PN 5 Flashcards
What monitoring is recommended in first 24 hrs routinely
bP first 6 hrs (PE can present for first time postpartum). If normal, don’t need to retest
First urine void- within 6 hrs
How does BP change normally for women with Pe, postpartum
bP increases between day 3-5
Returns to normal day by day 16
What is normal BP monitoring for woman with PE
If they have hypertension/ PE already, BP should be monitored regularly during PN - stay in hospital for 72hrs
Once BP stable, measure BP daily until day 7, then weekly for 6wks
What are causes for urinary retention post Partum
Likely multi factorial
Psychological , mechanical, neurological
When / why should women begin gentle mobilisation
Within first 24hrs
Avoid VTE (main direct cause of maternal death)
What are signs of VTe
Swelling (usually unilateral, left)
Lower abdo pain
Low grade temp
Sob (dyspnoea)
Chest pain
Coughing up blood (haemoptysis)
Collapsr
When is VTE at highest risk
Puerperium (6-8wks post partum)
How do we diagnose VTe
Clinical diagnosis unreliable
Use Doppler ultrasound/ compression ultrasonography
How long does a woman stay on anticoagulant therapy
6wks (calf pain thrombosis)
3mths (proximal dvt, PTE)
Stockings -2yrs after event
When can you use warfarin
Not in pregnancy
Postpartum- 2-3 days after birth (avoid risk of PPH)
What are common effects of secondary pph
Anaemia and iron deficiency
When do most women present for secondary pph
2nd wk after birth
What are clinical signs if secondary pph
Offensive smelling lochia
Abdo cramps
Uterine tenderness (esp with High/ deviated uterine fundus)
Pyrexia >37.5
Enlarged uterus
(Amount I’d bleeding is not what defines a secondary pph)
What is antibiotics for secondary pph
Iv- febrile
Oral- afebrile
Anpicillin
Gentamicin
Metronidazole
What is mgmt of secondary pph?
What is biggest risk?
Administer uterotonic
Antibiotics (most secondary PPh caused by rpoc or uterine infection)
Surgical - evacuation of uterus / repair of lacerations
(Uterine perforation)
