Obs - Puerpartum

Question 1

When can COCP be given postpartum

Answer 1

• 6mo if breastfeeding
• 3wks = immediately effective
• 6wks +barrier

Question 2

Describe pathophys of placental abruption

Answer 2

separation of normally sited placenta from uterine wall = maternal haemorrhage into intervening space

Question 3

Clinical fts of placental abruption

Answer 3

• shock out of keeping with visible loss
• pain constant
• tender, tense uterus
• normal lie/presentation
• fetal heart absent/distressed
• coag problems
• compl: pre-eclampsia, DIC, anuria

Question 4

Stereotypical presentation of placenta accreta

Answer 4

passive post-partum haemorrhage

Question 5

Basic pathophys of placenta accreta

Answer 5

placenta is attached to the myometrium

Question 6

Gestational age to offer external cephalic version (if indicated)

Answer 6

36/40

Question 7

Gestational age for doses of anti-D prophylaxis (routine)

Answer 7

1st dose = 28/40
2nd dose = 34/40

Question 8

Causes of primary postpartum haemorrhage (mnemonic)

Answer 8

4Ts
Tone (uterine atony) - vast majority
Trauma (perineal tear)
Tissue - retained placenta
Thrombin (clotting/bleeding disorders

Question 9

Define primary PPH

Answer 9

within 24hrs of delivery

Question 10

Define secondary PPH

Answer 10

between 24hrs - 6 weeks after delivery

Question 11

cause of secondary PPH

Answer 11

typically due to retained planetal tissue/endometritis