
  • DVT (low-grade pyrexia)
28
Q

How to manage sepsis in someone who has recently given birth?

A

Call for help from senior obstetrician and midwives
Sepsis 6:
1. Blood cultures
2. Venous lactate
3. Empirical broad-spectrum antibiotics (piperacillin, tazobactam and gentamicin OR amoxicillin, clindamycin and gentamicin)
4. IV fluids
5. Oxygen
6. Catheterisation and urine output

29
Q

Where should women with existing mental health concerns before or during pregnancy be referred to and why?

A

Perinatal mental health services
* Advice and specialist input
* Ongoing management of psychiatric medications
* Plans for delivery to ensure they are followed up closely with help from midwives, health visitors, GPs, family and friends

30
Q

What is postnatal depression?

A

Depressive episode within the first 12 months after delivery

31
Q

Risk factors for postnatal depression

A
  • Lack of social support - poor relationship with partner, unstable or absent family, lack of support from relatives and friends
  • History of depression or other psychiatric illnesses
  • Family history of depression or other psychiatric illnesses
  • Antenatal thyroid dysfunction
  • First-time mother
  • Ambivalence about pregnancy
  • Pregnancy complications
  • < 16 when giving birth
  • Poor or inadequate antenatal care
32
Q

Presentation of postnatal depression

A

Depressive symptoms, typically 3 months after giving birth
* Fatigue and tiredness
* Feelings of being a bad mother
* Overwhelming feelings of responsibility
* Insomnia
* Lack of emotional bonding
* Excessive or unrealistic worry about the baby (not being able to care for them, harming them)
* Irritability
* Social withdrawal

33
Q

Red flags in postnatal depression

A
  • Suicidal ideation
  • Feelings of incompetence as a parent
  • Estrangement from child
  • Hallucinations
34
Q

What can be use to screen for postnatal depression?

A

Edinburgh postnatal depression scale (EPDS)

35
Q

Which antidepressant is best for those breastfeeding?

A

SSRI (paroxetine)

36
Q

What are some non-pharmacological treatments for postpartum depression?

A
  • Additional social support and assistance in caring for the baby
  • Psychoeducation
  • Self-help CBT
  • Couples therapy
  • Group therapy
37
Q

Management of severe postnatal depression

A
  • Urgent referral to specialist mental health services
  • Inpatient care on the mother and baby unit
38
Q

Complications of postnatal depression on the baby

A
  • Sudden infant death syndrome
  • Harm
  • Failure to thrive
  • Attachment disorder
  • Developmental delay
  • Depression in adolescents and young adults
  • Compromised mother-infant interaction
39
Q

What is a genital tract fistula?

A

Hole between the vagina/uterus and any adjacent organ

40
Q

Most common genital tract fistulae

A
  • Vesicovaginal fistula (vagina and bladder)
  • Rectovaginal fistula (vagina and rectum)
41
Q

Causes of genital tract fistulae

A
  • Childbirth
  • Surgery
  • Radiotherapy
42
Q

Symptoms of genital tract fistulae

A

Continuous leakage of urine (vesicovaginal) or faeces (rectovaginal)

43
Q

How do you test for genital tract fistula?

A

Vaginal inspection with Sims speculum

44
Q

How can you test for a small genital tract vesicovaginal fistula?

A

Swabs in vagina
Methylene blue in bladder

45
Q

1st line management of small vesicovaginal fistulae

A

Drain bladder continuously for 14 days
May close spontaneously

46
Q

Management for rectovaginal fistulae and larger fistulae

A

Surgery

47
Q

Why may a fistulae happen 5-14 days after the procedure?

A

When the traumatised ischaemic tissue sloughs

48
Q
A

Phase 3a Medicine (7 decks)

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