OTHER POSTNATAL COMPLICATIONS Flashcards
What is the other term for postnatal infection?
Puerperal pyrexia / infection
What is the definition of puerperal pyrexia?
Maternal temperature of 38˚C maintained for 4-6 hours in the first 14 days after delivery
What is the most common infection associated with puerperal pyrexia?
Endometritis caused by Group A Streptococcus
What is the most common cause of maternal death in the UK?
Sepsis
What are the usual sites of infection in postnatal infection?
Uterus Abdominal incision Perineum Chest UTI Breast
What are the risk factors for developing endometritis?
Caesarian section
Retained products
Manual removal of placenta
What are the symptoms of endometritis?
Lower abdominal pain
Foul smelling vaginal discharge
Fever
What are the risk factors for postpartum infection of the perineum?
Vaginal tear
Episiotomy
What is the antibiotic of choice for postpartum mastitis?
Flucloxacillin
Should a woman being treated for postpartum mastitis continue to breast feed?
Yes
What antibiotics should be given for endometritis causing puerperal pyrexia?
Clindamycin and gentamicin until afebrile for more than 24 hours
What is the incidence of post-natal depression?
Around 10% of women
What is the incidence of puerperal psychosis?
0.2%
What is the incidence of baby blues?
70% of women
What is the normal time frame for the baby blues?
Typically seen 3-7 days postpartum with a peak of 5 days
Who is normally affected by baby blues?
Primips
What are the features of the baby blues?
Anxiety
Irritable
Tearful
What is the time frame for postnatal depression?
Most cases occur within a month and peak at 3 months
What are the features of postnatal depression?
Similar to depression in other circumstances:
Anxiety Low mood Fatigue Irritability Feelings of inadequacy Ambivalence towards baby Reduced or absent libido
What is the time frame for puerperal psychosis?
Onset is usually in the first 2-3 weeks postpartum
What are the features of puerperal psychosis?
Insomnia or early morning wakening Lability of mood Overactivity Disorientation Lack of insight Hallucinations Persecutory beliefs Recurrent thoughts of death
How do we manage the baby blues?
Reassurance
Support
How do we manage postnatal depression?
CBT
SSRIs can be used if severe
Which SSRIs are recommended in postnatal depression?
Paroxetine (low milk/plasma ratio) or Sertraline
Fluoxetine not recommended because of long half life
How do we manage puerperal psychosis?
Normally requires admission to hospital
Lithium not recommended with breast feeding
ECT is safe
