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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
If post partum what is best contraception
Progesterone forms
26
What contraception give post partum if difficult to maintain a schedule
Progesterone implant
27
What is WHO advice for breastfeeding
Exclusive breastfeeding for 6 months Followed by a combination of foods and breastfeeding up to 2 years of age and beyond
28
How does candida of breast present
Erythematous Swollen Fissured White plaques in babys mouth Symptoms worse after feeding
29
Management of candida of breastfeeding
Mother - miconazole cream after every feed Baby - miconazole gel in mouth (unlicensed in under 4 months)
30
What is management of breastfeeidng mastitis
Continue breast feeding with analgesia If fissure or symptoms not improving after 24 hours of expressing milk then oral flucloxacillin
31
What does lochia worsen with
Breastfeeding as stimulates uterine contraction
32
What drugs should be avoided if breastfeeding
Abx- Tetracyclines, chloramphenicol, sulphonamides Lithium Benzos Aspirin Carbimazole Sulphonylureas Amiodarone Chemo
33
What are grades to perineal tear
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
Management of different perineal tears
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
Rfx for perineal tears
primigravida large babies precipitant labour shoulder dystocia forceps delivery
36
Analgesia ladder if breastfeeding
Paracetamol Ibuprofen Codeine at low doses
37
Signs of a good latch
Chin touching breast Mouth covering most of areola No noises No pain No sounds
38
How should low birth weight babies be fed after birth
If under 2.5 kg Breast milk regardless if own mothers or not
39
What is breast engorgement and how does it present
When breasts feel full May feel full and tight
40
Management of breast engorgement
Wear loose fitting clothes Feed with no restrictions Heat packs or shower before feeds
41
Management of blocked duct in breast
Advise on frequent feeding from affected breast Use of heat packs Gentle massage of the breast
42
Management of nipple infection
Topical fusidic acid Avoid breastfeeding but encourage expression of milk
43
If breasts are very red and inflammed how manage in addition to abx
1% hydrocortisone
44
Postnatally with chest pain and SOB with signs of HF
Peripartum cardiomyopathy
45
Rfx for peripartum cardiomyopathy
Advanced age HTN in pregnancy Multiple pregnancy
46
Prolonged time for periods to return
Breastfeeding Sheehans syndrome
47
Most common cause of secondary post partum haemorrhage
Endometritis
48
What happens if rhesus positive baby born to negative mother
500IU within 72 hours Kleihauer test
49
How does cerebral venous sinus thrombosis present
Severe headache but can get blurred vision
50
How is cerebral venous sinus thrombosis investigated
MRI
51
Manageent of cerebral venous sinus thrombosis
IV heparin
52
How long after obstetric anal sphincter injury should women return to significant physical activity
4-6 weeks
53
Most significant risk factor for endometritis
C-section
54
Lump in breast after stopping breastfeeding
Galactocele
55
Fluids used for major PPH
2L isotonic crystalloid then 1.5L colloid
56
What do after compress uterus in PPH
Empty bladder with foley catheter not oxytocin next
57
What is given to women with grade 3 and 4 tears on dishcarge
Laxatives

Obs (Owen) (9 decks)

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