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Obs (Owen) > Post-natal > Flashcards

Post-natal Flashcards

1
Q

What are the 2 types of post partum haemorrhage

A

Primary- occurs within 24 hours
Secondary

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2
Q

What is most common cause of post partum haemorrhage

A

Atony

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3
Q

What are causes of post partum haemorrhage

A

4 Ts
Tone (atony)
- macrosomia
- prolonged labour
- multiple pregnancy
Trauma
- perineal tear
Tissue
- retained placenta
Thrombin
- bleeding disorders

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4
Q

What defines a post partum haemorrhage

A

Over 500mls of blood lost from birth of baby

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5
Q

How are post partum haemorrhages classified

A

Minor- 500-1000ml
Major- over 1L

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6
Q

Investigations for PPH

A

Bloods
- FBC
- coagulation including fibrinogen

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7
Q

Resus for a minor PPH

A

A-E- assess for shock
Lie flat
IV access and take bloods for FBC, clotting
Infused warmed crystalloid
Obs every 15 mins

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8
Q

What is resus for major PPH

A

A-E assessing for shock
Position flat
3.5L of warmed colloid- 2L of isotonic crystalloid then give 1.5L colloid
Transfuse blood if needed (depends on clinical need)

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9
Q

How is PPH prevented

A

If no risks and vaginal
- oxytocin IM 10units
If risks
- ergometrine-oxytocin unless HTN
If c-section
- oxytocin slow infusion

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10
Q

When do you transfuse platelets in PPH

A

If below 75

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11
Q

Management of PPH

A

Resus
Uterine compression at the top
Empty bladder
IV oxytocin
IV ergometrine if no HTN
IV carboprost if asthma
Misoprostol
Surgical
- first line is balloon

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12
Q

What is post partum thyroiditis

A

Within 6 months of giving birth can get antibodies against the thyroid gland- anti-TPO present in 90%
Initially get hyperthyroid then get hypothyroid before it returns to normal

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13
Q

Rfx for post partum thyroiditis

A

T1DM
Previous post partum thyroiditis

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14
Q

Management of post partum thyroiditis

A

When hyperthyroid use propanolol
When hypo treat with thyroxine

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15
Q

Management of PPH if less than 500ml lost and no signs of shock

A

Provide sanitary pads as likely to be lochia

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16
Q

What is lochia

A

Discharge you get after giving birth containing mixture of mucous blood and uterine tissue

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17
Q

How does lochia change in appearance

A

Initially fresh bleeding but then becomes brown

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18
Q

If want to stop lactating what is advice

A

Stop any suckling
Well supported bra and analgesia
If wants medication- dopamine agonist

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19
Q

After how long should continuous lochia be investigated

A

6 weeks

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20
Q

What is puerperal pyrexia defined as

A

Fever over 38 hours in 14 days after birth

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21
Q

Causes of puerperal pyrexia

A

Endometritis
UTI
Wound infection
Mastitis

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22
Q

Important causes of secondary PPH

A

Retained products
Endometritis

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23
Q

Management of suspected endometritis

A

Admit to hospital
High vaginal and endocevical swabs
IV clindamycin and gentamicin

24
Q

Management of retained products of conception post natally

A

Pelvic USS
Evacuation of retained products

25
Q

If post partum what is best contraception

A

Progesterone forms

26
Q

What contraception give post partum if difficult to maintain a schedule

A

Progesterone implant

27
Q

What is WHO advice for breastfeeding

A

Exclusive breastfeeding for 6 months
Followed by a combination of foods and breastfeeding up to 2 years of age and beyond

28
Q

How does candida of breast present

A

Erythematous
Swollen
Fissured
White plaques in babys mouth
Symptoms worse after feeding

29
Q

Management of candida of breastfeeding

A

Mother
- miconazole cream after every feed
Baby
- miconazole gel in mouth (unlicensed in under 4 months)

30
Q

What is management of breastfeeidng mastitis

A

Continue breast feeding with analgesia
If fissure or symptoms not improving after 24 hours of expressing milk then oral flucloxacillin

31
Q

What does lochia worsen with

A

Breastfeeding as stimulates uterine contraction

32
Q

What drugs should be avoided if breastfeeding

A

Abx- Tetracyclines, chloramphenicol, sulphonamides
Lithium
Benzos
Aspirin
Carbimazole
Sulphonylureas
Amiodarone
Chemo

33
Q

What are grades to perineal tear

A

1- through perineal skin or vaginal mucosa
2- perineal muscles involved
3A- less than 50% of external anal sphincter
3B- more than 50% of external anal sphincter
3C- involves internal sphincter
4- involves anorectal mucosa

34
Q

Management of different perineal tears

A

Grade 1- no repair needed
Grade 2- midwife in delivery suite
Grade 3 and 4- in theater under anaesthetic by trained specialist, use vaginal packing prior to taking to surgery, laxatives

35
Q

Rfx for perineal tears

A

primigravida
large babies
precipitant labour
shoulder dystocia
forceps delivery

36
Q

Analgesia ladder if breastfeeding

A

Paracetamol
Ibuprofen
Codeine at low doses

37
Q

Signs of a good latch

A

Chin touching breast
Mouth covering most of areola
No noises
No pain
No sounds

38
Q

How should low birth weight babies be fed after birth

A

If under 2.5 kg Breast milk regardless if own mothers or not

39
Q

What is breast engorgement and how does it present

A

When breasts feel full
May feel full and tight

40
Q

Management of breast engorgement

A

Wear loose fitting clothes
Feed with no restrictions
Heat packs or shower before feeds

41
Q

Management of blocked duct in breast

A

Advise on frequent feeding from affected breast
Use of heat packs
Gentle massage of the breast

42
Q

Management of nipple infection

A

Topical fusidic acid
Avoid breastfeeding but encourage expression of milk

43
Q

If breasts are very red and inflammed how manage in addition to abx

A

1% hydrocortisone

44
Q

Postnatally with chest pain and SOB with signs of HF

A

Peripartum cardiomyopathy

45
Q

Rfx for peripartum cardiomyopathy

A

Advanced age
HTN in pregnancy
Multiple pregnancy

46
Q

Prolonged time for periods to return

A

Breastfeeding
Sheehans syndrome

47
Q

Most common cause of secondary post partum haemorrhage

A

Endometritis

48
Q

What happens if rhesus positive baby born to negative mother

A

500IU within 72 hours
Kleihauer test

49
Q

How does cerebral venous sinus thrombosis present

A

Severe headache but can get blurred vision

50
Q

How is cerebral venous sinus thrombosis investigated

A

MRI

51
Q

Manageent of cerebral venous sinus thrombosis

A

IV heparin

52
Q

How long after obstetric anal sphincter injury should women return to significant physical activity

A

4-6 weeks

53
Q

Most significant risk factor for endometritis

A

C-section

54
Q

Lump in breast after stopping breastfeeding

A

Galactocele

55
Q

Fluids used for major PPH

A

2L isotonic crystalloid then 1.5L colloid

56
Q

What do after compress uterus in PPH

A

Empty bladder with foley catheter not oxytocin next

57
Q

What is given to women with grade 3 and 4 tears on dishcarge

A

Laxatives

Obs (Owen) (9 decks)

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